Critical care medicine
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Critical care medicine · Aug 2000
Clinical TrialEffect of norepinephrine on the outcome of septic shock.
Despite increasingly sophisticated critical care, the mortality of septic shock remains elevated. Accordingly, care remains supportive. Volume resuscitation combined with vasopressor support remains the standard of care as adjuvant therapy, and many consider dopamine to be the pressor of choice. Because of fear of excessive vasoconstriction, norepinephrine is considered to be deleterious. The present study was designed to identify factors associated with outcome in a cohort of septic shock patients. Special attention was paid to hemodynamic management and to the choice of vasopressor used, to determine whether the use of norepinephrine was associated with increased mortality. ⋯ Our results indicate that the use of norepinephrine as part of hemodynamic management may influence outcome favorably in septic shock patients. The data contradict the notion that norepinephrine potentiates end-organ hypoperfusion, thereby contributing to increased mortality. However, the present study suffers from some limitation because of its nonrandomized, open-label, observational design. Hence, a randomized clinical trial is needed to clearly establish that norepinephrine improves mortality of patients with septic shock, as compared with high-dose dopamine or epinephrine. Pneumonia as the cause of septic shock, high blood lactate concentration, and low urine output on admission are strong indicators of a poor prognosis. Multiple organ failure is confirmed as a reliable predictor of mortality in septic patients.
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Critical care medicine · Aug 2000
Immune depression in polymicrobial sepsis: the role of necrotic (injured) tissue and endotoxin.
Recent studies suggest immune dysfunction seen after the onset of polymicrobial sepsis, as produced by cecal ligation and puncture (CLP), is not caused by endotoxin (ETX) alone, but may be caused by the combined effect of the necrotic tissue (cecal ligation, [CL]) and other microbial components. Thus, the objective of this study was to assess the ability of necrotic tissue, in the presence or absence of low-dose endotoxin, to induce changes in the capacity of immune cells to produce proinflammatory or anti-inflammatory cytokines approximating those seen in CLP. ⋯ These results collectively suggest that the response to devitalized tissue produced by cecal ligation may predispose the host to the induction of a suppressive macrophage phenotype. The subsequent exposure of these animals to microbial agents induces immune dysfunction, as well as mortality seen after such a polymicrobial septic challenge.
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Critical care medicine · Aug 2000
Long-term survival and health status after prolonged mechanical ventilation after cardiac surgery.
To determine hospital mortality, weaning from mechanical ventilation, long-term survival, and functional health status in patients receiving > or =7 days of mechanical ventilation after cardiac surgery. ⋯ Patients' chances of being liberated from mechanical ventilation are excellent. Their long-term survival and health status are good.
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Critical care medicine · Aug 2000
Comparative StudyIntraosseous blood gases during hypothermia: correlation with arterial, mixed venous, and sagittal sinus blood.
Especially in pediatric patients with severe hypothermia, intraosseous access may be more readily available than intravascular access during an early phase of treatment and therefore, may be helpful to optimize management. The purpose of this study was to determine whether intraosseous blood gases are comparable with arterial, mixed venous, and sagittal sinus blood gases during different degrees of hypothermia. ⋯ During hypothermia, intraosseous P(CO2) values were predictable for mixed venous Pco2 and arterial P(CO2). Intraosseous pH values also correlated with mixed venous and sagittal sinus blood samples. Accordingly, interpretation of blood gas values obtained from bone marrow aspirates may be helpful to adjust ventilation and optimize fluid and drug therapy during the early treatment of patients with severe hypothermia.
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Critical care medicine · Aug 2000
Development of a survey to measure parent satisfaction in a pediatric intensive care unit.
To use classic survey methodology to develop a specific survey tool that can assess parent satisfaction with medical care in a pediatric intensive care setting. ⋯ Classic survey design methodology was applied to develop a specific satisfaction survey in a pediatric inpatient setting. This stepwise method yielded a parent survey specific to one type of inpatient unit, and the resultant survey tool reliably measured levels of parent satisfaction with medical care in that area. This study demonstrates the feasibility of applying classic survey methodology to develop a statistically analyzed parent satisfaction survey for an inpatient setting.