Critical care medicine
-
Critical care medicine · May 1996
Meta AnalysisDoes selective decontamination of the digestive tract reduce mortality for severely ill patients?
To investigate the relationship between baseline risk of death and reduced mortality after selective decontamination of the digestive tract in intensive care unit patients. ⋯ Mortality reduction from selective decontamination of the digestive tract appears related to the mortality risk of patients at the time of study entry. Future trials should consider using baseline risk assessment as part of trial design and outcome analysis.
-
Critical care medicine · May 1996
Comparative StudyNitric oxide synthase inhibition versus norepinephrine for the treatment of hyperdynamic sepsis in sheep.
To investigate the effects of Nomega-mono-methyl-L-arginine (L-NMMA), an inhibitor of nitric oxide synthesis, on hemodynamics, oxygen transport, and regional blood flow in an ovine model of hyperdynamic sepsis and to compare these effects with the responses to norepinephrine. ⋯ Blocking nitric oxide synthase had a marked vasoconstrictive effect. Both norepinephrine and L-NMMA increased arterial pressure without reducing renal blood flow, leading to an improved renal function.
-
Critical care medicine · May 1996
Accuracy and reliability of disposable pressure transducers coupled with modern pressure monitors.
To determine the bedside accuracy of direct patient pressure monitoring when used with new and clinically used disposable blood pressure (BP) transducers. ⋯ All disposable BP transducers tested were much more accurate than the American National Standards Institute standard for accuracy. Even the worst case transducers were twice as accurate as required by the American National Standards Institute standard. Only one bedside monitor was outside the +/- 2% accuracy range (103 mm Hg). Based on these findings, this author recommends that fixed calibration disposable transducers and fixed calibration bedside pressure monitoring systems be used. The clinical risks of air embolism and infection from the calibrating mercury manometer and the complexity of the calibration task are the overriding factors for making these recommendations.
-
Critical care medicine · May 1996
Randomized Controlled Trial Multicenter Study Clinical TrialAssessment of the safety and efficacy of the monoclonal anti-tumor necrosis factor antibody-fragment, MAK 195F, in patients with sepsis and septic shock: a multicenter, randomized, placebo-controlled, dose-ranging study.
To investigate the safety, biological effects, and efficacy of the anti-tumor necrosis factor (TNF) antibody fragment, MAK 195F, in a phase II trial in patient with severe sepsis. ⋯ There was no increase in survival from sepsis for the patients receiving anti-TNF treatment in the overall study population. Retrospective stratification of patients by IL-6 concentrations suggests beneficial effects of the drug for patients with baseline circulating IL-6 concentrations of > 1000 pg/mL. This hypothesis requires validation in a larger, blinded, prospective study.
-
Critical care medicine · May 1996
Multicenter StudyPRISM III: an updated Pediatric Risk of Mortality score.
The relationship between physiologic status and mortality risk should be reevaluated as new treatment protocols, therapeutic interventions, and monitoring strategies are introduced and as patient populations change. We developed and validated a third-generation pediatric physiology-based score for mortality risk, Pediatric Risk of Mortality III (PRISM III). ⋯ PRISM III resulted in several improvements over the original PRISM. Reassessment of physiologic variables and their ranges, better age adjustment for selected variables, and additional risk factors resulted in a mortality risk model that is more accurate and discriminates better. The large number of diverse ICUs in the database indicates PRISM III is more likely to be representative of United States units.