Intensive care medicine
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To determine the magnitude of the treatment effect of low-dose dopamine on renal function in patients at risk of and in patients with early renal injury. ⋯ The results of this meta-analysis confirms that low-dose dopamine has no reno-protective effect. Considering the potential side-effects of dopamine this agent should not be used for this indication.
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Intensive care medicine · Jul 2002
Comparative Study Clinical Trial Controlled Clinical TrialThe effect of propofol on airway pressures generated by magnetic stimulation of the phrenic nerves.
To assess the effect of propofol on the change in airway pressure produced by diaphragmatic contraction. ⋯ Propofol does reduce the effectiveness with which diaphragmatic contraction produces changes of pressure in the airway.
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Intensive care medicine · Jul 2002
Clinical Trial Controlled Clinical TrialChest physiotherapy for the prevention of ventilator-associated pneumonia.
Pneumonia is an important complication in patients who are intubated and mechanically ventilated, when it is commonly referred to as ventilator-associated pneumonia (VAP). Since VAP may be contributed to by impaired sputum clearance, we studied whether chest physiotherapy designed to enhance sputum clearance decreases the occurrence of VAP. ⋯ In this small trial, chest physiotherapy in ventilated patients was independently associated with a reduction in VAP. This suggested benefit of physiotherapy in prevention of VAP requires confirmation with a larger randomised controlled trial.
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Intensive care medicine · Jul 2002
ReviewClinical implications of antibiotic-induced endotoxin release in septic shock.
Antibiotic-induced release of bacterial cell wall components can have immediate adverse effects for the patient. This article reviews the data on endotoxin release after initiation of antibiotic therapy and its role in the pathogenesis of sepsis and septic shock. ⋯ Antibiotics that induce the formation of long, aberrant bacterial cells before effectively killing the microorganisms show the highest degree of endotoxin liberation. There is increasing evidence from animal models and clinical studies of sepsis that the antibiotic-mediated release of biologically active cell wall components derived from Gram-positive, Gram-negative or fungal organisms is associated with a rapid clinical deterioration.