Critical care medicine
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Critical care medicine · Oct 1998
Randomized Controlled Trial Clinical TrialHelium-oxygen improves Clinical Asthma Scores in children with acute bronchiolitis.
To determine the efficacy of a helium-oxygen mixture in children admitted to the pediatric intensive care unit with acute respiratory syncytial virus (RSV) bronchiolitis. ⋯ Inhaled helium-oxygen improves the overall respiratory status of children with acute RSV lower respiratory tract infection. In patients with mild-to-moderate bronchiolitis (Clinical Asthma Scores of <6), the beneficial effects of helium-oxygen were most pronounced in children with the greatest degree of respiratory compromise.
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Critical care medicine · Oct 1998
Randomized Controlled Trial Clinical TrialEffect of a chimeric antibody to tumor necrosis factor-alpha on cytokine and physiologic responses in patients with severe sepsis--a randomized, clinical trial.
Tumor necrosis factor (TNF)-alpha appears central to the pathogenesis of severe sepsis, but aspects of the cytokine cascade and the link to physiologic responses are poorly defined. We hypothesized that a monoclonal antibody to TNF-alpha given early in the course of severe sepsis would modify the pattern of systemic cytokine release and, as a consequence, resuscitation fluid requirements, net proteolysis, and hypermetabolism would be reduced. ⋯ A single dose of cA2 did not alter the overall pattern of cytokine activation or the profound derangements in physiologic function that accompany severe sepsis.
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Critical care medicine · Oct 1998
Randomized Controlled Trial Clinical TrialInfluence of angiotensin-converting enzyme inhibitor enalaprilat on endothelial-derived substances in the critically ill.
To assess the effects of the angiotensin-converting enzyme inhibitor enalaprilat on endothelial cells in septic patients. ⋯ The complex pathogenesis of endothelial function abnormalities in sepsis may offer a large number of pharmacologic interventions. Administration of the angiotensin-converting enzyme inhibitor enalaprilat resulted in a reduced release of soluble endothelial-derived substances into the circulating blood, which may indicate an improved endothelial function. The specific actions of enalaprilat on the endothelium have to be elucidated in further studies.
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To review current knowledge about the effects of vasoactive agents on gastric intramucosal pH (pHi). ⋯ Overall, the effects of vasoactive agents on pHi are unpredictable. Among the catecholamines, dopamine is the least likely, and dobutamine the most likely, to increase pHi.
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To compare pediatric intensive care unit (ICU) mortality risk using models from two distinct time periods; and to discuss the implications of changing mortality risk for severity systems and quality-of-care assessment. ⋯ This study documents differences in pediatric ICU risk of mortality over time that are consistent with a general improvement in the quality of pediatric intensive care. Despite continued widespread use of the original PRISM, recent improvements in pediatric ICU quality of care have negated its usefulness for many intended applications, including quality-of-care assessment.