Critical care medicine
-
Critical care medicine · Feb 1995
Round table conference on clinical trials for the treatment of sepsis.
Using an evidence-based approach for a round table conference, to discuss sepsis according to its current epidemiology and clinical management, lessons which we feel can be learned by investigators from the design and conduct of previous clinical trials of drug therapy, and to describe the "optimum" clinical trials design for treatments of this syndrome. ⋯ Recommendations for the design, conduct and analysis of future trials of sepsis therapies were summarized.
-
Critical care medicine · Feb 1995
Frequency and importance of barotrauma in 100 patients with acute lung injury.
To determine the occurrence rate of barotrauma in acute lung injury patients, whether barotrauma is an independent risk factor for mortality, and the role of barotrauma in the outcome of those patients who died. ⋯ Barotrauma occurred in only 13% of patients with acute lung injury. Barotrauma was an independent marker of mortality when adjusted for other predictors of mortality. However, barotrauma directly contributed to < 2% of all deaths. We hypothesize that barotrauma is an indication of severity of acute lung injury rather than a major cause of increased mortality.
-
Critical care medicine · Feb 1995
Pre mortem analysis of lung injury and lung function in oxygen toxic rabbits.
To determine whether respiratory system mechanics measurements could detect lung injury in oxygen toxic rabbits before clinical deterioration. To determine whether respiratory system mechanics measurements, using a power analysis, have the statistical power to detect significant reductions in hyperoxic lung injury due to an intervention when compared with traditional post mortem measurements of lung injury, extravascular lung water, and bronchoalveolar lavage protein concentration. ⋯ Measurements of respiratory system mechanics can detect lung injury in hyperoxic rabbits before the onset of severe clinical deterioration or death. Furthermore, measurement of static compliance of the respiratory system is likely to be a powerful tool to detect a reduction in lung injury produced by an intervention.
-
Critical care medicine · Feb 1995
Respiratory deadspace measurements in neonates with congenital diaphragmatic hernia.
To apply the technique of respiratory deadspace measurement to consecutive infants with congenital diaphragmatic hernia, who were referred to our institution, in order to assess the efficiency of gas exchange. ⋯ Predictors of outcome in infants with congenital diaphragmatic hernia have been complicated and contradictory, particularly in the ECMO era. We demonstrated that the respiratory deadspace can be easily quantified in these infants, and that a physiologic deadspace of > 0.60 is associated with a 15-fold increase in mortality rate. We also demonstrated that in those infants treated with ECMO, the survivors manifested a significant decrease in their deadspace/tidal volume ratio before ECMO decannulation.
-
Critical care medicine · Feb 1995
Hypertonic saline-dextran resuscitation from hemorrhagic shock induces transient mixed acidosis.
To evaluate the magnitude and mechanism of potential metabolic acidosis after resuscitation with 7.5% sodium chloride/6% dextran-70. ⋯ Hypertonic saline/dextran caused an immediate, transient acidemia, which was primarily due to a hyperchloremic, hypokalemic, metabolic acidosis with normal anion gap and decreased inorganic strong ion difference, but which was partially due to a mild transient respiratory acidosis. The acidemia was transient because of the offsetting alkalotic effects of decreasing serum protein, normalization of electrolytes, and transient nature of the increase in CO2. Lactic acidosis was not the cause of the acidemia. Over time, the acid-base status appeared to be improved more effectively with hypertonic saline/dextran than with isotonic saline resuscitation.