Critical care medicine
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Critical care medicine · Sep 2004
Importance of platelets and fibrinogen in neutrophil-endothelial cell interactions in septic shock.
To examine the role of platelets, fibrin, and adhesion molecules in mediating neutrophil-endothelial cell interactions in septic shock. ⋯ These data suggest that platelets and fibrinogen play an important role in mediating neutrophil-endothelial cell adherence in septic shock.
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Critical care medicine · Sep 2004
Wide variation in cardiopulmonary resuscitation interruption intervals among commercially available automated external defibrillators may affect survival despite high defibrillation efficacy.
Recent studies have associated interruptions of cardiopulmonary resuscitation imposed by automated external defibrillators (AEDs) with poor resuscitation outcome. In particular, the "hands-off" interval between precordial compressions and subsequent defibrillation shock has been implicated. We sought to determine the range of variation among current-generation AEDs with respect to this characteristic. ⋯ In addition to defibrillation waveform and dose, researchers should consider the hands-off cardiopulmonary resuscitation interruption interval between cardiopulmonary resuscitation and subsequent defibrillation shock to be an important covariate of outcome in resuscitation studies. Defibrillator design should minimize this interval to avoid potential adverse consequences on patient survival.
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Critical care medicine · Sep 2004
Detrimental hemodynamic effects of assisted ventilation in hemorrhagic states.
Our goal was to demonstrate explicitly that lower-frequency positive-pressure ventilation not only preserves adequate oxygenation and acid-base status in hemorrhagic states, but also that "normal" or higher respiratory rates significantly compromise hemodynamics, even with moderate degrees of hemorrhage. ⋯ After moderate hemorrhage, animals maintain adequate oxygenation and acid-base status with lower-frequency respiratory rates, whereas increasingly higher respiratory rates progressively and significantly impair hemodynamics. Current ventilatory protocols for trauma resuscitation should be re-examined and considered a possible cause of worsened clinical outcomes and unrecognized confounded study results.