Journal of critical care
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Journal of critical care · Dec 1995
Multicenter Study Comparative Study Clinical TrialThe influence of clinical study design on cost-effectiveness projections for the treatment of gram-negative sepsis with human anti-endotoxin antibody.
This study was performed to compare the effect of entry criteria, patient population, and study design on outcome and projected cost-effectiveness of human anti-endotoxin antibody (HA-1A). ⋯ Extrapolating cost-effectiveness from RCT-derived analyses to open-label usage may yield widely inaccurate projections because of only small differences in patient population and the drug administration protocol.
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The effective treatment of sepsis and septic shock has remained elusive despite intense research efforts. The tools of molecular biology have been applied to the problem of sepsis in an attempt to design more rational, directed therapy. Cellular interactions with invading microorganisms begin a series of stimulation events within the cell. ⋯ The measurement of cytokines is critically important to our understanding of their role in health and disease. Cytokines may be measured by either immunologic methods or biological assays. Molecular biology has made important contributions to our understanding of sepsis by precisely identifying some of the mediators and providing reagents for therapeutic use.
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Although pyruvate supplementation enhances endurance in humans and increases cardiac output in dogs, its effects on cardiac and peripheral vascular function are not known. Thus, we assessed the cardiovascular effects of pyruvate infusion. ⋯ We conclude that pyruvate infusion in normal dogs induces venodilation but does not alter either cardiac contractility or arterial tone.
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Journal of critical care · Sep 1995
Inspiratory tidal volume sparing effects of tracheal gas insufflation in dogs with oleic acid-induced lung injury.
Tracheal gas insufflation (TGI) improves the efficiency of conventional mechanical ventilation (CMV) by reducing the series dead space of the airways. Consequently, application of TGI as an adjunct to CMV may permit reducing tidal volume (VT) while limiting CO2 retention. We tested the extent to which panexpiratory TGI allows reduction of VT while maintaining PaCO2 constant in an oleic acid-induced lung injury model. ⋯ We conclude that TGI can be a useful adjunct to CMV during acute lung injury to limit VT while avoiding CO2 retention.
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The high mortality associated with sepsis syndrome and multiple organ dysfunction syndrome has persisted despite extraordinary research efforts in the laboratory and the intensive care unit. These syndromes produce systemic tissue damage that is likely to result from widespread inflammation and subsequent endothelial injury. ⋯ As a result of systemic inflammation and nonmetabolic oxygen use, oxidative stress may occur both outside and inside the cell. The consequences of these oxidative processes during sepsis may be ongoing cell damage mediated by reactive oxygen and nitrogen oxide species that culminates in multisystem organ failure.