Critical care medicine
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Critical care medicine · Jul 2000
Early hyperthermia after traumatic brain injury in children: risk factors, influence on length of stay, and effect on short-term neurologic status.
a) To determine the risk factors for early hyperthermia after traumatic brain injury in children; b) to identify the contribution of early hyperthermia to neurologic status at pediatric intensive care unit (PICU) discharge and to PICU length of stay in head-injured children. ⋯ Early hyperthermia is independently associated with a measure of early neurologic status and resource utilization in children with traumatic brain injury serious enough to require PICU admission. These results support the prevention of hyperthermia in the management of traumatic brain injury in children. Further research is required to understand the mechanisms of this response and to identify appropriate preventive or therapeutic interventions.
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Critical care medicine · Jul 2000
Pharmacoeconomic impact of rational use guidelines on the provision of analgesia, sedation, and neuromuscular blockade in critical care.
To determine the cost-effectiveness and safety of a set of rational use guidelines for analgesia, sedation, and neuromuscular blockade in critically ill ventilated patients when compared with similar factors in standard prescribing. ⋯ Rational use guidelines resulted in safe, cost-effective improvements in the provision of continuous analgesia, sedation, and neuromuscular blockade to critically ill patients requiring ventilator management when compared with similar factors in baseline prescribing strategies.
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Critical care medicine · Jul 2000
Alteration in diaphragmatic contractility during septic peritonitis in rats: effect of polyethylene glycol-absorbed superoxide dismutase.
To assess the alterations in diaphragmatic contractility measured in vitro during experimental septic peritonitis and to evaluate the effect of polyethylene glycol-absorbed superoxide dismutase (PEG-SOD) on the alterations in contractility. ⋯ Intra-abdominal sepsis (CLP) induced a marked reduction in diaphragmatic contractility, but PEG-SOD attenuated this reduction. Therefore, we conclude that oxygen-derived free radicals play an important role in the alterations in diaphragmatic contractility during intra-abdominal sepsis.
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Critical care medicine · Jul 2000
Randomized Controlled Trial Comparative Study Clinical TrialDifferential effects of dopamine, dopexamine, and dobutamine on jejunal mucosal perfusion early after cardiac surgery.
To evaluate the potential differential effects of dopamine, dopexamine, and dobutamine on jejunal mucosal perfusion, assessed by endoluminal laser Doppler flowmetry in uncomplicated postcardiac surgical patients. ⋯ Endoluminal laser Doppler flowmetry is a new tool for the detection of perfusion changes at the local intestinal mucosal level. Dopamine, dopexamine, and dobutamine have differential effects on jejunal mucosal perfusion probably because of their different receptor stimulating properties. These findings may be of clinical importance when the therapeutic goal is to improve gut mucosal perfusion.
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Critical care medicine · Jul 2000
Multicenter Study Comparative StudyDiabetic patients have a decreased incidence of acute respiratory distress syndrome.
Our ability to predict which critically ill patients will develop acute respiratory distress syndrome (ARDS) is imprecise. Based on the effects of diabetes mellitus on the inflammatory cascade, we hypothesized that a history of diabetes might alter the incidence of ARDS. ⋯ In patients with septic shock, a history of diabetes is associated with a lower risk of developing ARDS compared with nondiabetics.