Critical care medicine
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Critical care medicine · Dec 1993
Randomized Controlled Trial Multicenter Study Clinical TrialImpact of multiple risk factors and ranitidine prophylaxis on the development of stress-related upper gastrointestinal bleeding: a prospective, multicenter, double-blind, randomized trial. The Ranitidine Head Injury Study Group.
To evaluate the impact of risk factors on the development of stress-related upper gastrointestinal bleeding in severe head injury patients randomized to treatment with a 6.25 mg/hr continuous ranitidine infusion or placebo. ⋯ The full risk to develop stress-related upper gastrointestinal bleeding was realized when two risk factors were present concomitantly. The presence of additional risk factors did not increase the occurrence of bleeding. A continuous infusion of ranitidine at 6.25 mg/hr provided significant protection from bleeding, regardless of the number of risk factors present.
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Critical care medicine · Dec 1993
Comparative StudyControl and variability of gastric pH in critically ill children.
To determine the effect of illness severity and acute central nervous system injury on the control and variability of gastric pH in pediatric intensive care unit (ICU) patients receiving ranitidine. ⋯ a) Continuous infusion of ranitidine decreases variability of gastric pH in pediatric ICU patients; b) gastric pH variability may make intermittent monitoring of gastric pH inaccurate; c) children with acute central nervous system injury or PRISM scores of > or = 20 have poor control of gastric pH; d) type of injury and PRISM scores predict response to ranitidine therapy.
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Critical care medicine · Dec 1993
Multicenter Study Clinical TrialPrognostic value of the dobutamine test in patients with sepsis syndrome and normal lactate values: a prospective, multicenter study.
To determine the oxygen supply (DO2) and uptake (VO2) responses to a 60-min dobutamine infusion in critically ill septic patients without circulatory shock and with normal blood lactate concentrations. Also, to determine whether these responses would predict outcome. ⋯ Most of these septic patients without shock or hyperlactatemia responded to dobutamine infusion in one of two ways: with little increase in DO2 and no increase in VO2, or with significant increases in both DO2 and VO2. The latter response is typical of healthy volunteers given dobutamine. Because of the calorigenic effect of dobutamine, our results imply nothing about the presence or absence of oxygen supply limitation. Still, patients who had increases in DO2 and VO2 had a much higher survival rate than patients who did not. We speculate that the inability of some patients to respond to dobutamine and the associated higher mortality rate may be related to beta-adrenoreceptor dysfunction.
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Critical care medicine · Dec 1993
Comparative Study Clinical TrialRespiratory deadspace measurements in neonates during extracorporeal membrane oxygenation.
To evaluate the bias and precision of a simple, bedside method of quantification of minute CO2 production (study 1) and then apply the technique to measure physiologic deadspace in a group of neonates undergoing extracorporeal membrane oxygenation (ECMO) (study 2). ⋯ Minute CO2 production can be measured simply and accurately, using equipment readily available in most ICU settings. The same method can be utilized to calculate the deadspace/tidal volume ratio, which provides valuable information regarding the gas exchanging efficiency of the neonatal lung during ECMO.
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Critical care medicine · Dec 1993
Comparative StudyRelationship of burn-induced lung lipid peroxidation on the degree of injury after smoke inhalation and a body burn.
We compared the effect of a modest smoke inhalation injury, a burn injury alone, and a smoke inhalation injury plus a body burn, on the degree of lung oxidant-induced lipid peroxidation and lung injury. ⋯ We conclude that alveolar capillary permeability is not increased early after a moderate smoke injury or smoke injury with burn. Lipid peroxidation is not increased in large airway or lung parenchyma with early after-smoke exposure. The addition of a burn significantly increases lung parenchymal lipid peroxidation, but the oxidant changes do not correspond with the degree of early lung dysfunction.