Critical care medicine
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Critical care medicine · Feb 2008
Randomized Controlled TrialRandomized, double-blind, placebo-controlled trial of granulocyte colony-stimulating factor in patients with septic shock.
To investigate the effect of early administration of granulocyte colony-stimulating factor (G-CSF) on hospital mortality in nonneutropenic patients with septic shock, excluding patients with melioidosis. ⋯ G-CSF does not improve outcomes in patients with septic shock, excluding melioidosis. Increased hepatic dysfunction and higher peak troponin levels in patients receiving G-CSF have not been reported in previous clinical trials and warrant further investigation.
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Critical care medicine · Feb 2008
Randomized Controlled TrialInfluence of critical illness on physicians' prognoses for underlying disease: a randomized study using simulated cases.
During critical illness, physicians often provide estimates of the severity of underlying disease to aid patients and families when formulating care directives. We sought to determine whether factors such as the superimposed acute illness, the prognoses of other patients cared for by the same physician, or the phrasing of inquiry influence these assessments of underlying disease. ⋯ Physician appraisal of underlying disease severity is potentially vulnerable to a number of biases that may be relevant in the critical care setting. These biases appear to vary with the nature of the underlying disease.
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Critical care medicine · Feb 2008
Effects of hypertonic/hyperoncotic treatment and surgical evacuation after acute subdural hematoma in rats.
The treatment of acute subdural hematoma (ASDH) consists mainly of surgical evacuation of the hematoma. It is conceivable that early preoperative neuroprotection with hypertonic/hyperoncotic treatment (HHT) can improve survival rates. The present study investigated the benefit of treatment with hypertonic/hyperoncotic solution on functional and histologic outcome as supportive therapy accompanying surgical intervention. ⋯ In this rat model, HHT led to a decrease of ICP after ASDH. This significantly improved functional and histologic outcome, which was comparable to the effects after blood evacuation alone. The combination of evacuation of subdural blood and early HHT improved histologic outcome further but not significantly, which was due to the strong effects of single treatments and a ceiling effect of the combined treatment in this model.
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Critical care medicine · Feb 2008
Meta AnalysisEffect of prone positioning in patients with acute respiratory distress syndrome: a meta-analysis.
To review the effectiveness of prone position as compared with supine position, with respect to mortality, improvement in oxygenation, number of days on mechanical ventilation, and ventilator-associated pneumonia. ⋯ Based on the results of this meta-analysis, prone position improves oxygenation in patients with adult respiratory distress syndrome, and in patients with higher illness severity, it also may reduce mortality.