Critical care medicine
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Critical care medicine · Feb 1995
Randomized Controlled Trial Comparative Study Clinical TrialComparison of propofol and midazolam for sedation in intensive care unit patients.
To evaluate the comparative safety and effectiveness of intravenous infusion of propofol or midazolam when used for 12 to 24 hrs of sedation and to evaluate the quality of sedation during stimulation. ⋯ Propofol was as safe and as efficacious as midazolam for continuous intravenous sedation. The quality of sedation was better in the propofol group.
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Critical care medicine · Feb 1995
Clinical Trial Controlled Clinical TrialMicrovascular function and rheologic changes in hyperdynamic sepsis.
To investigate the rheologic changes and circulatory abnormalities at the microvascular level during severe sepsis. ⋯ Reactive hyperemia in the forearm is significantly diminished in patients with sepsis, suggesting impaired microvascular blood flow. Rheologic changes, including impaired red blood cell deformability, increased leukocyte aggregation, and endothelial adherence, may contribute to this abnormality by compromising effective capillary cross-sectional area.
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Critical care medicine · Feb 1995
Multicenter Study Comparative StudyComparative assessment of pediatric intensive care: a national multicenter study. Pediatric Intensive Care Assessment of Outcome (PICASSO) Study Group.
Comparative assessment of performance of pediatric intensive care. ⋯ Differences in mortality rates among pediatric ICUs were largely explained by differences in severity of illness. High efficiency rates combined with adequate effectiveness were found in several centers, indicating that admission and discharge decisions might be improved in less efficient centers.
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To review the evolution and development of mortality risk prediction methods as they have been applied to the management of septic patients. ⋯ Severity of illness scoring systems are widely used in critically ill patients. However, their use in patients with sepsis has largely been limited to a means of stratification in clinical trials. As newer sepsis therapies become available, it may be possible to use such systems for refining their indications, and monitoring their utilization. Finally, as the databases supporting the systems increase in size and complexity, it may be possible to utilize them in clinical decision-making.
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Critical care medicine · Feb 1995
Clinical Trial Controlled Clinical TrialMethylene blue administration in septic shock: a clinical trial.
A release of nitric oxide has been incriminated in the cardiovascular alterations of septic shock. Since guanylate cyclase is the target enzyme in the endothelium-dependent relaxation mediated by nitric oxide, we studied the acute effects of methylene blue, a potent inhibitor of guanylate cyclase in patients with septic shock. ⋯ In septic shock patients, the administration of methylene blue results in a transient and reproducible increase in arterial pressure, associated with an improvement in cardiac function, but does not increase cellular oxygen availability. The significant reduction in blood lactate concentration is probably related to the reductor effect of methylene blue, rather than to an improvement in tissue oxygenation.