Lancet
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The cause of postoperative delirium is unknown. In 7 patients with postcardiotomy delirium (6 men, 1 woman; mean age 67 years), we observed a plasma concentration of tryptophan and a plasma tryptophan ratio significantly lower than in 8 non-delirious postoperative control patients. We suggest that the mental symptoms of postcardiotomy delirium are the consequence of a reduced cerebral tryptophan availability due to a catabolic state.
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To assess the effect of selective decontamination of the digestive tract on respiratory tract infections and survival of patients treated in an intensive care unit, we carried out a meta-analysis of clinical studies comparing patients treated with selective decontamination with untreated controls. From eleven trials (1489 patients), differences between observed and expected respiratory tract infections and mortality were compared, and odds ratios (ORs) calculated. Analysis was done according to study design. ⋯ By contrast, the mortality benefit was less clear. Studies with historical controls and randomised trials showed that mortality was not significantly different between treatment and control patients. The evidence from these studies is at best consistent with a very limited effect of selective decontamination of the digestive tract on survival of patients in the intensive care unit, despite a clear preventive effect on the occurrence of respiratory tract infections.