Critical care medicine
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Critical care medicine · Mar 1999
Review Practice Guideline GuidelinePractice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine.
To present guidelines for hemodynamic support of adult patients with sepsis. ⋯ The panel formulated an underlying approach to the hemodynamic support of sepsis. Hemodynamic therapies should be titrated to specific and definable endpoints. The effects of therapy should be assessed by monitoring a combination of parameters of global and regional perfusion. Using this approach, the panel made specific recommendations for fluid resuscitation, vasopressor therapy, and inotropic therapy of septic patients.
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Critical care medicine · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of silver-coating central venous catheters in reducing bacterial colonization.
To compare silver-coated and uncoated central venous catheters regarding bacterial colonization. To assess the relative contribution of catheter hub and skin colonization to catheter tip colonization. ⋯ Silver-coating of DLCs did not significantly reduce bacterial catheter colonization compared with the control catheters. PFGE analysis of coagulase-negative staphylococci and other bacteria demonstrated various pathogenic routes of catheter-related colonization, whereby the microorganisms of the skin flora around the insertion site must be regarded as the main source of catheter-related infections.
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Critical care medicine · Mar 1999
Randomized Controlled Trial Clinical TrialEffects of ventilator resetting on indirect calorimetry measurement in the critically ill surgical patient.
To evaluate the effect of acute changes in minute ventilation (VE) on oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory quotient, and energy expenditure during volume-controlled mechanical ventilation in the critically ill surgical patient. The effects on some oxygen transport variables were assessed as well. ⋯ We conclude that, during controlled mechanical ventilation, the time course and the magnitude of the effect on gas exchange and energy expenditure measurements caused by acute changes in VE suggest that VO2 and energy expenditure measurements can be used reliably to evaluate and quantify metabolic events and that VCO2 and respiratory quotient measurements are useless for metabolic purposes at least for 120 mins after ventilator resetting.
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Critical care medicine · Mar 1999
Quinolinic acid in the cerebrospinal fluid of children after traumatic brain injury.
To measure quinolinic acid, a macrophage-derived neurotoxin, in the cerebrospinal fluid (CSF) of children after traumatic brain injury (TBI) and to correlate CSF quinolinic acid concentrations to clinically important variables. ⋯ A large and progressive increase in the macrophage-derived neurotoxin quinolinic acid is seen following severe TBI in children. The increase is strongly associated with increased mortality. Increased CSF quinolinic acid concentration on admission in children with shaken infant syndrome could reflect a delay in presentation to medical attention or age-related differences in quinolinic acid production. These findings raise the possibility that quinolinic acid may play a role in secondary injury after TBI in children and suggest an interaction between inflammatory and excitotoxic mechanisms of injury following TBI.
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Critical care medicine · Mar 1999
Practice Guideline GuidelineGuidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine.
To provide guidelines for admission, discharge, and triage of adult patients to the intensive care unit (ICU), based on expert opinion and the relevant literature. ⋯ Although little scientifically rigorous data exist validating the criteria for admission, discharge, and triage of adult patients to the ICU, current literature and expert opinion support guidelines to streamline the admission, discharge, and triage process.