Critical care medicine
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Critical care medicine · Jan 2008
Evaluation of the effect of intensity of care on mortality after traumatic brain injury.
To evaluate the effect of age on intensity of care provided to traumatically brain-injured adults and to determine the influence of intensity of care on mortality at discharge and 12 months postinjury, controlling for injury severity. ⋯ There is a lower intensity of care provided to older adults with traumatic brain injury. Although the specific contributions of specialists to patient management are unknown, their consultation was associated with decreased risk of in-hospital death and death within 12 months. It is important that careproviders have an increased awareness of the potential contribution of multidisciplinary clinical decision making to patient outcomes in older traumatically brain-injured patients.
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Critical care medicine · Jan 2008
Comparative StudyGas exchange and lung inflammation using nasal intermittent positive-pressure ventilation versus synchronized intermittent mandatory ventilation in piglets with saline lavage-induced lung injury: an observational study.
Physiologic and pathologic comparison of two modes of assisted ventilation, nasal intermittent positive-pressure ventilation (NIPPV) and synchronized intermittent mandatory ventilation (SIMV), in spontaneously breathing term newborn piglets with saline lavage-induced lung injury. ⋯ In surfactant-deficient term newborn piglets, NIPPV offers an effective and noninvasive ventilatory strategy with the potential for less pathologic lung inflammation.
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Critical care medicine · Jan 2008
Comparative StudyElectrocardiogram waveforms for monitoring effectiveness of chest compression during cardiopulmonary resuscitation.
Newer guidelines address the importance of effective chest compressions, citing evidence that this primary intervention is usually suboptimally performed during cardiopulmonary resuscitation. We therefore sought a readily available option for monitoring the effectiveness of chest compressions, specifically using the electrocardiogram. ⋯ The effectiveness of chest compressions was reflected in the amplitude spectrum area values. Accordingly, the amplitude spectrum area predictor may be incorporated in current automated external defibrillators to monitor and prompt the effectiveness of chest compression during cardiopulmonary resuscitation.
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Critical care medicine · Jan 2008
Comparative StudyMelatonin receptors mediate improvements of liver function but not of hepatic perfusion and integrity after hemorrhagic shock in rats.
Melatonin has been demonstrated to attenuate organ damage in models of ischemia and reperfusion. Melatonin treatment before hemorrhagic shock has been shown to improve liver function and hepatic perfusion. Proposed mechanisms of the pineal hormone involve direct inactivation of reactive oxygen species and induction of antioxidative enzymes. However, recent evidence suggests a strong influence of melatonin receptor activation for these effects. Specific protection of organ function by melatonin after hemorrhage has not been investigated yet. In this study, we evaluated whether melatonin therapy after hemorrhagic shock improves liver function and hepatic perfusion, with emphasis on melatonin receptor activation. ⋯ Melatonin therapy after hemorrhagic shock improves liver function, hepatic perfusion, redox state, and hepatic integrity. With respect to liver function, beneficial effects of the pineal hormone seem to be dependent on melatonin receptor activation.
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Critical care medicine · Jan 2008
Comparative StudyModification of acute cardiovascular homeostatic responses to hemorrhage following mild to moderate traumatic brain injury.
The cardiovascular homeostatic responses to hemorrhage are coordinated in the central nervous system. Coincidental brain injury, which is present in 64% of trauma patients, could impair these responses. Our objective was to test the hypothesis that mild to moderate traumatic brain injury alters cardiovascular reflex responses to acute hemorrhage. ⋯ Acute mild and moderate traumatic brain injury disrupts cardiovascular homeostatic responses to extracranial hemorrhage; this disruption is graded according to the severity of traumatic brain injury. Severe disruption is associated with an increase in early mortality.