Critical care medicine
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Critical care medicine · Nov 1994
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialPlatelet-activating factor receptor antagonist BN 52021 in the treatment of severe sepsis: a randomized, double-blind, placebo-controlled, multicenter clinical trial. BN 52021 Sepsis Study Group.
To evaluate the safety and efficacy of a natural platelet-activating factor receptor antagonist, BN 52021 (Ginkgolide B), in the treatment of patients with sepsis syndrome. ⋯ The studied platelet-activating factor receptor antagonist (BN 52021) seems to be a safe and promising treatment for patients with severe Gram-negative sepsis.
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Critical care medicine · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialPreservation of humidity and heat of respiratory gases in patients with a minute ventilation greater than 10 L/min.
To compare the temperature and humidification output of one heated humidifier system (Bennett Cascade 2 Humidifier) and two heat and moisture exchangers (Pall Ultipor, BB 50, and Humid-Vent Filter) in intensive care unit (ICU) patients submitted to a minute ventilation of > 10 L/min. ⋯ In patients with a minute ventilation of > 10 L/min (> 10.5 to 16.0 L/min), the Humid-Vent Filter had a temperature and humidification output close to the reference system (the Bennett Cascade 2 Humidifier). The Pall Ultipor Filter had a significantly lower temperature and humidification output in these patients.
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Critical care medicine · Nov 1994
Noninvasive monitoring of end-tidal CO2 via nasal cannulas in spontaneously breathing children during the perioperative period.
To determine the correlation between end-tidal CO2 and PaCO2 values measured via nasal cannulas in spontaneously breathing children during the perioperative period. ⋯ End-tidal CO2 measurement by infrared spectroscopy provided an accurate estimation of PaCO2 in this patient population. Its use may limit the need for invasive monitoring and/or repeated arterial blood gas analysis.
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Critical care medicine · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialInfluence of N-acetylcysteine on indirect indicators of tissue oxygenation in septic shock patients: results from a prospective, randomized, double-blind study.
Deactivation of endothelium-derived relaxing factor due to an increased oxygen radical load during sepsis may contribute to an impairment in microcirculatory blood flow. We investigated whether treatment with the sulfhydryl donor and oxygen radical scavenger, N-acetylcysteine, would improve whole-body oxygen consumption (VO2), gastric intramucosal pH, and veno-arterial CO2 gradient (veno-arterial PCO2) during septic shock. ⋯ N-acetylcysteine provided a transient improvement in tissue oxygenation in about half of the septic shock patients, as indicated by an increase in VO2 and gastric intramucosal pH and a decrease in veno-arterial PCO2. The higher survival rate in the N-acetylcysteine responders and the fact that half of the patients receiving N-acetylcysteine did not respond, suggests that, in some patients, sepsis irreversibly damages the microvasculature to the extent that N-acetylcysteine has no effect. If analyzed by intention to treat, the N-acetylcysteine did not produce effects that were significantly different from the placebo. Whether the N-acetylcysteine challenge was merely diagnostic or whether N-acetylcysteine can be effective in the treatment of sepsis deserves further investigation.
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Critical care medicine · Nov 1994
Randomized Controlled Trial Comparative Study Clinical TrialA prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management.
To compare the safety of a conventional polyurethane transparent dressing and a novel highly permeable polyurethane dressing, as compared with standard gauze and tape, as site dressings for pulmonary artery catheters; and to rigorously determine the sources of bloodstream infections deriving from these catheters. ⋯ The incidence of pulmonary artery catheter-related bloodstream infection has decreased over the past 5 yrs. Pulmonary artery catheter-related bloodstream infections originate from multiple sources, indicating that measures to prevent bacteremic infections of these devices must focus both on reducing cutaneous colonization at the insertion site and averting contamination of infusate and catheter hubs. Efforts should be made to limit the duration of catheterization with pulmonary artery catheters (including the introducer) to no longer than 4 days. The polyurethane dressings studied appear to be safe for use with pulmonary artery catheters and may be left on for up to 5 days between dressing changes.