Critical care medicine
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Critical care medicine · Aug 2002
Randomized Controlled Trial Comparative Study Clinical TrialC1-inhibitor in patients with severe sepsis and septic shock: beneficial effect on renal dysfunction.
To investigate the efficacy and the safety of the parenteral administration of C1-inhibitor to patients with severe sepsis or septic shock. ⋯ C1-inhibitor administration attenuated renal impairment in patients with severe sepsis or septic shock.
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Critical care medicine · Aug 2002
Randomized Controlled Trial Comparative Study Clinical TrialImproved resuscitation minimizes respiratory dysfunction and blunts interleukin-6 and nuclear factor-kappa B activation after traumatic hemorrhage.
We hypothesized that modifying resuscitation would alter hemorrhagic shock-induced respiratory dysfunction and correlate with nuclear factor-kappa B and cytokine expression. ⋯ Group II demonstrated the least improvement in serum lactate after resuscitation, the most significant acute lung injury, and the greatest interleukin-6 and nuclear factor-kappa B response. Group IV mice had the least acute lung injury, with no detectable interleukin-6 response. Improved resuscitation with crystalloid and shed blood minimized acute lung injury. The reduction in pulmonary dysfunction after improved resuscitation may be attributable to a blunting of the nuclear factor-kappa B and interleukin-6 responses to hemorrhage.
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Critical care medicine · Aug 2002
Review Randomized Controlled Trial Clinical TrialActivated protein C in normal human pregnancy and pregnancies complicated by severe preeclampsia: a therapeutic opportunity?
Given the efficacy and safety of recombinant human activated protein C (rhAPC) in the systemic inflammatory response syndrome, this study was designed to review the evidence for a role for APC in the pathogenesis of preeclampsia. Preeclampsia is a proinflammatory and procoagulant state, and it is a pregnancy-specific condition that mimics the systemic inflammatory response syndrome. rhAPC reduces mortality in patients with systemic inflammatory response syndrome and could potentially have a role as disease-modifying therapy in preeclampsia. To determine which patients would be offered rhAPC, the literature pertaining to fetal/neonatal outcomes for preeclampsia remote from term, transplacental transport of protein C, and pregnancy experience with the compound were reviewed. ⋯ Sufficient data exist to support the use of rhAPC in phase II clinical studies for women with either early onset preeclampsia or severe or deteriorating postpartum disease.
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Critical care medicine · Aug 2002
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialCandidemia as a cause of septic shock and multiple organ failure in nonimmunocompromised patients.
To describe outcomes of septic shock and multiple organ failure arising from candidemia. ⋯ Candidemia with septic shock is infrequent in nonimmunocompromised patients but has a very high mortality rate, a high likelihood of associated multiple organ failure, and possibly a delayed recovery from multiple organ failure. Patients with candidemic septic shock are more likely to have underlying renal failure at baseline.
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Critical care medicine · Aug 2002
Randomized Controlled Trial Comparative Study Clinical TrialBeneficial effect of a prone position for patients with hypoxemia after transthoracic esophagectomy.
Although the prone position has been reported to improve arterial oxygenation in patients with acute respiratory distress syndrome, there have been no reports on its efficacy in patients with hypoxemia after transthoracic esophagectomy with three-field lymphadenectomy. This study was undertaken to assess the efficacy of the prone position on hypoxemia after three-field lymphadenectomy for thoracic esophageal carcinoma. ⋯ In hypoxemic patients after three-field lymphadenectomy, the prone position improved arterial oxygenation without any deleterious effects. The beneficial effect of the prone position is possibly attributable to opening of the bronchi obstructed by secretions.