Critical care medicine
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Critical care medicine · Apr 1998
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEffect of prophylactic administration of recombinant human granulocyte colony-stimulating factor (filgrastim) on the frequency of nosocomial infections in patients with acute traumatic brain injury or cerebral hemorrhage. The Filgrastim Study Group.
To determine whether the use of prophylactic recombinant human granulocyte colony-stimulating factor (filgrastim) reduces the frequency of nosocomial infections in patients with either acute traumatic brain injury or cerebral hemorrhage. ⋯ In this patient population, use of filgrastim was safe and the agent appeared to reduce the risk of primary bacteremias but had no beneficial effects on mortality, length of stay, or other nosocomial infections.
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Critical care medicine · Apr 1998
Randomized Controlled Trial Multicenter Study Clinical TrialReversal of late septic shock with supraphysiologic doses of hydrocortisone.
Preliminary studies have suggested that low doses of corticosteroids might rapidly improve hemodynamics in late septic shock treated with catecholamines. We examined the effect of hydrocortisone on shock reversal, hemodynamics, and survival in this particular setting. ⋯ Administration of modest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of >96 hrs resulted in a significant improvement in hemodynamics and a beneficial effect on survival. These beneficial effects do not appear related to adrenocortical insufficiency.
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Critical care medicine · Apr 1998
Comparative StudyUnderstanding articles comparing outcomes among intensive care units to rate quality of care. Evidence Based Medicine in Critical Care Group.
Comparisons of risk-adjusted outcomes among intensive care units (ICUs) is a relatively new but rapidly expanding area of ICU health services research. By investigating those factors that lead ICUs to have patient outcomes that differ from the average, the overall quality of care across ICUs may be improved. Our goal is to teach clinicians how to evaluate these types of articles. CLINICAL EXAMPLE: An article describing the development and application of an index used to assess the clinical performance and cost-effectiveness of 25 ICUs. ⋯ The potential for misinterpretation of outcome performance ratings may decrease if articles describing outcome differences are evaluated, using the criteria outlined in this article.
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Critical care medicine · Apr 1998
Comparative StudyTotal plasma antioxidant capacity is not always decreased in sepsis.
To compare total plasma antioxidant capacity and selected individual antioxidants in patients with varying degrees of severity of sepsis. ⋯ Although total plasma antioxidant capacity is decreased from normal levels in septic patients, an increase in some oxidants contributes to an increased total antioxidant capacity in septic shock patients.