Journal of intensive care medicine
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J Intensive Care Med · Nov 1992
Critical appraisal of therapeutic interventions in the intensive care unit: human monoclonal antibody treatment in sepsis. Journal Club of the Hamilton Regional Critical Care Group.
Using the medical literature to solve patient problems is challenging and rewarding. For intensive care physicians, this evidence-based medicine approach is more compelling when basic critical appraisal skills are developed. We highlight the important methodological points for interpreting the literature on treatment, using a cogent example from the critical care literature--monoclonal antibody therapy in sepsis. It is likely that as we move into the 1990s, growth in the number of articles on immunotherapy in the sepsis syndrome will parallel the growth of the general biomedical literature.
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J Intensive Care Med · Nov 1992
ReviewIndications, technical considerations, and strategies for renal replacement therapy in the intensive care unit.
Renal replacement therapy in the intensive care unit can vary from simple procedures to very complex technologies. I discuss the factors that contribute to the decisions regarding the selection of a specific therapy. These factors include immediate and intermediate therapeutic goals (e.g., solute removal, dehydration), hemodynamic stability and other clinical conditions, and the technical requirements obligate to specific therapies. The differences between convective and diffusive solute removal are described, as well as the rationale for choosing one over the other. This choice is particularly relevant to and dependent on the therapeutic goal. Spontaneous blood flow versus pumped blood flow is debated. Lastly, the removal of middle molecular weight molecules is discussed in the context of toxic cytokines or bacterial products.