Journal of critical care
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Journal of critical care · Mar 2001
Accuracy of predictions of survival at admission to the intensive care unit.
The purpose of this study was to compare the accuracy of outcome predictions made on the day of intensive care unit (ICU) admission by critical care physicians, critical care fellows, and primary team physicians. ⋯ ICU attendings predicted most accurately and consistently the final outcome of patients, and ICU fellows estimated outcome more reliably than the primary service. For the most part, the primary service tended to overestimate the probability of favorable outcome of patients for whom ICU admission had been requested. Additionally, clinical accuracy of survival or mortality was best for those patients at the extremes of clinical compromise: this point seems to confirm the validity of using clinical judgement as a guide to restricting ICU resources for those severely compromised or mildly compromised.This study also indicates that predictions of outcome in critically ill patients made within days of admission are statistically valid but not sufficiently reliable to justify irrevocable clinical decisions at present.
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Journal of critical care · Mar 2001
Comparative StudyEffects of isoflurane, enflurane, and halothane on skeletal muscle microcirculation in the endotoxemic rat.
The cardiovascular effects of volatile anesthetics during sepsis sets patients at high risk for hemodynamic deterioration. We compared the microcirculatory alterations in skeletal muscle under anesthesia with isoflurane, enflurane, and halothane in an endotoxemic rat preparation. ⋯ Isoflurane, enflurane, and halothane exert significantly different effects on vasoregulation of skeletal muscle arterioles in the endotoxemic rat.
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Journal of critical care · Mar 2001
L-canavanine, a selective inhibitor of inducible NO synthase, increases plasma endothelin-1 concentrations in dogs with endotoxic shock.
The purpose of this article is to elucidate the effect of L-canavanine, a selective inhibitor of inducible NO synthase (iNOS), on hemodynamics, blood gas parameters, and plasma concentrations of lactate and endothelin-1 (ET-1) during endotoxic shock. ⋯ This study suggests that L-canavanine induces tissue hypoperfusion and ischemia with concomitant hypersecretion of ET-1 in dogs with endotoxic shock.
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Journal of critical care · Mar 2001
Activation of alveolar phospholipase A2 after hydrochloric acid aspiration in rats.
The present study was carried out to determine phospholipase A2 (PLA2) activity in the bronchoalveolar lavage fluid (BALF) in rats subjected to HCI aspiration. ⋯ There is an increase in the alveolar LM-PLA2 at inflammatory phase after HCI aspiration, suggesting the pathophysiologic role of LM-PLA2 in the acute lung injury.
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Journal of critical care · Mar 2001
Randomized Controlled Trial Clinical TrialNutritional deficiencies and blunted erythropoietin response as causes of the anemia of critical illness.
The purpose of this article was to determine the prevalence of iron, vitamin B12, and folate deficiency and to evaluate the erythropoietin (EPO) response to anemia in a cohort of long-term intensive care unit (ICU) patients. ⋯ In this cohort, screening for iron, B12, and folate deficiency identified potentially correctable abnormalities in more than 13% of patients and should be considered in those who are anticipated to have long ICU stays. Even at an early point of critical illness, most patients had iron studies consistent with anemia of chronic disease (ACD), as well as a blunted EPO response that may contribute to this ACD-like anemia of critical illness.