Critical care medicine
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Critical care medicine · Nov 1993
Randomized Controlled Trial Comparative Study Clinical TrialA double-blind, prospective, randomized trial of ketoconazole, a thromboxane synthetase inhibitor, in the prophylaxis of the adult respiratory distress syndrome.
To determine if ketoconazole, a thromboxane A2 synthetase inhibitor, given within the first 24 hrs after diagnosis and arrival in the intensive care unit (ICU) would decrease the frequency of adult respiratory distress syndrome in the septic patient population. ⋯ Ketoconazole (400 mg through the gastrointestinal tract) given early in the septic course may prevent ARDS and decrease the mortality rate in high-risk, septic patients.
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Critical care medicine · Nov 1993
Comparative StudyMultiple organ failure in patients with thermal injury.
To assess the frequency and significance of multiple organ failure in patients with burn injuries. ⋯ Multiple organ failure was almost invariably present in burn patients who died > 72 hrs after injury. Burn victims, who have been excluded from reviews of multiple organ failure, appear to manifest organ failure in a manner similar to that of other surgical populations. The scoring system reported here may prove useful in evaluating organ failure in thermally injured patients.
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Critical care medicine · Nov 1993
Comparative StudyDecreased mortality rate and length of hospital stay in surgical intensive care unit patients with successful selective decontamination of the gut.
Current studies concerning selective decontamination of the digestive tract have failed to demonstrate a decrease in the length of hospital stay and mortality rate, despite the finding of a significantly lower number of infections. To evaluate this issue in more detail, the relationship between the mortality rate and length of stay with respect to colonization and infections was studied within a group of patients receiving selective decontamination. Special attention was given to the efficacy of decontamination within each patient. The main question addressed was whether an effect on mortality rate was present, and if so, why this effect was not apparent until now. ⋯ These results indicate that selective decontamination is beneficial in terms of mortality rate and length of stay in surgical patients only when successful decontamination has been achieved. The subgroup of patients for whom decontamination is not successful might be responsible for the obscurity in mortality effects of selective decontamination in studies until now. It is expected that identification and subsequent elimination of possible risk factors that cause a failure of selective decontamination can result in lower morbidity and mortality rates in critically ill, surgical patients admitted to the ICU.
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Critical care medicine · Nov 1993
Comparative Study Clinical TrialRelationship between oxygen uptake and oxygen delivery in septic patients: effects of prostacyclin versus dobutamine.
To compare the effects of prostacyclin (PGI2) and dobutamine on the relationship between oxygen delivery (DO2) and oxygen uptake (VO2) in stable septic patients. ⋯ PGI2 and dobutamine at the doses used have similar effects on oxygen extraction in critically ill, septic patients, but dobutamine increases DO2 more consistently and is better tolerated than prostacyclin.