Articles: critical-illness.
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Critical care medicine · May 1992
Randomized Controlled Trial Clinical TrialGastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized, controlled trial.
To study the effects of pharmacologically increasing gastric pH on gastric colonization and the development of pneumonia in intubated critically ill patients. ⋯ Pharmacologically increasing gastric pH increases the risk for developing pneumonia in intubated critically ill patients. The pneumonia occurs earlier than in untreated control patients.
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AACN Clin Issues Crit Care Nurs · May 1992
ReviewEndocrine responses to the stress of critical illness.
The physiologic and psychologic stress of critical illness produces systemic endocrine responses that affect the body's ability to achieve and maintain homeostasis. Regardless of the nature of the stress or illness, specific hormonal changes occur in thyroid, adrenal, and posterior pituitary activity. This article describes the physiologic and pathophysiologic basis underlying endocrine responses to the stress of critical illness. The critical care nurse is challenged by the complexity of this patient and needs to be familiar with the endocrine responses to critical illness for assessment and clinical interventions to be meaningful.
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Critical care medicine · May 1992
ReviewSelective decontamination of the digestive tract in the intensive care unit: current status and future prospects.
To evaluate the available data on selective decontamination of the digestive tract. This therapy aims to prevent infection in critically ill patients admitted to ICUs. Microbial carriage in the oropharynx, stomach, and gut; infection; mortality rate; and antibiotic resistance are the outcome events that are being reviewed. ⋯ There is a general consensus about the efficacy of selective decontamination in diminishing microbial carriage and acquired infection rates, although conclusions about benefits related to mortality rates vary. Differences in mortality rate are found in the selective decontamination studies of patients with curable diseases, including multitrauma and cardiovascular patients. More data on resistance, collected over a longer period of time, are needed. Practical problems of blinding and the major ecological effect of selective decontamination may explain the lack of a randomized, placebo-controlled, double-blind trial.
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Critical care medicine · May 1992
Dobutamine pharmacokinetics and pharmacodynamics in pediatric intensive care patients.
To evaluate the pharmacokinetics and pharmacodynamics of dobutamine in critically ill children. ⋯ There was no effect of plasma dobutamine concentration or infusion rate on plasma clearance rate. For this group of patients, over the range of the intravenous doses studied, dobutamine pharmacokinetics followed a first-order kinetic model. Threshold values for dobutamine usually show increases in cardiac output before changes in heart rate. These data demonstrate that dobutamine is an effective inotropic agent in critically ill pediatric patients and has minimal chronotropic action.
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Critical care medicine · Apr 1992
Comparative StudyComparison of gastric intramucosal pH with measures of oxygen transport and consumption in critically ill patients.
To determine the relationship of tonometrically measured gastric intramucosal pH to clinically accepted indices of systemic oxygenation. ⋯ In this group of patients, death was associated with increased tissue needs for oxygen that were not adequately satisfied by the available levels of oxygen supply. We also conclude that tonometrically measured gastric intramucosal pH is a useful noninvasive adjunct to current methods of monitoring systemic oxygenation.