Intensive care medicine
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Intensive care medicine · Jul 1998
Clinical Trial Controlled Clinical TrialEffect of L-NAME, an inhibitor of nitric oxide synthesis, on plasma levels of IL-6, IL-8, TNF alpha and nitrite/nitrate in human septic shock.
We tested the effects of NG-nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide (NO) synthesis, on plasma levels of interleukin (IL) IL-6, IL-8, tumor necrosis factor-alpha (TNFalpha) and nitrite/nitrate (NO2-/ NO3-) in patients with severe septic shock. ⋯ NO plays a role in the cardiovascular derangements of human septic shock. Inhibition of NO synthesis with L-NAME does not promote excessive cytokine release in patients with severe sepsis.
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Intensive care medicine · Jul 1998
Proxy-perceived prior health status and hospital outcome among the critically ill: is there any relationship?
To measure the health status of critically ill patients prior to hospital admission and to study the relationship between prior health status (PHS) and hospital mortality. ⋯ The PHS of critically ill patients varied according to admission category. Given the instruments used and population studied, there was no association between PHS and hospital outcome.
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Intensive care medicine · Jul 1998
Case ReportsSurvival in a case of life-threatening flecainide overdose.
Flecainide acetate is a potent class Ic anti-arrhythmic drug with major sodium channel blocking actions. On the surface electrocardiogram this results in QTc interval prolongation. ⋯ This report describes a case of life-threatening flecainide overdose in a previously fit individual, resulting in a combination of cardiac disturbances. The treatment options and management are discussed.
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Intensive care medicine · Jul 1998
Randomized Controlled Trial Multicenter Study Meta Analysis Clinical TrialAntithrombin III in patients with severe sepsis. A randomized, placebo-controlled, double-blind multicenter trial plus a meta-analysis on all randomized, placebo-controlled, double-blind trials with antithrombin III in severe sepsis.
To evaluate the safety and potential efficacy of antithrombin III (AT III) in reducing mortality in patients with severe sepsis. ⋯ The administration of AT III was safe and well-tolerated. It was followed by a 39 % reduction in 30-day all-cause mortality (NS). The reduction in mortality was accompanied by a considerably shorter stay in the ICU. Patients treated with AT III exhibited a better performance in overall severity of illness and organ failure scores (Acute Physiology and Chronic Health Evaluation II, multiple organ failure, organ system failure), which was noticeable soon after initiation of treatment. Patients treated with AT III demonstrated a better resolution of pre-existing organ failures and a lower incidence of new organ failures during the observation period. A meta-analysis comprising this and two other double-blind, placebo-controlled trials with AT III with a total of 122 patients suffering from severe sepsis confirms the positive trend. The results of the meta-analysis demonstrate a 22.9 % reduction in 30-day all-cause mortality in patients treated with AT III. Although still too small to be confirmative, the meta-analysis clearly points to the fact that a sufficiently powered phase III trial is warranted to prove whether AT III has a beneficial role in the treatment of severe sepsis.
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Intensive care medicine · Jul 1998
Acute hypoxemic respiratory failure in children: case mix and the utility of respiratory severity indices.
Acute hypoxemic respiratory failure (AHRF) is a common reason for emergency pediatric intensive care. An objective assessment of disease severity from acute physiological parameters would be of value in clinical practice and in the design of clinical trials. We hypothesised that there was a difference in the best early respiratory indices in those who died compared with those who survived. ⋯ The original hypothesis was refuted. It appears that the outcome of AHRF in present day pediatric critical care is principally related to the severity of associated pathology and now no longer solely to the severity of respiratory failure. Further studies in larger series are needed to confirm these findings.