Critical care medicine
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Critical care medicine · Nov 1994
Effect of ventilation on acid-base balance and oxygenation in low blood-flow states.
To investigate how minute ventilation affects the partial pressure of end-tidal CO2 and arterial and mixed venous pH, PCO2, PO2, and the concentration of bicarbonate during low blood-flow states. We tested the null hypothesis that acid-base conditions during low rates of blood flow are not significantly different when minute ventilation is doubled or halved. ⋯ During low rates of blood flow similar to those rates found in shock and cardiopulmonary resuscitation, alterations in minute ventilation significantly influenced end-tidal CO2 and both arterial and mixed venous pH and PCO2. These findings may have clinical importance in improving the treatment of shock and cardiac arrest.
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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.
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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 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.