Critical care medicine
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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.
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Critical care medicine · May 1996
Effect of human hemoglobin on systemic and regional hemodynamics in a porcine model of endotoxemic shock.
Excessive release of nitric oxide has been implicated as being an important factor contributing to systemic arterial hypotension in septic shock. Hemoglobin is an effective nitric oxide scavenger. The purpose of this study was to test the hypothesis that treatment with cross-linked human hemoglobin can ameliorate systemic arterial hypotension and improve organ perfusion in a porcine model of normodynamic endotoxemic shock. ⋯ Treatment with hemoglobin improved mean arterial pressure in endotoxemic swine without significantly impairing blood flow to the renal or mesenteric vascular beds. Infusion of hemoglobin, however, significantly exacerbated endotoxin-induced pulmonary hypertension and arterial hypoxemia. Additional pharmacologic strategies may be necessary to ameliorate the potential adverse pulmonary effects of administering hemoglobin solutions to patients with sepsis.
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Critical care medicine · May 1996
Relationship between arterial carbon dioxide and end-tidal carbon dioxide in mechanically ventilated adults with severe head trauma.
To examine the agreement and association of a noninvasive method of measuring CO2 (using end-tidal PCO2) with PaCO2 in mechanically ventilated adults with severe head trauma. ⋯ This study indicated that end-tidal PCO2 monitoring correlated well with PaCO2 in patients without respiratory complications or without spontaneous breathing, resulting in rebreathing of gases. However, its clinical validity is questionable in patients who have the greatest need for end-tidal PCO2 monitoring (i.e., patients who have respiratory distress or who are breathing spontaneously and overriding the ventilator.
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To investigate the relationship between neurologic outcome and blood glucose concentrations in survivors of cardiopulmonary arrest. ⋯ The present study does not support an association between the concentration of glucose post-CPR and neurologic outcome. The previously reported casual relationship between hyperglycemia and neurologic prognosis may be an epiphenomenon of the severity of global cerebral ischemia in humans.
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Critical care medicine · May 1996
Risk factors for nosocomial infection in critically ill children: a prospective cohort study.
To identify factors in pediatric intensive care unit (ICU) patients that are associated with an increased risk of nosocomial infections. ⋯ Patients at risk for developing nosocomial infection can be identified using a multivariate logistic regression model with a high degree of sensitivity and specificity. These data indicate that institutional nosocomial rates need to be adjusted for risk factors. This model could help target patients at high risk for developing nosocomial infections for preventive strategies.