Intensive care medicine
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Neutrophils play a key role in the development of the systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS). Since the lungs are the main target in these syndromes, with adult respiratory distress syndrome (ARDS) as the outcome, extensive research has been undertaken to prevent or mitigate ARDS. As evidence of the involvement of neutrophils in ARDS has accumulated, modulation of their function has become a major goal in terms of a therapeutic approach. ⋯ Secondly, we described the different mediators, including cytokines, which are released by neutrophils. Lastly, we discussed the possible modulation of their function. Although we cannot assess the clinical usefulness of biochemical substances merely on the basis of their in vitro effects, understanding these mechanisms is fundamental to the success of the new therapeutic approach which is currently under way.
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Intensive care medicine · Feb 1995
Comparative StudyTreatment of surgical and non-surgical septic multiorgan failure with bicarbonate hemodialysis and sequential hemofiltration.
Hospital mortality of patients with septic multiorgan failure (MOF) is still around 95%. The present study investigates whether this high mortality could be significantly reduced by the addition of sequential hemofiltration (SH) with bicarbonate hemodialysis (HD) to the currently used life supportive measures. ⋯ Mortality observed in this retrospective, uncontrolled study was significantly lower than that currently observed with conventional supportive therapy, with or without the addition of other forms of blood purification, e.g. CAVH and CAVHD. This improvement in results appears to be related to the property of SH to completely clear 90% of the blood from mediators of inflammation in only one passage through the hemofilter, and to better tolerance of HD done using bicarbonate buffer. A definite evaluation of this technique will be eventually reached by a programmed, appropriate sample size study, which is out of reach for one individual ICU.
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Intensive care medicine · Feb 1995
Review Comparative StudyCharacteristics of the ventilator pressure- and flow-trigger variables.
Pressure- and flow-triggering are available in the Puritan Bennett 7200ae and Siemens SV 300. Using a mechanical lung model, we described the characteristics of the pressure- and flow-triggered continuous positive airway pressure (CPAP) of both ventilators. In the Puritan Bennett 7200ae, the pressure-triggered CPAP is characterized by the relatively insufficient flow delivery after the triggering, resulting in a greater lung pressure-time product (total PTP) than the flow-triggered CPAP. ⋯ Total PTP is less with pressure- or flow-triggered CPAP of the Siemens SV 300 than that of the Puritan Bennett 7200ae, respectively. The application of small pressure- or flow-triggered pressure support in the Puritan Bennett 7200ae eliminates the difference. The impact of these differences on patient inspiratory muscle work remains to be determined.