Critical care medicine
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Critical care medicine · May 1998
Randomized Controlled Trial Comparative Study Clinical TrialEffects of isoenergetic glucose-based or lipid-based parenteral nutrition on glucose metabolism, de novo lipogenesis, and respiratory gas exchanges in critically ill patients.
To compare the effects of isocaloric, isonitrogenous carbohydrate nutrition vs. lipid-based total parenteral nutrition on respiratory gas exchange and intermediary metabolism in critically ill patients. ⋯ The rate of glucose administration commonly used during TPN of critically ill patients does not suppress endogenous glucose production or net protein loss, but markedly stimulates de novo lipogenesis and CO2 production. Increasing the proportion of fat may be beneficial, provided that lipid emulsion has no adverse effects.
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Critical care medicine · May 1998
Review Comparative StudyComplications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens.
To describe the various complications that have been reported with use of midazolam for sedation in the intensive care unit (ICU). ⋯ Continuous infusion midazolam provides effective sedation in the ICU with few complications overall, especially when the dose is titrated.
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Critical care medicine · May 1998
Comparative Study Clinical TrialGastric intramucosal acidosis in mechanically ventilated patients: role of mucosal blood flow.
To investigate whether gastric intramucosal acidosis is associated with a decreased gastric mucosal blood flow in mechanically ventilated patients. ⋯ Our results support the hypothesis that gastric mucosal hypoperfusion underlies the development of intramucosal acidosis in mechanically ventilated patients.
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Critical care medicine · May 1998
Comparative StudyIncreased circulating thrombomodulin in children with septic shock.
To test the hypothesis that children diagnosed with septic shock have increased plasma thrombomodulin values as a manifestation of microcirculatory dysfunction and endothelial injury; to determine whether plasma thrombomodulin concentrations are associated with the extent of multiple organ system failure and mortality. ⋯ Pediatric survivors and nonsurvivors of septic shock have circulating thrombomodulin concentrations 1.5 and 3 times greater than healthy control patients. These findings likely represent sepsis-induced endothelial injury. Patients with multiple organ system failure have circulating thrombomodulin concentrations which are associated with the extent of organ dysfunction. We speculate that measurement of plasma thrombomodulin concentrations in septic shock may be a useful indicator of the severity of endothelial damage and the development of multiple organ system failure.
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Critical care medicine · May 1998
Comparative StudyPredictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units.
To compare the performance of four severity scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II, the new versions of the Mortality Prediction Model (MPM0 and MPM24), and the Simplified Acute Physiology Score (SAPS) II. ⋯ Despite an overall good discrimination, APACHE II, MPM0, MPM24, and SAPS II showed a less satisfactory calibration in our Tunisian sample of ICU patients. Part of the models inaccuracy could be related to quality of care problems in our ICUs, but this issue needs further analysis.