Critical care medicine
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Critical care medicine · Feb 1999
Comparative StudyThe extent of traumatic damage determines a graded depression of the endotoxin responsiveness of peripheral blood mononuclear cells from patients with blunt injuries.
To study whether the endotoxin responsiveness of peripheral blood mononuclear cells correlates with the severity of injury in trauma patients. ⋯ The extent of traumatic tissue damage leads to a graded depression of immunocyte function and appears to be amplified by surgical treatment. The endotoxin responsiveness of peripheral blood mononuclear cells displays a functional marker of the anatomically defined severity of injury and gives insights into the regulation of immunocyte function after severe blunt trauma.
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Critical care medicine · Feb 1999
Dopexamine attenuates flow motion in ileal mucosal arterioles in normotensive sepsis.
Injury to the small intestine is thought to play a crucial role in the development and propagation of sepsis. Cellular hypoxia, caused by hypoperfusion, may result in increased mucosal permeability, thus allowing the translocation of bacteria and endotoxin to the circulation. The purpose of this study was to assess the effect of the synthetic catecholamine, dopexamine, on the mucosal microcirculation of the septic rat ileum. ⋯ These results indicate that dopexamine increased overall blood flow and possibly oxygen delivery to the mucosa by altering patterns of blood flow within the villi. The observation that the diameter of the marginal arterioles is not affected by dopexamine indicates that dopexamine influences the mucosal microcirculation at the level of higher order arterioles. We conclude that sepsis results in abnormal microvascular villus blood flow and that dopexamine can partially restore these changes towards normal.
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Critical care medicine · Feb 1999
Comparative StudyImpact of exogenous beta-adrenergic receptor stimulation on hepatosplanchnic oxygen kinetics and metabolic activity in septic shock.
To investigate the impact of exogenous beta-adrenergic receptor stimulation on splanchnic blood flow, oxygen kinetics, glucose-precursor flux, and liver metabolism in septic shock. ⋯ Exogenous beta-adrenergic receptor stimulation determines splanchnic blood flow, oxygen delivery, and glucose precursor flux but not splanchnic oxygen utilization in septic shock. Gluconeogenesis is not directly affiliated to hepatosplanchnic oxygen kinetics. The different response of glucose and MEGX production rates, metabolic pathways of the periportal and perivenous region, may document intrahepatic heterogeneity associated with hepatocellular metabolic compartmentation.
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Critical care medicine · Feb 1999
Editorial Comment ReviewPEEP: blood gas cosmetics or a therapy for ARDS?
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Critical care medicine · Feb 1999
Comparative StudyEffects of adrenergic-receptor blockade and ligation of spleen vessels on the hemodynamics of dogs injected with scorpion venom.
In dogs, scorpion venom evokes a rapid increase in cardiac output (CO) that decreases below baseline level in 1 hr. The changes in CO have recently been shown to be related to the effect of the venom on venous return. In the present study, we tested the hypothesis that changes in determinants of venous return are secondary to sympathoadrenal stimulation evoked by the venom, which causes splenic contracture in the first stage of envenomation leading to increased mean circulatory pressure (MCP) and CO. Persistence of adrenergic response is the main factor leading to the second stage of envenomation, characterized by an increase in resistance to venous return (Rv) and a decrease in CO. ⋯ The changes in CO and MCP following scorpion venom injection in dogs are in part related to sympathetic stimulation. Adrenergic-receptor blockade attenuated the initial inotropic effect of the venom and completely prevented a late decrease in CO and MCP. The increase in Rv is the most important factor for late decrease in CO, and results from persistent adrenergic-receptor stimulation. In addition, an Rv increase apparently expresses vasoconstriction and redistribution of blood flow. The initial increase in CO and MCP is explained mainly by adrenergic-receptor effects on the spleen leading to augmented circulatory blood volume.