Critical care medicine
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Critical care medicine · Jan 1995
Randomized Controlled Trial Clinical TrialPretreatment of normal humans with monophosphoryl lipid A induces tolerance to endotoxin: a prospective, double-blind, randomized, controlled trial.
Endotoxin is one of the principal mediators of Gram-negative septic shock. Pretreatment with monophosphoryl lipid A, a hydrolyzed derivative of endotoxin from Salmonella minnesota R595, induces endotoxin tolerance and nonspecific resistance to infection in experimental animals. The present clinical trial was undertaken to test the response to monophosphoryl lipid A in humans and the ability of monophosphoryl lipid A to attenuate the response of normal human volunteers to U.S. Reference Ec-5 endotoxin. ⋯ Data indicate that monophosphoryl lipid A, in a dose 10,000 times that of endotoxin, used in experimental pyrogenicity trials, is well tolerated in human volunteers. Pretreatment of normal human volunteers with monophosphoryl lipid A attenuated the systemic response to bacterial endotoxin. These data support further clinical testing of monophosphoryl lipid A for the prevention or amelioration of the severe sequelae of sepsis.
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Critical care medicine · Jan 1995
Randomized Controlled Trial Clinical TrialFemoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial.
To determine the frequency of central venous catheter-induced deep vein thrombosis of the femoral vein. ⋯ Based on the data from this study, we concluded that femoral vein catheterization is associated with a 25% frequency of lower extremity deep vein thrombosis compared with similar patients receiving subclavian or internal jugular vein catheters. The femoral vein remains an important emergency venous access route. Physicians inserting femoral vein catheters should be aware of the risk of lower extremity deep vein thrombosis and should consider performing lower extremity duplex ultrasound examinations on removal of femoral vein catheters.
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Critical care medicine · Jan 1995
Case ReportsCirculating interleukin-1 receptor antagonist concentrations are increased in adult patients with thermal injury.
To investigate the balance between circulating concentrations of interleukin (IL)-1 and its natural inhibitor interleukin-1 receptor antagonist (IL-1Ra) in human inflammation. ⋯ Thermal injury causes an increase of circulating IL-1Ra, especially in patients with inhalation injuries. With the current plasma assays for IL-1 beta, IL-1Ra may be a more sensitive marker of human inflammation than IL-1 beta or TNF-alpha.
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Critical care medicine · Jan 1995
Colloid infusion after brain injury: effect on intracranial pressure, cerebral blood flow, and oxygen delivery.
We sought to determine the effects of colloid osmotic pressure on cerebral edema formation after brain injury. We hypothesized that an increase in plasma oncotic pressure accompanying a colloid infusion would be associated with a decrease in intracranial pressure and increases in cerebral blood flow and oxygen delivery when compared with isotonic crystalloid. ⋯ Colloid infusion after a focal cryogenic injury does not increase cerebral oxygen delivery or reduce either cerebral edema formation or intracranial pressure when compared with lactated Ringer's solution. Colloid is not superior to isotonic crystalloid in the management of isolated brain injury.
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Critical care medicine · Jan 1995
Prediction of outcome in intensive care patients using endocrine parameters.
To determine the ability of various endocrine parameters, measured at the time of intensive care unit (ICU) admission, to predict patient outcome. ⋯ An endocrine prognostic index based on ICU admission measurements of thyroxine, thyrotropin, and cortisol concentrations is a superior discriminator of patient outcome than the APACHE II score.