Critical care medicine
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To present and discuss the rationale and results of clinical trials using antithrombin (AT) supplementation in patients with sepsis. ⋯ Together, these studies are consistent with the positive effect seen with AT supplementation in patients with severe sepsis. A multicenter phase III trial is currently in progress to definitively document its effect on mortality.
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Critical care medicine · Sep 2000
Randomized Controlled Trial Multicenter Study Clinical TrialA controlled trial of cardiopulmonary resuscitation training for ethnically diverse parents of infants at high risk for cardiopulmonary arrest.
Parents of infants hospitalized in the neonatal intensive care unit are routinely taught cardiopulmonary resuscitation (CPR) as part of the preparation for transition to home. A variety of methods are used to teach CPR knowledge and skills. The purpose of this study was to compare the psychosocial consequences of three different methods of CPR training for parents of infants at high risk for cardiopulmonary arrest. ⋯ The results confirm that parents have difficulty adjusting after an infant's discharge from the neonatal intensive care unit and support the positive psychosocial effects of helping parents prepare for a home emergency by teaching CPR. The additional staff resources required to provide parents with social support along with CPR training are not justified based on the findings of the current study.
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Because coagulatory activation in sepsis is triggered mainly by tissue factor release from endothelial cells and blood monocytes during their activation via proinflammatory cytokines, inhibition of coagulation by exogenous administration of coagulation inhibitors has been proposed. These strategies should allow us to prevent and treat excessive coagulatory activation, thereby potentially preventing sepsis-induced organ dysfunction. Potential therapies include the natural coagulation inhibitors antithrombin, activated protein C, and tissue factor pathway inhibitor, as well as direct thrombin inhibition by recombinant hirudin. ⋯ The biological properties of coagulatory activation during sepsis (coagulation as a protective mechanism to control the septic focus, e.g., fibrin deposition during peritonitis) are not completely understood. Therefore, one has to be careful when administering coagulatory inhibitors, especially because patients with multiple organ dysfunction syndrome often do not show the widespread fibrin deposition in nutritive blood vessels that have been seen experimentally. How might these patients benefit from thrombin inhibition? Coagulatory activation per se seems unlikely to directly cause deterioration of organ function, although it is involved in generalized endothelial activation with consecutive mediator release and increased leukocyte-endothelial cell interaction. Antagonism of inflammatory mediators and, consecutively, endothelial cell activation might be a better target in adjunctive sepsis therapy, with improvement in septic microcirculatory disturbances. Administration of natural pleiotropic coagulation inhibitors that are documented positive effects on the microcirculation, (such as activated protein C, antithrombin) seems to be promising.