Critical care medicine
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Critical care medicine · Feb 1993
ReviewAdoptive immunotherapy of gram-negative sepsis: use of monoclonal antibodies to lipopolysaccharide.
To provide a succinct overview of the scientific rationale for adoptive immunotherapy of Gram-negative sepsis using antibodies directed at epitopes in the core region of the lipopolysaccharide molecule. ⋯ Adoptive immunotherapy using monoclonal anticore antibodies seems to improve survival rate in selected patients with Gram-negative sepsis. Nevertheless, because of concerns about costs and the interpretation of the results from the completed clinical trials, these new agents have generated enormous controversy. The precise role of adoptive immunotherapy against lipopolysaccharide in the practice of critical care medicine in the United States remains unclear.
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To provide an overview of the splanchnic hemodynamic response to circulatory shock. ⋯ While angiotensin II has been viewed primarily as the mediator responsible for the increased total vascular resistance seen during (and after) cardiopulmonary bypass, it may also cause the disproportionate decrease in mesenteric perfusion, as measured in human subjects by intraluminal gastric tonometry and galactose clearance by the liver, as well as the consequent development of the multiple organ failure syndrome seen in 1% to 5% of patients after cardiac surgery.
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Critical care medicine · Feb 1993
High-frequency oscillatory ventilation in pediatric respiratory failure.
To evaluate the safety and effectiveness of high-frequency oscillatory ventilation using a protocol designed to achieve and maintain optimal lung volume in pediatric patients with respiratory failure. ⋯ High-frequency oscillatory ventilation, using a high-volume strategy, may be used safely and effectively in pediatric patients with respiratory failure and with high predicted mortality rates. High mean airway pressure during oscillatory ventilation does not appear to compromise DO2. Whether this technique can alter morbidity or mortality rates in this population awaits prospective randomized study.
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Critical care medicine · Feb 1993
Physiologic response of stress and aminoglycoside clearance in critically ill patients.
To examine the relationships between aminoglycoside clearance and physiologic parameters associated with the physiologic response to injury. ⋯ Along with renal function estimates, the physiologic response to stress should be considered when treating critically ill patients with aminoglycosides and other, similar, renally eliminated drugs.
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Critical care medicine · Feb 1993
Increased serum concentrations of procollagen type III peptide in severely injured patients: an indicator of fibrosing activity?
To determine the serum concentrations of procollagen type III peptide in severely injured patients with different outcomes and to evaluate the relationship between serum procollagen type III peptide concentrations, sources of increased posttraumatic fibrotic activity (wounds, lung, liver, kidney), and decreased elimination of procollagen type III peptide (liver). ⋯ Serum procollagen type III peptide concentrations in severely injured patients may be considerably increased in correlation with injury severity and outcome. Procollagen type III peptide serum concentrations seem to reflect the sum of increased collagen formation from wound healing and fibrogenesis of mediator-related organ damage (especially lung) and decreased procollagen type III peptide excretion due to impaired liver function. Further data are necessary to evaluate the role of hepatic elimination in these patients.