Journal of intensive care medicine
-
J Intensive Care Med · Jul 1995
Clinical Trial Controlled Clinical TrialA prospective study of continuous venovenous hemodiafiltration in critically ill patients with acute renal failure.
We studied the biochemical and the clinical consequences of the application of continuous venovenous hemodiafiltration to the management of acute renal failure in critically ill patients. One hundred consecutive surgical and medical ICU patients with acute renal failure were entered into a prospective clinical study at an intensive care unit of tertiary institution. ⋯ included the following: mean patient age was 60.9 years (range 21-81 yr); mean APACHE II score, 28.6 (95% confidence interval; 27.4-29.8); and number of failing organs, mean, 4.1 (95% confidence interval; 3.8-4.4). At commencement of continuous venovenous hemofiltration with dialysis, 79% of patients were receiving inotropic drugs and 72% were septic, and, in 35%, bacteremia or fungemia was demonstrated. Renal replacement therapy was applied for a mean duration of 186.2 hours (95% confidence interval; 149.2-223.7), with a mean hourly net ultrafiltrate production of 621 mL (95% confidence interval; 594-648) and a mean urea clearance of 28.1 mL/min (95% confidence interval; 26.7-29.5). Azotemia was controlled in all patients (plasma urea < 30 mmol/L). During the more than 18,000 hours of treatment, there was no therapy-associated hemodynamic instability. Complications were rare. They included two cases of hemofilter rupture with minor blood loss and a single case of bleeding at the site of the vascular-access catheter. Forty-three patients survived to ICU discharge, and 40 survived to hospital discharge. Continuous venovenous hemodiafiltration is a safe and an effective form of renal replacement therapy in critically ill patients. In such patients, who have a high predicted mortality rate, it was associated with a 40% survival rate. These findings suggests that continuous venovenous hemodiafiltration may be ideally suited to patients with multisystem organ failure with acute renal failure.
-
Inhalation remains the most frequent and serious comorbid event that occurs in thermally injured patients. A thorough understanding of the pathophysiology enables individualization of therapy and appropriate triage of patients. We summarize our current knowledge of the pathophysiology, diagnosis, and treatment of inhalation injury, with a focus on newer treatment strategies that are evolving secondary to laboratory research.
-
J Intensive Care Med · Mar 1995
ReviewMedical therapy of acute myocardial infarction: Part I. Role of thrombolytic and antithrombotic therapy.
Thrombolytic therapy has been established as a safe and effective therapeutic strategy in acute myocardial infarction (MI). Its efficacy is improved with early administration, although modest benefits can be demonstrated for up to 12 hours. Tissue plasminogen activator (TPA) appears to offer benefits over streptokinase when administered to patients who present within 4 hours, those with an anterior MI, and who are less than 75 years old. ⋯ These issues and the role of newer antiplatelet and antithrombin agents are being examined in ongoing clinical trials. The objective of this review is to provide the information needed for careful and appropriate judgment in the use of thrombolytic agents and antithrombotic therapy. General principles are emphasized, and specific recommendations are included as guidelines.
-
J Intensive Care Med · Jan 1995
ReviewTreatment of hypothermia in trauma victims: thermodynamic considerations.
The relatively high specific heat of the human body makes hypothermia very difficult to treat. Although there are many treatment methods available, most evaluations of rewarming techniques are based on clinically observed rewarming rates, and they do not take into account initial core temperature, ambient temperature, the patient's own heat production, the effects of anesthesia, paralytic agents, and other variables. ⋯ A commercially available routine is used to solve the equations, which also include any heat exchange between the patient's body and the environment, as well as metabolic heat generation as a function of time and core temperature. This thermodynamic analysis of rewarming, based on computer modeling of heat transfer, provides a scientific basis on which to establish guidelines for appropriate selection of treatment strategies for hypothermia, and it indicates that direct blood warming or infusion of warm intravenous fluids are the most effective rewarming techniques.