Critical care medicine
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Critical care medicine · Apr 2003
Acute pancreatitis in intensive care unit patients: value of clinical and radiologic prognosticators at predicting clinical course and outcome.
To assess the value of clinical and/or radiographic prognostic indices in predicting the clinical course and outcome of patients with acute pancreatitis, in the intensive care unit. ⋯ The clinical course and outcomes of intensive care unit patients with acute pancreatitis can be highly variable. An APACHE II score <10 during the initial 48 hrs correlated with mild pancreatitis and uncomplicated intensive care unit course; however, multifactorial prognosticators were not useful for the early identification of patients who developed complications or required extended intensive care unit care.
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Critical care medicine · Apr 2003
Gabexate mesilate, a synthetic anticoagulant, inhibits the expression of endothelial leukocyte adhesion molecules in vitro.
Gabexate mesilate, a synthetic protease inhibitor, has been shown to reduce endotoxin-induced pulmonary vascular injury in an animal model of sepsis by inhibiting leukocyte activation. We examined whether gabexate mesilate inhibits tumor necrosis factor-alpha-induced expression of leukocyte adhesion molecules in cultured endothelial cells. ⋯ Gabexate mesilate inhibited the expression of leukocyte adhesion molecules by inhibiting the nuclear factor-kappaB-mediated transcription in HUVECs. Inhibition of nuclear factor-kappaB activation by gabexate mesilate could be explained by inhibition of degradation of IkappaB. Gabexate mesilate might reduce lipopolysaccharide-induced pulmonary vascular injury not only by inhibiting monocytic tumor necrosis factor-alpha production but by inhibiting the expression of endothelial leukocyte adhesion molecules.
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Palliative care is an important component of critical care medicine. Few fellowship programs have developed a curriculum designed to teach palliative care precepts to trainees. We describe our 2-yr experience in teaching palliative care to multidisciplinary critical care medicine fellows. ⋯ Palliative care training for critical care fellows is feasible. Fellows value skills training more than a clinical rotation in palliative care. Baseline knowledge of palliative care is low.
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Critical care medicine · Apr 2003
Meta AnalysisExtended somatic support for pregnant women after brain death.
To review case reports of pregnant women who have been supported after brain death until successful delivery of their infants. From these reports and other literature about brain death, normal physiologic changes of pregnancy, and specific needs for fetal development, recommendations were made to assist in supporting pregnant women after brain death until delivery of a mature fetus who is likely to survive. ⋯ Preservation of uterine/placental blood flow is the most important priority during somatic support. Imprecise autoregulation of the uterine vasculature during maternal hypoxemia or hypotension makes this goal a significant challenge. Special considerations for nutrition; medication use; cardiovascular, respiratory, or endocrine therapy; fetal monitoring; hormone replacement; and ethical concerns are discussed.