Critical care medicine
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Critical care medicine · Apr 1996
Comparative StudyA descriptive study of skeletal muscle metabolism in critically ill patients: free amino acids, energy-rich phosphates, protein, nucleic acids, fat, water, and electrolytes.
To characterize biochemical changes in skeletal muscle in critically ill patients. ⋯ Although critically ill patients are a very heterogeneous group from a clinical point of view, there is a remarkable homogeneity in many of the biochemical parameters regardless of the severity of illness and the length of the ICU admission. The three most consistent differences were the skeletal muscle low glutamine concentration, the decrease in protein content, and the increase in extracellular water in the patients.
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Critical care medicine · Apr 1996
Comparative StudyLiver function and morphology after resuscitation from severe hemorrhagic shock with hemoglobin solutions or autologous blood.
To test the effects of three hemoglobin solutions on liver function and hepatic morphology after resuscitation from severe hemorrhagic shock. ⋯ Morphologic studies at necropsy and liver function tests in dogs receiving hemoglobin solutions, compared with autologous blood, support the conclusion that the PHP and stroma-free hemoglobin solutions tested did not produce hepatic toxicity when used as resuscitation fluids in this model of severe shock.
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Critical care medicine · Apr 1996
Comparative StudyNonrespiratory predictor of mechanical ventilation dependency in intensive care unit patients.
To determine the role of serum albumin concentration as a predictor of mechanical ventilation dependency. ⋯ Initial serum albumin concentration did not necessarily predict weaning success. However, when serum albumin concentration was assessed on a daily basis, its trend was important in determining the relative chance of being successfully weaned from the ventilator. This finding suggests that albumin may be an index of the metabolic status of the patient, which could be important in determining the weanability of the patients who are mechanically ventilated for prolonged periods of time.
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Critical care medicine · Apr 1996
Comparative StudyEffect of jet ventilation on heart failure: decreased afterload but negative response in left ventricular end-systolic pressure-volume function.
To examine the mechanism of cardiac assist with systolic jet ventilation, specifically effects on loading conditions and left ventricular pressure-volume function. Both systolic and diastolic jet ventilation were compared in the absence and presence of heart failure. ⋯ Jet ventilation did not decrease stroke volume in failing hearts because of the afterload-reducing benefit (decreased transmural left ventricular end-systolic pressure) of increased intrapleural pressure in dilated ventricles. Moreover, jet ventilation did not have positive effects on myocardial function and had negative effects on left ventricular elastance in the postjet ventilation period in both normal and failing hearts. Cardiac assist by jet ventilation was not cycle specific, suggesting no selective benefit of jet ventilation over conventional positive-pressure ventilation during heart failure. These studies demonstrate a negative inotropy associated with jet ventilation that, during heart failure, may compromise the general benefit of positive-pressure-mediated increases in intrapleural pressure.
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Critical care medicine · Mar 1996
ReviewIs it time to reposition vasopressors and inotropes in sepsis?
To review the literature on the current use of vasopressors and inotropes in patients with sepsis and sepsis syndrome with respect to the choice of agent, therapeutic end points, and safe and effective doses to be used. To examine the available evidence that supports or refutes goal-directed therapy toward supranormal oxygen transport in optimizing the outcome of critically ill sepsis syndrome patients. ⋯ Insufficient evidence exists to support goal-directed therapy with vasopressors and inotropes in the treatment of sepsis syndrome. No definitive recommendations can be made about the superiority of a vasopressor or inotropic agent due to the lack of data. However, it may be that evaluation of vasopressors earlier in sepsis syndrome will yield more promising results. Large, comparative, controlled trials assessing mortality rate and development of multiple organ system dysfunction are needed.