Critical care medicine
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Critical care medicine · Jun 2002
Randomized Controlled Trial Clinical TrialErythromycin and early enteral nutrition in mechanically ventilated patients.
To determine whether erythromycin facilitates early enteral nutrition in mechanically ventilated, critically ill patients. ⋯ In critically ill patients receiving invasive mechanical ventilation, erythromycin promotes gastric emptying and improves the chances of successful early enteral nutrition.
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Critical care medicine · Jun 2002
Multicenter StudyCost effectiveness of aggressive care for patients with nontraumatic coma.
To estimate the cost effectiveness of aggressive care for patients with nontraumatic coma. ⋯ Continuing aggressive care after day 3 of nontraumatic coma is associated with a high cost per QALY gained, especially for patients at high risk for poor outcomes. Earlier decisions to withhold life-sustaining treatments for patients with very poor prognoses may yield considerable cost savings.
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Critical care medicine · Jun 2002
ReviewAcute upper gastrointestinal bleeding in critically ill patients: causes and treatment modalities.
Upper gastrointestinal bleeding from peptic ulcers or other nonvariceal causes generally stops spontaneously; if it fails to do so, aggressive management is required. Such measures also are necessary for patients at high risk for rebleeding. Endoscopic therapy achieves hemostasis in >90% of bleeding patients and reduces mortality. ⋯ Although this drug does not seem to reduce the need for surgical intervention or to decrease mortality, the trial does indicate the promise of intravenous proton pump inhibitors in reducing upper gastrointestinal bleeding. Evidence from additional well-controlled trials is needed to confirm this finding. The use of proton pump inhibitors in this setting also may have a positive economic impact, and a decrease in the percentage of patients who experience rebleeding will eliminate the cost of further management strategies in those cases.
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Critical care medicine · Jun 2002
Effect of increasing norepinephrine dosage on regional blood flow in a porcine model of endotoxin shock.
To evaluate the effect of a norepinephrine-induced differential increase in mean arterial pressure on splanchnic and renal perfusion in a porcine model of volume-resuscitated endotoxic shock. ⋯ Norepinephrine, administered to increase mean arterial pressure by 10 mm Hg in an acute model of volume-resuscitated endotoxic shock, improved systemic and regional perfusion. The administration of norepinephrine to increase mean arterial pressure 20 mm Hg above shock did not increase renal and splanchnic blood flows, despite an enhanced cardiac output.
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Critical care medicine · Jun 2002
Inducible nitric oxide synthase pathway in the central nervous system and vasopressin release during experimental septic shock.
Septic shock is characterized by arteriolar vasodilation and hypotension. We have tested the hypothesis that nitric oxide arising from inducible nitric oxide synthase in the central nervous system is responsible for the deficiency in vasopressin release and consequent hypotension during experimental septic shock. ⋯ These data indicate that central nitric oxide arising from the inducible nitric oxide synthase pathway plays an important inhibitory role in vasopressin release during experimental septic shock and may be responsible for the hypotension occurring in this vasodilatory shock.