Intensive care medicine
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Intensive care medicine · Jan 2001
Epinephrine, norepinephrine and dopamine infusions decrease propofol concentrations during continuous propofol infusion in an ovine model.
To determine the effects of exogenous ramped infusions of epinephrine, norepinephrine and dopamine on arterial and effluent brain blood concentrations of propofol under steady state intravenous anesthesia. ⋯ Catecholamines produced circulatory changes that reversed propofol anesthesia. These observations have potential clinical implications for the use of propofol in hyperdynamic circulatory conditions, either induced by exogenous catecholamine infusions or pathological states.
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Intensive care medicine · Jan 2001
Review Practice Guideline GuidelineSource control in the management of sepsis.
The process of surgical decision making is based on both general principles that are amenable to evaluation using rigorous techniques of clinical research and the intangible element of surgical judgment that seeks to apply those principles to the care of an individual patient. The role of surgical judgment is inescapable, even though it is intrinsically subjective and recalcitrant to objective evaluation, for a host of factors modify the application of principle in each patient, and render the circumstances of a given problem sufficiently distinctive, that evidence must be tempered with common sense. We have tried to provide, through an evidence-based approach to a series of questions, the rationale for the basic principles that should guide the clinician in initiating or modifying source control, recognizing that sound clinical judgement demands, at times, that these be set aside. ⋯ Their implementation in practice, however, is more complex, and does not, as a rule, lend itself to simple algorithms that are applicable in all cases. Moreover evidence-based support for these principles is weak. In the final analysis, the elusive process of experienced surgical judgement is invaluable for all but the most straightforward problems.
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Intensive care medicine · Jan 2001
Review Practice Guideline GuidelineOther supportive therapies in sepsis.
Patients who survive the circulatory and organ deficits in sepsis may still fall victim to complications such as pulmonary embolism and stress ulcer bleeding. Although there is no clearcut evidence to quantitate the impact of such complications on mortality, the anticipated impact is grave when considering the compromised physiological reserve of these patients. For this reason it is important to institute effective prophylaxis to minimize the impact. ⋯ Early and adequate nutritional support therefore appears important. There is much controversy and lack of prospective research regarding effect of supportive therapies on outcome in patients with severe sepsis. This research is needed.
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Intensive care medicine · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialEvaluation of two processed EEG analyzers for assessment of sedation after coronary artery bypass grafting.
Processed EEG monitoring has been suggested for sedation depth evaluation in intensive care unit (ICU) patients. The present study investigated the efficacy of two processed EEG monitors using SEF90% or SEF95% and BIS to differentiate between conscious (Ramsay score 4) and unconscious sedation (Ramsay score 6). ⋯ The use of processed EEG monitoring cannot be recommended for assessing sedation depth after cardiac surgery.