Critical care medicine
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Critical care medicine · Feb 1993
Randomized Controlled Trial Multicenter Study Clinical TrialDetrimental effects of high-dose methylprednisolone sodium succinate on serum concentrations of hepatic and renal function indicators in severe sepsis and septic shock. The Methylprednisolone Severe Sepsis Study Group.
To evaluate the effects of high-dose methylprednisolone sodium succinate on biochemical markers of hepatic and renal function in patients with severe sepsis and septic shock. ⋯ The frequency of acutely increased blood urea nitrogen and bilirubin concentrations in severe sepsis was increased significantly with high-dose methylprednisolone therapy. Similar frequencies of circulatory shock in the study groups excluded differences in global perfusion as a cause of this phenomenon. Possible adverse effects of pharmacologic concentrations of methylprednisolone in critically ill patients should be considered in planning treatment.
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Critical care medicine · Feb 1993
Comparative StudyImposed work of breathing and methods of triggering a demand-flow, continuous positive airway pressure system.
To compare the inspiratory imposed work of breathing during spontaneous ventilation with continuous positive airway pressure using three methods of triggering "ON" the demand-flow system of a ventilator: a) conventional pressure triggering with the pressure measuring/triggering site inside the ventilator on the exhalation limb of the breathing circuit; b) tracheal pressure triggering from the tracheal or carinal end of the endotracheal tube; and c) flow-by (flow triggered) triggering. ⋯ An endotracheal tube is a resistor in the breathing apparatus over which a pressure decrease must be developed by the patient in order to inhale spontaneously. An endotracheal tube, therefore, imposes substantial resistance and work. The results indicate that the pressure measuring/triggering site for a ventilator's demand-flow system should be at the tracheal or carinal end of an endotracheal tube so as to effectively decrease the resistance of the endotracheal tube, thus, decreasing the patient's work of breathing.
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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
Association of hypomagnesemia and mortality in acutely ill medical patients.
To test the hypothesis that the mortality rate of acutely ill patients admitted to a medical ward or medical ICU is higher for those patients who present with hypomagnesemia than for those patients who do not present with hypomagnesemia. ⋯ Hypomagnesemia detected at the time of admission of acutely ill medical patients is associated with an increased mortality rate for both ward and medical ICU patients.
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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.