Critical care medicine
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Critical care medicine · Dec 1998
Comparative StudyTreatment of septic shock in rats with nitric oxide synthase inhibitors and inhaled nitric oxide.
To evaluate the effect of treatment with a combination of nitric oxide synthase inhibitors and inhaled nitric oxide on systemic hypotension during sepsis. ⋯ In this animal model, LPS-induced hypotension was alleviated slightly and durably after AG, but only transiently after LNA. Furthermore, co-administration of NO with AG had no added benefits but alleviated the severity of metabolic acidosis and mortality after LNA. We conclude that nitric oxide synthase (NOS) inhibitors, given as a single large bolus in the early phase of sepsis, can exhibit some beneficial effects. Administration of inhaled NO with NOS inhibitors provided more benefits in some conditions and therefore may be a useful therapeutic combination in sepsis. NO production in sepsis does not seem to be a primary cause of systemic hypotension. Other factors are likely to have a major role.
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Critical care medicine · Dec 1998
Randomized Controlled Trial Comparative Study Clinical TrialDiffusive vs. convective therapy: effects on mediators of inflammation in patient with severe systemic inflammatory response syndrome.
To compare two forms of continuous renal replacement therapy, continuous venovenous hemofiltration (CVVH) vs. continuous venovenous hemodialysis (CVVHD), in terms of the removal of inflammatory mediators from the blood of patients with systemic inflammatory response syndrome and acute renal failure. ⋯ CVVH resulted in a decrease in plasma TNF-alpha concentrations as compared with CVVHD, while the type of transport mechanism used did not influence plasma concentrations of IL-6, IL-10, soluble L-selectin, or endotoxin. Differences in clearance for IL-6 between CVVH and CVVHD did not translate into significant changes in circulating IL-6 concentrations.
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Critical care medicine · Dec 1998
Review Case ReportsLactic acidemia and bradyarrhythmia in a child sedated with propofol.
To describe a severe adverse reaction in a child who received an infusion of propofol for sedation in the intensive care unit (ICU). To describe the management and further investigation of this patient and review similar published reports. ⋯ Propofol has been associated with severe adverse reactions in children receiving intensive care. The biochemical and histologic abnormalities described in this patient may guide further investigation. We advise against prolonged use of propofol for sedation in children.
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Critical care medicine · Dec 1998
Comparative StudyActivation of the extrinsic coagulation pathway in patients with severe sepsis and septic shock.
To obtain systematic information on the extrinsic coagulation pathway, as well as to investigate the time course of the coagulation abnormalities in sepsis. ⋯ We systematically elucidated coagulation disorders in newly defined sepsis. The extrinsic coagulation pathway is activated in patients with severe sepsis and septic shock. In these patients, enhanced thrombin generation and activation, and fibrin formation were demonstrated when compared with the control subjects. Furthermore, the thrombin generated appears not to be fully neutralized by antithrombin III.