Critical care medicine
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Critical care medicine · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialDirect comparison of cerebrovascular effects of norepinephrine and dopamine in head-injured patients.
To directly compare the cerebrovascular effects of norepinephrine and dopamine in patients with acute traumatic brain injury. ⋯ Norepinephrine may be more predictable and efficient to augment cerebral perfusion in patients with traumatic brain injury.
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Critical care medicine · Apr 2004
Clinical Trial Controlled Clinical TrialProspective controlled trial of effect of medical emergency team on postoperative morbidity and mortality rates.
To determine whether the introduction of an intensive care unit-based medical emergency team, responding to hospital-wide preset criteria of physiologic instability, would decrease the rate of predefined adverse outcomes in patients having major surgery. ⋯ The introduction of an intensive care unit-based medical emergency team in a teaching hospital was associated with a reduced incidence of postoperative adverse outcomes, postoperative mortality rate, and mean duration of hospital stay.
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Critical care medicine · Apr 2004
Randomized Controlled Trial Comparative Study Clinical TrialRandomized controlled trial of aerosolized prostacyclin therapy in children with acute lung injury.
To investigate whether aerosolized prostacyclin improves oxygenation in children with acute lung injury. ⋯ Aerosolized prostacyclin improves oxygenation in children with acute lung injury. Future trials should investigate whether this treatment will positively affect outcome.
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Critical care medicine · Apr 2004
ReviewPerioperative diabetic and hyperglycemic management issues.
To review and discuss selected literature, expert opinion, and conventional care of the hyperglycemic perioperative or critically ill patient. ⋯ Up to 25% of patients admitted to the intensive care unit have previously diagnosed diabetes. Diabetics are most commonly admitted for treatment of complications of comorbid diseases. New-onset hyperglycemia also is common in critically ill patients, and it affects patient morbidity and mortality rates. A growing body of literature supports the benefits of tight glycemic control in certain patient populations. However, further data are needed about the optimal concentration of blood glucose, the role of maintaining euglycemia in a broader group of patients (including the medically critically ill), and the mechanisms of benefit of infused glucose and insulin.
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Critical care medicine · Apr 2004
Comparative StudyClinical relevance of angiotensin-converting enzyme gene polymorphisms to predict risk of mechanical ventilation after coronary artery bypass graft surgery.
Prolonged mechanical ventilation is a significant complication after coronary artery bypass graft surgery. Angiotensin-converting enzyme mediates ischemia-reperfusion injury, which is an important mechanism of postcoronary artery bypass graft complications. An insertion/deletion polymorphism within the angiotensin-converting enzyme gene is associated with variable concentrations of angiotensin-converting enzyme. Whether this polymorphism is associated with prolonged mechanical ventilation is not known. The primary objective was to determine whether the insertion/deletion angiotensin-converting enzyme gene polymorphism is associated with prolonged mechanical ventilation. The release of inflammatory mediators and risk of prolonged mechanical ventilation are higher after conventional coronary artery bypass graft compared with off-pump coronary artery bypass graft. Therefore, we examined the risk of prolonged mechanical ventilation for angiotensin-converting enzyme genotypes in patients undergoing conventional coronary artery bypass graft and off-pump coronary artery bypass graft separately. Tumor necrosis factor down-regulates angiotensin-converting enzyme concentrations, and functional polymorphisms within the tumor necrosis factor gene have been associated previously with prolonged mechanical ventilation. Therefore, we examined interactions between these polymorphisms. ⋯ Angiotensin-converting enzyme gene polymorphisms are associated with respiratory complications postcardiopulmonary bypass. The increased risk associated with genotype may be amenable to alternative surgical technique or pharmacologic manipulation.