Intensive care medicine
-
Intensive care medicine · Jun 1999
Comparative Study Clinical TrialIV milrinone for cardiac output increase and maintenance: comparison in nonhyperdynamic SIRS/sepsis and congestive heart failure.
To characterize the effect of the phosphodiesterase inhibitor (PDEI) milrinone in adult patients with a non-hyperdynamic condition during the course of the systemic inflammatory response syndrome (SIRS) or sepsis when compared with patients with congestive heart failure (CHF). PDEIs are potent inhibitors of cytokine production and expression. We hypothesized that there might be an outstanding beneficial effect of PDEIs in the setting of SIRS/sepsis. ⋯ Milrinone administration is feasible in selected patients with a non-hyperdynamic condition during SIRS/sepsis and with preexisting heart disease. Under the conditions of this study, milrinone was no better in terms of CI and LVSWI maintenance in septic cardiac dysfunction when compared with CHF. These results do not necessarily extend to other cohorts with no preexisting heart disease.
-
Intensive care medicine · Jun 1999
Randomized Controlled Trial Clinical TrialThe prognostic significance of passing a daily screen of weaning parameters.
While "weaning parameters" are commonly used to guide removal of mechanical ventilation devices, little information exists concerning their prognostic value. We evaluated whether passing weaning parameters was associated with survival. ⋯ Passing a daily screen of weaning parameters is an independent predictor of successful extubation and survival, but its prognostic value decreases over time. Time spent on mechanical ventilation after passing the daily screen presents an important opportunity to optimize liberation from the ventilator.
-
Intensive care medicine · Jun 1999
Clinical Trial Controlled Clinical TrialAlterations of soluble L- and P-selectins during cardiac arrest and CPR.
To investigate the relationship between cytokines and the inflammatory responses in patients with out-of-hospital cardiac arrest, we examined the changes of cytokines as well as alterations in the markers of neutrophil activation, platelet and endothelial activation, and endothelial injury. ⋯ Out-of-hospital cardiac arrest and CPR induces platelet, neutrophil, and endothelial activation and is associated with endothelial injury. Inflammatory cytokines may not have an important role in human whole-body ischemia-reperfusion injury.
-
Intensive care medicine · Jun 1999
Comparative Study Clinical TrialDoes noninvasive ventilation reduce the ICU nosocomial infection risk? A prospective clinical survey.
To observe the nosocomial infection (NI) distribution in ventilated patients of a single intensive care unit (ICU) according to the kind of control of the upper airways: noninvasive positive pressure ventilation (NPPV) versus endotracheal intubation (ETI). ⋯ The use of NPPV reduces the risk of VAP and NI, compared to ETI, irrespective of the severity of the patient's illness.
-
Intensive care medicine · Jun 1999
Clinical TrialSerum concentrations and clearances of folic acid and pyridoxal-5-phosphate during venovenous continuous renal replacement therapy.
To determine to what extent hydrosoluble vitamins are removed by continuous renal replacement therapy (CRRT); to evaluate clearances, removal rates, and evolution of serum concentrations of folic acid and pyridoxal-5'-phosphate (P-5'-P), the active moiety of vitamin B6 during CRRT. ⋯ Significant losses of folic acid and P-5'-P (and most likely of other hydrosoluble vitamins) occur during CRRT. Considering that stores of most hydrosoluble vitamins are relatively low in critically ill patients, supplementation should be provided to patients treated similarly.