Critical care medicine
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Critical care medicine · Oct 1999
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialContinuous plasmafiltration in sepsis syndrome. Plasmafiltration in Sepsis Study Group.
To assess the effect of plasmafiltration (PF) on biochemical markers of inflammation, cytokines, organ dysfunction, and 14-day mortality in human sepsis. ⋯ PF caused a significant attenuation of the acute-phase response in sepsis. There was no significant difference in mortality, but there was a trend toward fewer organs failing in the PF group that suggests that this procedure might be beneficial.
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Critical care medicine · Oct 1999
Comparative Study Clinical Trial Controlled Clinical TrialDopexamine increases splanchnic blood flow but decreases gastric mucosal pH in severe septic patients treated with dobutamine.
To assess the effects of dopexamine on splanchnic blood flow and splanchnic oxygen uptake in septic patients. ⋯ In hemodynamically stable, hyperdynamic septic patients being treated with dobutamine, dopexamine has no selective effect on splanchnic blood flow. In fact, a decreased pHi suggests a harmful effect on gastric mucosal perfusion.
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Critical care medicine · Oct 1999
Comparative StudyThe ventilatory effects of auto-positive end-expiratory pressure development during cardiopulmonary resuscitation.
Auto-positive end-expiratory pressure (auto-PEEP) is a physiologic phenomenon defined as the positive alveolar pressure that exists at the end of expiration. Normally, the alveolar pressure is near zero at the end of expiration. However, certain ventilatory and/or physiologic paradigms can cause the development of auto-PEEP during cardiopulmonary resuscitation (CPR). Auto-PEEP has a detrimental cardiovascular effect similar to that of positive end-expiratory pressure that is intentionally applied to the ventilatory circuit in a mechanically ventilated patient. The connection between auto-PEEP and its cardiovascular effects, however, may go undetected. In this study, the effect that ventilatory factors have on auto-PEEP in a simulation of patients with lung disease undergoing CPR was delineated. ⋯ We conclude from our findings that ventilation techniques during CPR may need to be altered to avoid the development of what may be a hemodynamically significant level of auto-PEEP.
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Critical care medicine · Oct 1999
Comparative StudyGlomerular permeability and trauma: a correlation between microalbuminuria and Injury Severity Score.
To determine if there is a correlation between an increase in glomerular permeability, the magnitude of trauma, and the severity of illness. ⋯ Patients with trauma show an increase in glomerular permeability during the first 24 hrs after injury. The magnitude of this increase is correlated with the extent of trauma but does not seem significant enough to be predictive of severity of illness and/or outcome.
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Critical care medicine · Oct 1999
Comparative Study Clinical TrialMyocardial ischemia and weaning failure in patients with coronary artery disease: an update.
To determine the frequency and effects of weaning-related myocardial ischemia on weaning outcomes in patients with coronary artery disease. ⋯ Electrocardiographic evidence of myocardial ischemia occurs frequently and is associated with significantly increased risk of first-day weaning failure in patients with coronary artery disease.