Critical care medicine
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Critical care medicine · Jul 1994
Plasma cytokine determinations in emergency department patients as a predictor of bacteremia and infectious disease severity.
To determine the predictive value of plasma interleukin (IL)-6 and tumor necrosis factor-alpha (TNF) measurements in assessing bacteremia and subsequent morbidity and mortality rates in emergency department patients. ⋯ Measurement of plasma IL-6 concentrations in a population of emergency department patients with apparent bacterial infections predicted bacteremia and death from infection. The characteristics of the test indicated a potential use in selecting patients for the administration of novel therapies for sepsis.
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Critical care medicine · Jul 1994
Comparative StudyEffect of carboxyhemoglobin on the accuracy of mixed venous oximetry monitors in dogs.
To assess the accuracy of mixed venous hemoglobin oxygen saturation estimated, using in vivo pulmonary artery reflectance oximetry with ranging concentrations of carboxyhemoglobin. ⋯ Mixed venous oxygen saturation monitoring does not detect the presence of carboxyhemoglobin and progressively overestimates fractional oxyhemoglobin as carboxyhemoglobin increases. Mixed venous oxygen saturation values of the standard pulmonary artery oximetry catheter approximately equal functional hemoglobin saturation. Bench co-oximeter blood analysis is required in patients suspected of having increased carboxyhemoglobin levels.
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Critical care medicine · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialMetabolic effects of a D-beta-hydroxybutyrate infusion in septic patients: inhibition of lipolysis and glucose production but not leucine oxidation.
To study the effect of a D-beta-hydroxybutyrate infusion on protein metabolism, lipolysis, and endogenous glucose production in septic patients. ⋯ Exogenous ketone-bodies infusion decreased lipolysis and glucose production in septic patients but had no beneficial effect on protein metabolism, as evaluated with L[1-13C]leucine.
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To review the difficulties associated with defining sepsis and its complications and to characterize the role of the proinflammatory cytokines in the development of human septic shock, adult respiratory distress syndrome, and the systemic inflammatory response syndrome. ⋯ Sepsis and its complications constitute a complex biological cascade that may be defined by specific clinical characteristics. The clinical variability in these events suggests that definitions based on clinical end points be used in combination with assessments of severity of illness to best define patient status, predict clinical course, and guide treatment decision-making.
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To review the role of antimediator therapy in the inflammatory cascade associated with sepsis, and to review the status of animal and clinical studies being conducted on novel therapies for septic shock. ⋯ Clinical trials of antiendotoxin antibodies have not shown them to have therapeutic benefit. New agents that neutralize or antagonize the cellular effects of endotoxin may provide an alternative means to inhibit endotoxin effects during severe Gram-negative infections. Anti-interleukin-1 and antitumor necrosis factor-alpha therapies have demonstrated efficacy in animal models, but the results have been inconsistent in human trials. Preliminary results from clinical trials of cytokine antagonists suggest that these therapies may be effective in the most severely ill patients. Further clinical trials will be required to determine the therapeutic role of these agents in septic shock.