Intensive care medicine
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Intensive care medicine · Jul 2000
Leukocyte activation in sepsis; correlations with disease state and mortality.
The immune response in sepsis shows a bimodal pattern consisting of an early, frequently exaggerated inflammatory response followed by a state of hyporesponsiveness often referred to as the compensatory anti-inflammatory response syndrome (CARS). Insight into the disease state may be helpful in deciding whether to choose immune stimulatory or anti-inflammatory therapy in these patients and may determine clinical outcome. We hypothesized that poor outcome in patients with sepsis is related to the severity of CARS, as reflected in the degree of leukocyte activation. ⋯ In sepsis, both neutrophils and monocytes are activated compared to healthy controls. Poor prognosis is associated with a lower expression of activation markers on monocytes and neutrophils, suggesting that poor outcome in these patients may be due to the compensatory anti-inflammatory response.
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Intensive care medicine · Jul 2000
Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. CT Scan ARDS Study Group.
To compare the computed tomographic (CT) analysis of the distribution of gas and tissue in the lungs of patients with ARDS with that in healthy volunteers. ⋯ These results demonstrate that striking differences in lung morphology, corresponding to different distributions of gas within the lungs, are observed in patients whose respiratory condition fulfills the definition criteria of ARDS.
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Intensive care medicine · Jul 2000
Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia.
This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children. ⋯ VAP accounts for a major delay of extubation in pediatric cardiac surgery.
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Sedation is central to the management of intensive care patients. Many different techniques have been tried, all have potential side effects, and some have been associated with serious adverse effects. The aim of this work is to establish current sedation practice in British ICUs; the use of neuromuscular blocking drugs and the indications for their use, the use of sedation policies and scoring systems, the influence of cost on drug choice, and the use of propofol for sedation in paediatric patients. ⋯ Drugs used for the sedation of patients in intensive care have changed since previous surveys. The sedation policy of most units relies on the combination of small numbers of drugs. Sedation policies now seem to concentrate on achieving a lightly sedated co-operative patient.
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Intensive care medicine · Jun 2000
Hypothermia and cytokines in septic shock. Norasept II Study Investigators. North American study of the safety and efficacy of murine monoclonal antibody to tumor necrosis factor for the treatment of septic shock.
Hypothermic patients with sepsis have been reported to have a higher mortality than febrile septic patients. The failure to mount a febrile response in sepsis is poorly understood. Since the proinflammatory cytokines play a crucial role in the genesis of fever, we postulated that hypothermic patients with sepsis would have lower circulating levels of these cytokines than febrile patients. ⋯ Hypothermic patients with septic shock have a significantly higher mortality with a higher incidence of organ dysfunction than febrile septic shock patients. The hypothermia in these patients cannot be explained by lower levels of circulating proinflammatory cytokines.