Critical care medicine
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Critical care medicine · May 2002
Effect of growth hormone on muscle and liver protein synthesis in septic rats receiving glutamine-enriched parenteral nutrition.
Administration of recombinant human growth hormone (rhGH) to critically ill adults in an attempt to attenuate catabolism was associated with increased morbidity and mortality. Possible explanations included inhibition of glutamine release from skeletal muscle and consequent restriction of splanchnic glutamine supply. In this study, we examined the effects of rhGH on plasma glutamine levels and on muscle and liver glutamine concentrations and protein synthesis rates in sepsis. We investigated the possibility that administration of supplemental glutamine might ameliorate any adverse effects of rhGH. ⋯ In sepsis, increased muscle protein synthesis with PN and rhGH administration is not associated with increased muscle glutamine levels. Administration of rhGH does not result in reduced liver glutamine levels or rates of hepatic protein synthesis. PN containing glutamine was no more efficacious than standard PN at increasing muscle protein synthesis.
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Critical care medicine · May 2002
Tracheal pressure control provides automatic and variable inspiratory pressure assist to decrease the imposed resistive work of breathing.
To evaluate the operation of a continuous positive airway pressure system by using tracheal airway pressure (PT) as the control signal for system operation (i.e., tracheal pressure control). ⋯ Tracheal pressure control results in automatic and variable levels of pressure assist to decrease imposed resistive work of breathing under conditions of varying spontaneous inspiratory flow demands and endotracheal tube occlusion. Conventional systems are potentially flawed when PY is used as the control signal because they do not function in this manner and do not accurately assess pulmonary airway pressure.
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Critical care medicine · May 2002
Impaired subcortical and cortical sensory evoked potential pathways in septic patients.
Sensory evoked potential (SEP) peak latencies were recorded in order to evaluate the incidence and severity of septic encephalopathy, testing the hypothesis that the occurrence of septic encephalopathy is more frequent than generally assumed. ⋯ Septic encephalopathy occurs more frequently than generally assumed, and its severity is associated with the severity of illness. The impairment of subcortical and cortical SEP pathways was not different between patients with severe sepsis and those with septic shock.
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Critical care medicine · May 2002
Coincidence of pro- and anti-inflammatory responses in the early phase of severe sepsis: Longitudinal study of mononuclear histocompatibility leukocyte antigen-DR expression, procalcitonin, C-reactive protein, and changes in T-cell subsets in septic and postoperative patients.
To determine the time course of histocompatibility leukocyte antigen (HLA)-DR expression in peripheral blood mononuclear cells and their relationship to markers of inflammation, organ function, and outcome during severe sepsis. ⋯ Decreases in monocytic HLA-DR expression occurred simultaneously with signs of hyperinflammation as early as the onset of severe sepsis and usually developed in opposite directions than inflammatory markers and sepsis severity scores.