Intensive care medicine
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This review presents the rationale for and main results of coagulation inhibitor substitution during experimental and human sepsis. Activation of the contact system induces activation of the classical complement pathway with generation of anaphylatoxins, of the kinins pathway and of fibrinolysis. Physiologic inhibition depends on the C1-inhibitor (C1-Inh.). ⋯ During sepsis, protein C activity is significantly reduced, either by acute consumption or by thrombomodulin down-regulation, and increased levels of plasma C4bBP inhibit protein S. Infusion of activated protein C and protein S substitution both protect animals from the lethal effects of bacteria. Combining these different coagulation inhibitors should be carefully studied before its use in septic patients is recommended.
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Intensive care medicine · Nov 1995
Editorial Comment ReviewWasted efforts and dyssynchrony: is the patient-ventilator battle back?
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Intensive care medicine · Nov 1995
The impact of HIV testing on blood utilization in the intensive care unit in patients with gastrointestinal bleeding.
To determine whether the AIDS epidemic has influenced physician use of blood products in intensive care unit management of gastrointestinal hemorrhage. ⋯ These data indicate that physicians are transfusing patients at lower hemoglobin levels than they did before the beginning of HIV testing. However, there has been no decrease in the total median amount of blood products transfused since that time. This change in practice may be due to increased concern about HIV transmission through blood products and suggests the need for greater awareness of existing transfusion guidelines.
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Intensive care medicine · Oct 1995
Comparative Study Clinical TrialParalysis has no effect on chest wall and respiratory system mechanics of mechanically ventilated, sedated patients.
To evaluate the separate effects of sedation and paralysis on chest wall and respiratory system mechanics of mechanically ventilated, critically ill patients. ⋯ This study demonstrates the lack of additive effects of muscle paralysis in mechanically ventilated, sedated patients. Also in view of the possible side effects of muscle paralysis, our results question the usefulness of generalized administration of neuromuscular blocking drugs in mechanically ventilated patients.