Critical care medicine
-
Critical care medicine · Jun 1998
Mortality is increased by procalcitonin and decreased by an antiserum reactive to procalcitonin in experimental sepsis.
Procalcitonin (ProCT), the precursor to the calcitonin hormone, is abnormally increased in experimental and clinical systemic inflammation, including sepsis. Initially, we investigated the effects of supraphysiologic amounts of ProCT administered to animals with septic peritonitis. Subsequently, we evaluated the efficacy of prophylactic and therapeutic immune blockade of ProCT in this lethal model of sepsis. ⋯ These results demonstrate that increased ProCT exacerbates mortality in experimental sepsis, whereas neutralization of ProCT increases survival. Thus, ProCT, in addition to being an important marker of severity of systemic inflammation and mortality, is an integral part of the inflammatory process and directly affects the outcome.
-
Critical care medicine · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialDelivery of high concentrations of inspired oxygen via Tusk mask.
Nonrebreather face masks (NRM) are frequently used in patients with respiratory distress and profound hypoxemia. A simpler modification to the partial rebreather face mask, using only two pieces of respiratory tubing or "tusks," has also been shown to increase FiO2 compared with the NRM in five normal subjects. Clinically, we have observed this modification to further increase PaO2 in critically ill patients already using the NRM in the intensive care unit. This study was designed to compare the Tusk mask with the NRM in both a larger group of normal subjects and in patients with underlying lung disease. ⋯ Both normal subjects and patients with compromised pulmonary function achieved a higher PaO2 using a Tusk mask than when using the conventional NRM, at the same oxygen flow rate. Patients with hypoxemia may obtain lifesaving benefit from the additional concentration of oxygen delivered via the Tusk mask.
-
Critical care medicine · Jun 1998
Comparative StudyUnplanned extubation: risk factors of development and predictive criteria for reintubation.
To define patients at risk for unplanned extubation; to assess the influence of nursing workload on the incidence of unplanned extubation; and to determine predictive criteria for patients requiring reintubation. ⋯ Patients at risk for unplanned extubation are characterized by oral intubation and insufficient sedation. In the department studied, and with the specific score used, we did not observe a relationship between the nursing workload and the incidence of unplanned extubation. A Glasgow Coma Score of <11, the accidental nature of unplanned extubation, and a PaO2/FiO2 ratio <200 torr (<26.7 kPa) are factors associated with a risk of reintubation.
-
Critical care medicine · Jun 1998
Comparative StudyValue of the venous-arterial PCO2 gradient to reflect the oxygen supply to demand in humans: effects of dobutamine.
To test the value of venous-arterial PCO2 gradient (deltaPCO2) measurements to reflect the adequacy of cardiac index (CI) to oxygen demand in patients submitted to rapid changes of CI and oxygen demand. ⋯ deltaPCO2 can be reliably used at the bedside for informing on the adequacy of CI with respect to a given metabolic condition, and particularly for detecting changes in oxygen demand (e.g., the changes accompanying drug-induced changes in CI). In this regard, deltaPCO2, together with O2 ER and SVO2, can help to assess the adequacy of CI to global oxygen demand.
-
Critical care medicine · Jun 1998
Gut intramucosal pH as an early indicator of effectiveness of therapy for hemorrhagic shock.
To determine the value of intramucosal pH for evaluating the effectiveness of treatment for hemorrhagic shock. ⋯ The change in pHi during the first hour of resuscitation could be used to divide animals treated uniformly from a hemodynamic point of view into two distinct groups with seemingly different outcome. The minimally invasive method could be of value for early evaluation of the results of treatment of hemorrhagic shock.