Critical care medicine
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Critical care medicine · Mar 1999
Review Practice Guideline GuidelinePractice parameters for hemodynamic support of sepsis in adult patients in sepsis. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine.
To present guidelines for hemodynamic support of adult patients with sepsis. ⋯ The panel formulated an underlying approach to the hemodynamic support of sepsis. Hemodynamic therapies should be titrated to specific and definable endpoints. The effects of therapy should be assessed by monitoring a combination of parameters of global and regional perfusion. Using this approach, the panel made specific recommendations for fluid resuscitation, vasopressor therapy, and inotropic therapy of septic patients.
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Critical care medicine · Mar 1999
Clinical TrialHemodynamic effects of fluid loading in acute massive pulmonary embolism.
To assess the hemodynamic effects of fluid loading in patients with acute circulatory failure caused by acute massive pulmonary embolism (AMPE). ⋯ These results suggest that fluid loading can improve hemodynamic status in patients with acute circulatory failure caused by AMPE.
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Critical care medicine · Mar 1999
Comparative StudyHypertonic saline without or with dextran-70 in the treatment of experimental acute myocardial ischemia and reperfusion.
To evaluate the effects of treatment with hypertonic saline without (HS) or with dextran (HSD) on cardiac function and myocardial damage during reperfusion after acute myocardial ischemia. ⋯ The administration of HSD but not HS will improve hemodynamics and myocardial performance during reperfusion after 45 mins of myocardial ischemia. The documented myocardial ischemic injury was not affected by any of the fluid therapies. Therefore, the present data do not support previously suggested detrimental effects of HS on myocardial ischemic injury.
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Critical care medicine · Mar 1999
Randomized Controlled Trial Comparative Study Clinical TrialEfficacy of silver-coating central venous catheters in reducing bacterial colonization.
To compare silver-coated and uncoated central venous catheters regarding bacterial colonization. To assess the relative contribution of catheter hub and skin colonization to catheter tip colonization. ⋯ Silver-coating of DLCs did not significantly reduce bacterial catheter colonization compared with the control catheters. PFGE analysis of coagulase-negative staphylococci and other bacteria demonstrated various pathogenic routes of catheter-related colonization, whereby the microorganisms of the skin flora around the insertion site must be regarded as the main source of catheter-related infections.
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Critical care medicine · Mar 1999
Randomized Controlled Trial Clinical TrialEffects of ventilator resetting on indirect calorimetry measurement in the critically ill surgical patient.
To evaluate the effect of acute changes in minute ventilation (VE) on oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory quotient, and energy expenditure during volume-controlled mechanical ventilation in the critically ill surgical patient. The effects on some oxygen transport variables were assessed as well. ⋯ We conclude that, during controlled mechanical ventilation, the time course and the magnitude of the effect on gas exchange and energy expenditure measurements caused by acute changes in VE suggest that VO2 and energy expenditure measurements can be used reliably to evaluate and quantify metabolic events and that VCO2 and respiratory quotient measurements are useless for metabolic purposes at least for 120 mins after ventilator resetting.