Critical care medicine
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Critical care medicine · Jan 2003
ReviewTargeting high mobility group box 1 as a late-acting mediator of inflammation.
Sepsis, a lethal systemic inflammatory response to infection, affects nearly 750,000 patients in the United States annually and has a mortality of 30%. Mounting evidence has implicated cytokines, circulating factors produced by the innate immune system, as critical mediators of sepsis-related tissue injury and death. ⋯ These and other findings, described in part in this review, suggest that successful clinical management of sepsis may be dependent on identification of late-acting, downstream lethal mediators that can be targeted in a broader therapeutic window. A candidate mediator of delayed lethality is high mobility group box 1, a cellular and nuclear protein that is now recognized as a cytokine and experimental therapeutic target.
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Critical care medicine · Jan 2003
Comparative StudyImpact of intensive care unit (ICU) drug use on hospital costs: a descriptive analysis, with recommendations for optimizing ICU pharmacotherapy.
To determine the cost impact of intensive care unit (ICU) drug use on a hospital's total drug expense and to compare ICU pharmacy resource utilization with resource utilization of other hospital departments that provided services to the ICU. Additionally, to suggest strategies, based on these methods and results, to optimize ICU drug use. ⋯ ICU drug therapies have a significant impact on hospital costs, and effective clinical informatics services and multidisciplinary collaboration programs are necessary to optimize ICU pharmacotherapy.
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Critical care medicine · Jan 2003
Mild hypothermia during hemorrhagic shock in rats improves survival without significant effects on inflammatory responses.
To explore the hypothesis that the survival benefit of mild, therapeutic hypothermia during hemorrhagic shock is associated with inhibition of lipid peroxidation and the acute inflammatory response. ⋯ These data suggest that lipid peroxidation and systemic inflammatory responses to hemorrhagic shock are minimally influenced by mild hypothermia, although liver injury is mitigated and survival improved. Other mechanisms of benefit from mild hypothermia need to be explored.
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Critical care medicine · Jan 2003
Endothelin receptor antagonist bosentan improves microcirculatory blood flow in splanchnic organs in septic shock.
Splanchnic ischemia is believed to play an important role in the development of multiple organ dysfunction in septic shock. The vasoconstrictor peptide endothelin can produce an intense and sustained splanchnic vasoconstriction and is increased in sepsis. The aim of this investigation was to study the effects of an endothelin antagonist on microcirculatory blood flow in multiple abdominal organs during septic shock. ⋯ The endothelin receptor antagonist bosentan significantly improved microcirculatory blood flow in many splanchnic organs and in peripheral tissues during septic shock. The results of this study are consistent with the hypothesis that endothelin plays an important role in the regulation of microcirculatory blood flow in splanchnic as well as in peripheral tissues during septic shock.