Critical care medicine
-
Critical care medicine · Sep 2000
ReviewUse of hypertonic saline solutions in treatment of cerebral edema and intracranial hypertension.
To review the literature on the use of hypertonic saline (HS) in treating cerebral edema and intracranial hypertension. ⋯ HS demonstrates a favorable effect on both systemic hemodynamics and intracranial pressure in both laboratory and clinical settings. Preliminary evidence supports the need for controlled clinical trials evaluating its use as resuscitative fluid in brain-injured patients with hemorrhagic shock, as therapy for intracranial hypertension resistant to standard therapy, as firstline therapy for intracranial hypertension in certain intracranial pathologies, as small volume fluid resuscitation during spinal shock, and as maintenance intravenous fluid in neurocritical care units.
-
Critical care medicine · Sep 2000
Randomized Controlled Trial Comparative Study Clinical TrialRandomized trial of the use of heliox as a driving gas for updraft nebulization of bronchodilators in the emergent treatment of acute exacerbations of chronic obstructive pulmonary disease.
To determine whether the bronchodilator effects of albuterol and ipratropium bromide are greater if updraft nebulization is driven by 80% helium and 20% oxygen (HELIOX) than if driven by compressed room air (AIR) during the treatment of an acute exacerbations of chronic obstructive pulmonary disease (COPD). ⋯ Use of HELIOX as a driving gas for the updraft nebulization of bronchodilators during the first 2 hrs of treatment of an acute COPD exacerbation failed to improve FEV1 faster than the use of AIR. The faster improvement in FEF25-75 during the first 2 hrs of treatment was small and of uncertain clinical significance.
-
Critical care medicine · Sep 2000
ReviewDo new strategies in meningococcemia produce better outcomes?
Meningococcal septic shock (MSS) has high mortality and morbidity rates. In addition to the traditional prompt antibiotics and respiratory and circulatory support, new treatment strategies have been proposed.
-
Critical care medicine · Sep 2000
ReviewNew therapeutic implications of anticoagulation mediator replacement in sepsis and acute respiratory distress syndrome.
To examine the relationship between the coagulation and immune systems in sepsis and acute respiratory distress syndrome and to review published experimental and clinical studies that use anticoagulation mediator replacement strategies in these conditions. ⋯ Coagulation abnormalities are common in the critically ill. Early studies using anticoagulation mediator replacement in patients with sepsis have suggested beneficial effects on organ function and outcome. The results from larger, randomized controlled trials are eagerly anticipated.
-
Critical care medicine · Sep 2000
ReviewCoagulation inhibitor replacement in sepsis is a potentially useful clinical approach.
In sepsis, levels of the endogenous coagulation inhibitors antithrombin III and protein C are lowered as a result of complex formation with multiple activated clotting factors. In addition, their activity can further be curtailed by proteolytic inactivation. Loss of antithrombin III and protein C activity blocks the endogenous control mechanism for thrombin generation resulting in a state of systemic activation of coagulation and inflammatory processes. ⋯ In addition to their anticoagulant effects, these inhibitors also have various anti-inflammatory activities that may contribute to their protective effects. Phase II studies in patients with severe sepsis using coagulation inhibitors have indicated that this therapeutic approach may be useful. Large-scale phase III trials will ultimately decide whether adjunctive coagulation inhibitor replacement will have a place in the treatment of patients with severe sepsis.