Critical care medicine
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Critical care medicine · May 1997
Relationship between hemodynamic and vital support measures and pharmacokinetic variability of amikacin in critically ill patients with sepsis.
To examine the relationship between aminoglycoside disposition kinetics and hemodynamic response to sepsis, as well as vital support therapy, in critically ill patients with sepsis. ⋯ Factors related to hemodynamic response and vital support measures have a significant influence on the disposition kinetics of amikacin in severely ill patients with sepsis. Consideration of hemodynamic response and vital support measures, in addition to other previously described covariates, can be of great value in the design of initial dosing regimens.
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Critical care medicine · May 1997
Comparative StudyTransfusing red blood cells stored in citrate phosphate dextrose adenine-1 for 28 days fails to improve tissue oxygenation in rats.
To determine whether the time that red blood cells are stored in citrate phosphate dextrose adenine-1 solution before transfusion alters the ability to improve tissue oxygenation. ⋯ Storage of rat red blood cells for 28 days in citrate phosphate dextrose adenine-1 impaired their ability to improve tissue oxygenation when transfused into either control or septic rats placed into supply dependency of systemic VO2.
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Critical care medicine · May 1997
Positive end-expiratory pressure increases pulmonary venous vascular resistance in patients after coronary artery surgery.
To investigate the effect of positive and-expiratory pressure (PEEP) on the longitudinal distribution of pulmonary vascular resistance in patients immediately after coronary artery bypass grafting. ⋯ PEEP increases pulmonary vascular resistance solely by increasing pulmonary venous resistance. When applying PEEP, changes in pulmonary vascular resistance may impede the resorption of pulmonary edema fluid.
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Critical care medicine · May 1997
Comparative StudyThe endothelin receptor antagonist, bosentan, in combination with the cyclooxygenase inhibitor, diclofenac, counteracts pulmonary hypertension in porcine endotoxin shock.
To prevent endotoxin-induced pulmonary hypertension in the pig with a combination of a nonpeptide mixed endothelin receptor antagonist, bosentan, and a cyclooxygenase inhibitor, diclofenac. ⋯ The combination of bosentan and diclofenac induced systemic and pulmonary vasodilation in the intrinsic state. During endotoxin shock, this drug combination efficiently counteracts pulmonary hypertension and improves cardiac performance and splenic and renal blood flow. These favorable circulatory effects may have resulted in a reduction of both sympathetic nervous system activation and metabolic acidosis. Thus, we conclude that the endothelin receptors participate in intrinsic regulation of vascular tone in the anesthetized pig. During endotoxin shock, blockade of these receptors, as well as inhibition of the cyclooxygenase enzymes, contributes to a less adverse effect on the systemic and pulmonary circulation.
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Critical care medicine · May 1997
Assessing the impact of patient characteristics and process performance on rural intensive care unit hospital mortality rates.
To examine the relationship between patient characteristics, processes of care, and risk of hospital mortality in rural intensive care units (ICU). ⋯ Most of the variation in mortality was explained by differences in patient physiologic and demographic characteristics at ICU admission. After adjusting for patient characteristics, better performance in some processes of care would have significant impact on reducing risk of mortality.