Critical care clinics
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In conclusion, dopamine has the unique ability, compared with other catecholamines, to improve renal blood flow, glomerular filtration rate, sodium excretion, and creatinine clearance, independent of its cardiac effects. In addition, low-dose dopamine can decrease renal and systemic vascular resistance, suppress aldosterone secretion, and interact with atrial natriuretic factor. Because of these clinically significant properties, dopamine has been used successfully to improve and treat acute oliguric renal failure in a variety of clinical situations as just described. ⋯ For those who are skeptical, we offer the following suggestion: "The obscure we see eventually, the obvious takes a little longer"--E. R. Murrow.
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Critical care clinics · Jul 1996
ReviewHypertensive, hypervolemic, hemodilutional therapy for aneurysmal subarachnoid hemorrhage. Is it efficacious? Yes.
Vasospasm is an important contributor to death and disability after aneurysmal SAH. CBF is decreased after SAH and correlates inversely with the severity of the clinical grade. ⋯ This is attributable, perhaps, to the fact that such trials are difficult to blind. Nevertheless, there is strong evidence that HHH therapy can reverse the delayed onset of profound neurologic deficits by restoring blood flow to ischemic regions, and its prophylactic use can reduce the incidence and severity of DID.
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The hypermetabolic state in critically ill patients is characterized by wasting of lean body mass and immunosuppression. The gut is among the most metabolically active organs. Failure to maintain gut function by way of early enteral nutrition can lead to increased infectious complications. Early enteral nutrition improves outcomes and may maintain muscle mass by blunting the cytokine-mediated hypermetabolic response.
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Critical care clinics · Jul 1996
ReviewHypertensive, hypervolemic, hemodilutional therapy for aneurysmal subarachnoid hemorrhage. Is it efficacious? No.
Many neurosurgeons routinely use hypertensive, hypervolemic, hemodilutional, or hyperdynamic therapy (HT) in some form to prevent or to treat vasospasm. Despite the widespread use of this therapy during the past 20 years, however, there are no randomized, prospective, controlled clinical studies demonstrating that HT improves the short- or long-term neurologic outcome or survival after subarachnoid hemorrhage. Guidelines need to be developed to standardize the clinical application of HT, and well-controlled, prospective, randomized clinical trials must be conducted before HT can become an accepted treatment for vasospasm.
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Critical care clinics · Jul 1996
ReviewDoes increasing oxygen delivery improve outcome in the critically ill? No.
The strategy of treating critically ill patients by increasing oxygen delivery and consumption to values previously observed among survivors of critical illness (supranormal values) is based on the belief that (1) tissue hypoxia may persist in critically ill patients despite aggressive early resuscitation to traditional endpoints of adequate tissue perfusion and (2) that increasing oxygen delivery can reverse tissue hypoxia. This article addresses the question of whether increasing oxygen delivery improves outcomes in critically ill patients by reviewing the relationship between whole-body oxygen delivery and consumption and by critically examining the randomized controlled trials that have increased oxygen delivery to supranormal values.