Critical care medicine
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Critical care medicine · Jul 2001
Splanchnic perfusion during hemodialysis: evidence for marginal tissue perfusion.
Splanchnic perfusion may be compromised during hemodialysis because of hypovolemia, inflammatory response, and blood flow redistribution. The aim of this study was to assess the response of splanchnic blood flow and oxygen transport to hemodialysis. ⋯ Hemodialysis and fluid removal in normotensive patients with acute renal failure may result in a reduction of systemic and splanchnic blood flow that is undetectable using traditional clinical signs. In contrast to what is observed in hypovolemia, the changes in regional blood flow are rapidly reversible after hemodialysis.
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Critical care medicine · Jul 2001
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of a high-carbohydrate diet in catabolic illness.
To determine within the setting of isocaloric, isonitrogenous enteral diets whether a diet that supplies most of its calories from fat or carbohydrate would be most beneficial at limiting muscle protein wasting in catabolic illness. ⋯ In severely burned pediatric patients, enteral nutrition supplied predominantly as carbohydrate rather than fat improves the net balance of skeletal muscle protein across the leg. This is attributable to decreased protein breakdown, suggesting a protein-sparing effect of high-carbohydrate feedings.
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Critical care medicine · Jul 2001
Multicenter Study Clinical TrialProspective trial of high-frequency oscillation in adults with acute respiratory distress syndrome.
To evaluate the safety and efficacy of high-frequency oscillatory ventilation (HFOV) in adult patients with the acute respiratory distress syndrome (ARDS) and oxygenation failure. ⋯ These findings suggest that HFOV has beneficial effects on oxygenation and ventilation, and may be a safe and effective rescue therapy for patients with severe oxygenation failure. In addition, early institution of HFOV may be advantageous.
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Critical care medicine · Jul 2001
Multicenter StudyEpidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care.
To determine the incidence, cost, and outcome of severe sepsis in the United States. ⋯ Severe sepsis is a common, expensive, and frequently fatal condition, with as many deaths annually as those from acute myocardial infarction. It is especially common in the elderly and is likely to increase substantially as the U.S. population ages.
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Critical care medicine · Jul 2001
Multicenter StudyForgoing life-sustaining treatments: how the decision is made in French pediatric intensive care units.
The decision to forgo life support is frequently made in pediatric intensive care units (PICUs). A group of experts is currently preparing recommendations for guidelines concerning this decision-making process in France. We have performed a prospective study to help the experts. This study documents how children die in French PICUs and how the decision to limit life support is made. ⋯ The decision to forgo life-sustaining treatment is frequently made for children dying in French PICUs. Guidelines must be available to help the medical staff reach this decision. Knowledge of the decision-making process in French PICUs provides the experts with information needed to elaborate such recommendations.