Critical care medicine
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Critical care medicine · Jun 2009
Randomized Controlled Trial Comparative StudyDuodenal versus gastric feeding in medical intensive care unit patients: a prospective, randomized, clinical study.
To determine whether medical intensive care unit (ICU) patients receiving nasoduodenal (ND) feedings achieve optimal nutritional support and better clinical outcomes compared with patients receiving nasogastric (NG) feedings. ⋯ Patients who received ND feedings achieved nutritional goals earlier than those who received NG feeding. ND feeding group also has a lower rate of vomiting and VAP in the medical ICU setting.
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Critical care medicine · Jun 2009
Effects of hydroxyethyl starch resuscitation on extravascular lung water and pulmonary permeability in sepsis-related acute respiratory distress syndrome.
Hydroxyethyl starch (HES) has greater volume expansion effect and longer intravascular persistence than crystalloids. HES also decreases microvascular permeability and capillary leakage by biophysically plugging endothelial leaks, exerting an anti-inflammatory effect, and decreasing activation of endothelial cells. The aim of our study was to determine whether medium molecular weight HES (pentastarch) resuscitation in the early stage of acute respiratory distress syndrome (ARDS) simultaneously increases cardiac output without worsening pulmonary edema and whether it attenuates pulmonary vascular permeability. ⋯ In patients with early ARDS, pentastarch resuscitation significantly improved their hemodynamics and cardiac output without worsening pulmonary edema and pulmonary mechanics. It even attenuated pulmonary vascular permeability.
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Critical care medicine · Jun 2009
Early assessment of outcome in cardiogenic shock: relevance of plasma N-terminal pro-B-type natriuretic peptide and interleukin-6 levels.
Plasma N-terminal pro-B-type natriuretic peptide (Nt-pro-BNP) levels are frequently elevated in critically ill patients and are associated with an increased mortality. In this study, we determined Nt-pro-BNP levels in patients with cardiogenic shock (CS) and evaluated its association with clinical and hemodynamic parameters and 30-day mortality. ⋯ The massive elevations of Nt-pro-BNP observed in the early phase of CS seem to be independent of ventricular performance. Nt-pro-BNP levels are nevertheless predictive of 30-day survival in patients with CS especially in those with successful revascularization and might be used in combination with IL-6 for estimation of outcome early on.
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Critical care medicine · Jun 2009
Low-volume resuscitation from traumatic hemorrhagic shock with Na+/H+ exchanger inhibitor.
To evaluate the use of a Na/H exchanger (NHE-1) inhibitor as a cardioprotective adjunct therapy to low-volume resuscitation in two different rat models of traumatic hemorrhagic shock. ⋯ NHE-1 inhibition facilitated the hemodynamic response to fluid resuscitation, attenuated tissue inflammatory injury, and organ dysfunction, but most importantly improved survival.
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Critical care medicine · Jun 2009
Influence of red blood cell transfusion on mortality and long-term functional outcome in 292 patients with spontaneous subarachnoid hemorrhage.
To analyze the influence of red blood cell (RBC) transfusions on mortality and outcome of patients with spontaneous subarachnoid hemorrhage (SAH) and to determine predictors of unfavorable neurologic long-term outcome in this patient population. ⋯ Transfusion of RBCs was not associated with in-neuro-ICU mortality or unfavorable long-term outcome. Of all patients with SAH, >41% have almost fully recovered with favorable neurologic long-term outcome.