Critical care medicine
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Critical care medicine · Sep 1997
Randomized Controlled Trial Multicenter Study Clinical TrialEarly postoperative enteral immunonutrition: clinical outcome and cost-comparison analysis in surgical patients.
To determine if early postoperative feeding of patients with upper gastrointestinal malignancy, using an enteral diet supplemented with arginine, dietary nucleotides, and omega-3 fatty acids (IMPACT, Sandoz Nutrition, Bern, Switzerland) results in an improved clinical outcome, i.e., reduced infectious and wound complications and decreased treatment costs when compared with an isocaloric, isonitrogenous control diet. ⋯ Early enteral feeding with an arginine, dietary nucleotides, and omega-3 fatty acids supplemented diet, as well as an isonitrogenous, isocaloric control diet (placebo) were well tolerated in patients who underwent upper gastrointestinal surgery. In patients who received the supplemented diet, a significant reduction in the frequency rate of late postoperative infectious and wound complications was observed. Thereby, the treatment costs were substantially reduced in the immunonutrition group as compared with the control group.
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Critical care medicine · Sep 1997
Case Reports Clinical Trial Controlled Clinical TrialInitial evaluation of diaspirin cross-linked hemoglobin (DCLHb) as a vasopressor in critically ill patients.
To evaluate the hemodynamic effects and any toxicologic effects of diaspirin cross-linked hemoglobin (DCLHb) in critically ill patients. ⋯ This preliminary study demonstrated that diaspirin cross-linked hemoglobin is a potent vasopressor agent in critically ill patients with septicemic shock or systemic inflammatory response syndrome. This vasopressor characteristic of diaspirin cross-linked hemoglobin may have future clinical applications.
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Critical care medicine · Sep 1997
Circulating methemoglobin and nitrite/nitrate concentrations as indicators of nitric oxide overproduction in critically ill children with septic shock.
To examine the relationship between circulating methemoglobin and nitrite/nitrate concentrations and to compare these markers of nitric oxide overproduction with clinical variables in children diagnosed with septic shock. ⋯ Circulating methemoglobin and nitrite/nitrate concentrations are increased in children diagnosed with septic shock. Plasma nitrite/nitrate values correlate with selected clinical variables in these children. Circulating methemoglobin measurements are not superior to plasma nitrite/nitrate concentrations as an indicator of endogenous overproduction of nitric oxide in children diagnosed with septic shock. A need remains to develop markers of endogenous nitric oxide activity that have greater accuracy and reliability.
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Critical care medicine · Sep 1997
Increased plasma concentrations of serum amyloid A: an indicator of the acute-phase response after cardiopulmonary bypass.
To assess the expression of mixed and hepatic venous serum amyloid A (SAA) concentrations and its relationship to plasma concentrations of C-reactive protein, interleukin-6 (IL-6), and endotoxin during and after cardiopulmonary bypass (CPB). ⋯ SAA is an additional and sensitive marker of the acute-phase response following CPB; the increase in SAA concentrations parallels the temporary increase in body core temperature and is preceded by endotoxemia and IL-6 secretion.