Critical care medicine
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Critical care medicine · Jul 2003
Comparative StudyResuscitation from hemorrhagic shock: experimental model comparing normal saline, dextran, and hypertonic saline solutions.
To compare the effectiveness of normal saline, dextran, hypertonic, and hypertonic-hyperoncotic solutions in hemorrhagic shock. ⋯ Resuscitation with a small volume of hypertonic-hyperoncotic solution allows systemic and splanchnic hemodynamic and oxygen transport recovery, without an increase in pulmonary artery pressure. It only transiently increased sodium concentration.
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Critical care medicine · Jul 2003
Attitudes and preferences of intensivists regarding the role of family interests in medical decision making for incompetent patients.
The role of family interests in medical decision making is controversial. Physicians who routinely treat incompetent patients may have preferred strategies for addressing family interests as they are encountered in surrogate medical decision making. We sought to determine how physicians view the role of family interests in surrogate medical decision making. ⋯ A majority of the academic intensivists in our study believed that family interests should play an important role in medical decision making for incompetent patients. Our findings suggest that the traditional view of the physician-patient relationship may represent an overly simplistic model for medical decision making.
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Critical care medicine · Jul 2003
Novel method to quantify loss of heart rate variability in pediatric multiple organ failure.
To develop a power-law model for measurement of heart rate variability (HRV) and to compare this model with established methods for measuring HRV in a group of children with organ failure (OF). ⋯ The power-law model is an appropriate measure of HRV in pediatric patients, being neither age nor heart rate sensitive. Loss of HRV occurs with increasing OF; this effect was better demonstrated by the model compared with other measures of HRV.
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Critical care medicine · Jul 2003
Marked elevation of human circulating CD4+CD25+ regulatory T cells in sepsis-induced immunoparalysis.
Immunoparalysis has recently emerged as a possible cause explaining the failure of clinical trials in septic shock. Because human peripheral blood CD4+CD25+ T cells have been characterized as suppressor T cells, we hypothesized they might be increased in sepsis-induced immunoparalysis. ⋯ These data support the concept that the persistence of a pronounced immunoparalysis after septic shock is associated with a poor outcome. Whether CD4+CD25+ T cells directly participate in sepsis-induced immunoparalysis remains to be investigated.
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Critical care medicine · Jul 2003
Editorial Comment Comparative StudyAntibiotic heterogeneity: should we use it?