Articles: critical-illness.
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Randomized Controlled Trial Comparative Study Clinical Trial
A double-blind, prospective, randomized study of glutamine-enriched compared with standard peptide-based feeding in critically ill patients.
Arterial and venous plasma amino acids were determined in 28 intensive care patients randomly assigned to receive 10 d of isoenergetic, isonitrogenous feedings that differed sixfold in glutamine content. Subjects were generally well-matched for age, injury severity, and disease diagnoses. Nasojejunal feedings were started within 48 h of admission. ⋯ There were, however, significant (P < 0.05) increases in arterial or venous plasma total, indispensable, and branched-chain amino acids of 125-144% by day 5 only in patients fed the standard control diet. The phenylalanine-tyrosine ratio was elevated on day 1 in both groups (1.3-1.4) but decreased significantly only in the glutamine-supplemented group (1.1 compared with 1.4) by day 5. Glutamine supplementation blunted the hyperaminoacidemia and elevated aromatic amino acid response to injury.
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Randomized Controlled Trial Comparative Study Clinical Trial Retracted Publication
Influence of different volume therapy regimens on regulators of the circulation in the critically ill.
Various vasoactive substances are involved in the regulation of the macro- and microcirculation. We have investigated if these regulators change during long-term volume therapy with human albumin (HA) or hydroxyethylstarch solution (HES) in trauma and sepsis patients. To maintain pulmonary capillary wedge pressure (PCWP) at 10-15 mm Hg, either 20% HA (HA-trauma, n = 14; HA-sepsis, n = 14) or 10% low-molecular weight HES solution (HES-trauma, n = 14; HES-sepsis, n = 14) were infused for 5 days, otherwise patient management did not differ between the two groups (trauma/sepsis). ⋯ In both sepsis groups, vasopressors (vasopressin, endothelin-1, noradrenaline and adrenaline) were significantly increased above normal at baseline and decreased more markedly in HES than in HA patients. Concentrations of atrial natriuretic peptide increased only in the HA patients (from 159 (SD 31) to 215 (38) pg ml-1 on day 2). Plasma concentrations of 6-keto-prostaglandin F1 alpha decreased significantly only in the HES sepsis patients (from 112 (25) to 47 (15) pg ml-1).
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Cardiologia (Rome, Italy) · Sep 1996
Randomized Controlled Trial Clinical TrialTransesophageal echocardiography in critically-ill patients using a miniaturized probe: feasibility, efficacy and indications.
Transesophageal echocardiography (TEE) with standard probes may be unsuccessful in emergencies, and in critically-ill or non collaborative patients. A miniaturized pediatric probe was used to overcome these limitations. Thirty-nine patients (age 18-87 years, height 155-184 cm, weight 45-102 kg) were studied with the pediatric probe, and 21 of them were studied using both the pediatric and adult probes in a random sequence. ⋯ Imaging projections and diagnostic accuracy in a wide range of cardiac, aortic and mediastinal diseases were similar for both the pediatric and adult probes. Patient's compliance was much improved by the pediatric probe. In conclusion, TEE by pediatric probes can be used in critically-ill adult patients when the approach with the standard probe is unfeasible or when sedation is undesirable.
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Anesthesia and analgesia · Aug 1996
Randomized Controlled Trial Clinical Trial Retracted PublicationThe effects of albumin versus hydroxyethyl starch solution on cardiorespiratory and circulatory variables in critically ill patients.
Sufficient intravascular fluid therapy is of major importance in the treatment of the critically ill patient. The present study assessed whether the cardiorespiratory response of long-term volume replacement with low-molecular weight (LMW) hydroxyethyl starch solution (HES) differs from that of human albumin (HA). According to a randomized sequence, 30 trauma patients (injury severity score [ISS] between 15 and 30) and 30 sepsis patients (secondary to major general surgery) received either 10% HES (mean molecular weight 200,000 daltons; HES trauma [n = 15], HES sepsis [n = 15]) or human albumin 20% (HA trauma [n = 15], HA sepsis [n = 15]) over 5 days to keep pulmonary capillary wedge pressure (PCWP) between 12 and 18 mm Hg. ⋯ We conclude that long-term intravascular fluid therapy with HA in traumatized and sepsis patients has no advantages in comparison to LMW-HES. In both groups, volume replacement with HES even resulted in improved systemic hemodynamics. Decrease in pHi in the sepsis patients was blunted by HES infusion indicating improved splanchnic perfusion by this regimen of volume therapy.
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Randomized Controlled Trial Clinical Trial
Effects of supplemental dietary arginine, canola oil, and trace elements on cellular immune function in critically injured patients.
Dietary nutrients may have pharmacological value in modulating the immune system. We studied the effects of two enteral diets, which differed in their content of arginine, fat source, and select trace elements, on immune function in critically injured patients. Leukocytes were isolated from healthy volunteers and severely injured (ISS > 13) patients on the first, sixth, and tenth day of receiving either a standard diet or experimental diet. ⋯ Leukocyte function was uniformly depressed compared to normal patients on day 1. The response of leukocytes from patients receiving experimental diet improved or "normalized" by day 6, while remaining depressed in patients receiving standard diet. Dietary nutrient modification can effect cellular immune responses to inflammatory stimuli in severely injured patients.