Critical care medicine
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Critical care medicine · Mar 2004
Randomized Controlled Trial Multicenter Study Clinical TrialAlbumin influences total plasma antioxidant capacity favorably in patients with acute lung injury.
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Critical care medicine · Mar 2004
Multicenter StudyRed blood cell transfusion and ventilator-associated pneumonia: A potential link?
To determine the relationship between packed red blood cell transfusion practice and the development of ventilator-associated pneumonia (VAP). ⋯ Transfusion of packed red blood cells increases the risk of developing VAP. Avoiding the unnecessary use of packed red blood cell transfusions may decrease the occurrence of VAP.
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Critical care medicine · Mar 2004
Multicenter StudyElevated plasma and lung endothelial selectin levels in patients with acute respiratory distress syndrome and a history of chronic alcohol abuse.
Activation of endothelial cells is a critical step in the pathogenesis of acute respiratory distress syndrome (ARDS). Soluble endothelial selectin (sE-selectin), an endothelial cell-specific molecule that mediates leukocyte-endothelial cell adhesion has never been measured in the bronchoalveolar lavage fluid of critically ill patients. Based on the effects of alcohol on endothelial cell and alveolar-capillary barrier function, we hypothesized that chronic alcohol exposure may be associated with increased sE-selectin in ARDS patients. ⋯ ARDS patients who chronically abuse alcohol have elevated concentrations of sE-selectin in both the plasma and epithelial lining fluid consistent with altered endothelial cell and alveolar-capillary barrier function.
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Critical care medicine · Mar 2004
Multicenter StudyUse of intensive care at the end of life in the United States: an epidemiologic study.
Despite concern over the appropriateness and quality of care provided in an intensive care unit (ICU) at the end of life, the number of Americans who receive ICU care at the end of life is unknown. We sought to describe the use of ICU care at the end of life in the United States using hospital discharge data from 1999 for six states and the National Death Index. ⋯ One in five Americans die using ICU services. The doubling of persons over the age of 65 yrs by 2030 will require a system-wide expansion in ICU care for dying patients unless the healthcare system pursues rationing, more effective advanced care planning, and augmented capacity to care for dying patients in other settings.