Critical care medicine
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Critical care medicine · Sep 1999
Randomized Controlled Trial Clinical TrialSelenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome.
To determine the effect of selenium replacement on morbidity and mortality in patients with systemic inflammatory response syndrome (SIRS). ⋯ Selenium replacement in patients with SIRS seems to improve clinical outcome and to reduce the incidence of acute renal failure requiring hemodialysis.
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Critical care medicine · Sep 1999
Comparative StudyRelationship between mixed venous oxygen saturation and markers of tissue oxygenation in progressive hypoxic hypoxia and in isovolemic anemic hypoxia in 8- to 12-day-old piglets.
To examine the hypothesis that mixed venous oxygen saturation (SvO2) values, which reflect the residual oxygen after tissue oxygen extraction, would be similar during hypoxic and anemic hypoxia. ⋯ In comparison with hypoxic hypoxia, critical values of SvO2 are higher in anemic hypoxia, indicating that oxygen unloading from blood to tissues is impaired in anemic hypoxia. These characteristics in oxygen transport and capillary hemodynamics should be taken into consideration when SvO2 is used in clinical critical care.
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Critical care medicine · Sep 1999
The effect of positive end-expiratory pressure during partial liquid ventilation in acute lung injury in piglets.
To investigate the effects of positive end-expiratory pressure (PEEP) application during partial liquid ventilation (PLV) on gas exchange, lung mechanics, and hemodynamics in acute lung injury. ⋯ Partial liquid ventilation is a useful technique to improve oxygenation in severe acute lung injury. The application of PEEP during PLV further improves oxygenation and lung mechanics. PEEP levels of 10 cm H2O seem to be optimal to improve oxygenation and lung mechanics.
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Critical care medicine · Sep 1999
Effects of a novel guanylyl cyclase inhibitor on the vascular actions of nitric oxide and peroxynitrite in immunostimulated smooth muscle cells and in endotoxic shock.
Nitric oxide (NO), produced by the inducible isoform of NO synthase (NOS) in circulatory shock exerts cytotoxic and vasodilator effects. Part of these effects are mediated by formation of peroxynitrite, a toxic oxidant produced by the rapid reaction of NO and superoxide. Other parts of the vascular actions of NO in shock are thought to be mediated by the action of NO on the soluble guanylyl cyclase (GC) in the smooth muscle and subsequent decrease in the intracellular calcium levels. Using 1H-(1,2,4)oxadiazolo(4,3-alpha)quinoxalin-1 -one (ODQ), a potent inhibitor of GC, we studied the role of GC activation in the NO- and peroxynitrite-related vascular alterations. ⋯ These studies indicate that GC activation does not contribute to NO- or peroxynitrite-induced cytotoxicity but does contribute to the vascular hyporeactivity induced by endotoxin in vitro and in vivo. GC inhibition alone is sufficient to influence survival in a murine model of severe sepsis.
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Critical care medicine · Sep 1999
ReviewIncorporating palliative care into critical care education: principles, challenges, and opportunities.
To identify the goals and methods for medical education about end-of-life care in the intensive care unit (ICU). ⋯ Teaching care of the dying in the ICU should emphasize the following: a) the goals of care should guide the use of technology; b) understanding of prognostication and treatment withholding and withdrawal is essential; c) effective communication and trusting relationships are crucial to good care; d) cultural differences should be acknowledged and respected; and e) the delivery of excellent palliative care is appropriate and necessary when patients die in the ICU.