Critical care medicine
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Critical care medicine · Aug 1996
Randomized Controlled Trial Comparative Study Clinical TrialPolysomnography after adenotonsillectomy in mild pediatric obstructive sleep apnea.
a) To determine the need for intensive monitoring on the first operative night of surgery in children undergoing adenotonsillectomy for mild obstructive sleep apnea; b) to examine the effect of narcotics on postoperative obstructive sleep apnea. ⋯ Our data suggest that children without underlying medical conditions, neuromotor diseases, or carniofacial abnormalities, 1 to 18 yrs of age, who suffer from mild obstructive sleep apnea, have improvements documented by polysomnography on the night of surgery following adenotonsillectomy and do not necessarily need to be monitored intensively. These findings were not significantly affected by the choice of intraoperative anesthetic.
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Critical care medicine · Aug 1996
Randomized Controlled Trial Clinical TrialPerioperative endotoxemia and bacterial translocation during major abdominal surgery: evidence for the protective effect of endogenous prostacyclin?
To investigate the potential role of endogenous prostacyclin (PGI2) released after mesenteric traction during major abdominal surgery on perioperative endotoxemia and bacterial translocation. ⋯ In ibuprofen-pretreated patients, significantly higher endotoxin concentrations as well as bacterial translocation to mesenteric lymph nodes occurred, despite the absence of a transient decrease in mean arterial pressure that had been associated with PGI2 release. Therefore, we hypothesized that during major abdominal surgery, endogenous PGI2 released in response to mesenteric traction may play a crucial role in maintaining splanchnic microcirculation and thus preserving gut mucosal barrier function.
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Critical care medicine · Aug 1996
Multicenter Study Comparative StudyComparative assessment of pediatric intensive care in Moscow, the Russian Federation: a prospective, multicenter study.
Comparative assessment of pediatric intensive care. ⋯ We provided a quantitative description and assessment of pediatric intensive care in Moscow. Moderate efficiency may reflect a low threshold for ICU admission due to poor nurse/patient ratios on the wards. Effectiveness in the low- and medium-risk strata is below standard, as compared with a Western reference population. Excess mortality was concentrated in the low- and medium-risk strata, and can only partially be explained by the inclusion of co-morbidity. Future analysis should focus on specific treatment protocols, protocol adherence, and the determination of infectious and therapeutic complications.
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Critical care medicine · Aug 1996
Comparative Study Clinical Trial Controlled Clinical TrialNuclear factor-kappa B is activated in alveolar macrophages from patients with acute respiratory distress syndrome.
The expression of proinflammatory cytokines is rapidly increased in experimental models of the acute respiratory distress syndrome (ARDS), in patients at risk for ARDS, and in patients with established ARDS. Because multiple cytokines are present in bronchoalveolar lavage fluid, a common, proximal activation mechanism may operate in these settings. The proinflammatory cytokines whose expression is increased in the lungs of patients with ARDS have binding sequences in their enhancer/promoter regions for transcriptional regulatory proteins, such as nuclear factor-kappa B (NF-kappa B), nuclear factor-IL6 (NF-IL6), cyclic adenosine monophosphate responsive element binding protein, serum protein-1, and activating protein-1. To test the hypothesis that activation of one or more of these nuclear transcriptional regulatory factors might provide a common mechanism for the simultaneous expression of multiple cytokine genes in the setting of ARDS, we measured activation of these factors in alveolar macrophages from patients with ARDS and from controls. ⋯ These experiments demonstrated increased in vivo activation of the nuclear transcriptional regulatory factor NF-kappa B (but not NF-IL6, cyclic adenosine monophosphate responsive element binding protein, activating protein-1, or serum protein-1) in alveolar macrophages from patients with ARDS. Because binding sequences for NF-kappa B are present in the enhancer/promoter sequences of multiple proinflammatory cytokines, activation of NF-kappa B may contribute to the increased expression of multiple cytokines in the lung in the setting of established ARDS.
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Critical care medicine · Aug 1996
Randomized Controlled Trial Clinical TrialN-acetyl-L-cysteine depresses cardiac performance in patients with septic shock.
To investigate the effects of adjunctive therapy with parenteral N-acetyl-L-cysteine in patients with newly diagnosed septic shock. ⋯ Adjunctive therapy with N-acetyl-L-cysteine in newly diagnosed septic shock was associated with a depression in cardiovascular performance, as indicated by progressive reductions in cardiac index, left ventricular stroke work index, and MAP.