Critical care medicine
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Critical care medicine · Mar 1999
ReviewAcadesine during fluid resuscitation from shock and abdominal sepsis.
To determine properties of acadesine, the prototype adenosine regulating agent, in an experimental model in which abdominal sepsis is superimposed onto hemorrhagic shock. ⋯ Fluid resuscitation with acadesine produced no adverse hemodynamic consequences and probably improved washout of metabolites from the reperfused microcirculation in sites other than the small intestine or heart. Taken together, these observations suggest that adenosine regulating agents might have therapeutic potential during fluid resuscitation from trauma. However, at least in these extreme conditions, the acute salutary effects of acadesine were probably overwhelmed by polymicrobial sepsis. Further studies must determine whether supplemental adjuvants to boost host defense during recovery from trauma will optimize adenosine-based resuscitation solutions.
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Critical care medicine · Mar 1999
Quinolinic acid in the cerebrospinal fluid of children after traumatic brain injury.
To measure quinolinic acid, a macrophage-derived neurotoxin, in the cerebrospinal fluid (CSF) of children after traumatic brain injury (TBI) and to correlate CSF quinolinic acid concentrations to clinically important variables. ⋯ A large and progressive increase in the macrophage-derived neurotoxin quinolinic acid is seen following severe TBI in children. The increase is strongly associated with increased mortality. Increased CSF quinolinic acid concentration on admission in children with shaken infant syndrome could reflect a delay in presentation to medical attention or age-related differences in quinolinic acid production. These findings raise the possibility that quinolinic acid may play a role in secondary injury after TBI in children and suggest an interaction between inflammatory and excitotoxic mechanisms of injury following TBI.
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Critical care medicine · Mar 1999
Practice Guideline GuidelineGuidelines for intensive care unit admission, discharge, and triage. Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine.
To provide guidelines for admission, discharge, and triage of adult patients to the intensive care unit (ICU), based on expert opinion and the relevant literature. ⋯ Although little scientifically rigorous data exist validating the criteria for admission, discharge, and triage of adult patients to the ICU, current literature and expert opinion support guidelines to streamline the admission, discharge, and triage process.
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Critical care medicine · Mar 1999
Clinical Trial Controlled Clinical TrialNeutrophil function capacity to express CD10 is decreased in patients with septic shock.
To evaluate the performance of a newly developed assay to assess neutrophil function capacity. After optimization, the assay was performed on samples derived from patients with septic shock and compared with healthy controls and patients with a systemic viral infection. ⋯ These results indicate that in circulating neutrophils, the secretory vesicles have been mobilized completely in patients with septic shock. The assay proves to be of acceptable analytical quality and can be quickly and easily performed. Regarding clinical performance, this assay may be helpful in diagnosing septic shock.
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Critical care medicine · Mar 1999
Syndrome of inappropriate antidiuretic hormone secretion in children following spinal fusion.
a) To determine if antidiuretic hormone (ADH) is elevated in patients undergoing spinal fusion, especially in those who have clinical evidence of syndrome of inappropriate antidiuretic hormone (SIADH); b) to evaluate the relationship between ADH secretion and the secretion of atrial natriuretic peptide (ANP). ⋯ SIADH occurs in a subset of children who undergo spinal fusion. The diagnosis of SIADH can be made easily using clinical parameters which are well-defined. In the face of SIADH, continued volume expansion may be harmful, and should therefore be avoided.