Critical care medicine
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Critical care medicine · Sep 1999
Continuous venovenous hemofiltration improves cardiac performance by mechanisms other than tumor necrosis factor-alpha attenuation during endotoxic shock.
To assess the effects of continuous venovenous hemofiltration (CWH) on global and regional hemodynamics, plasma lactate, and tumor necrosis factor-oa (TNF-a) levels during endotoxic shock in dogs. ⋯ In this acute endotoxic shock model, CWH at 3 Uhr improved cardiac performance and decreased pulmonary vasoconstriction. Moreover, CWH at 6 LUhr also increased arterial blood pressure and left ventricular stroke work, increased hepatic and femoral arterial blood flow, and decreased blood lactate levels. These effects were not attributable to TNF-alpha removal.
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Critical care medicine · Sep 1999
Randomized Controlled Trial Clinical TrialSelenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome.
To determine the effect of selenium replacement on morbidity and mortality in patients with systemic inflammatory response syndrome (SIRS). ⋯ Selenium replacement in patients with SIRS seems to improve clinical outcome and to reduce the incidence of acute renal failure requiring hemodialysis.
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Critical care medicine · Sep 1999
Extracellular lactate and glucose alterations in the brain after head injury measured by microdialysis.
To study cerebral glucose and lactate metabolism in head-injured patients using microdialysis. ⋯ Clinical neurochemical monitoring of glucose and lactate levels in the extracellular space of the cerebral cortex is technically feasible and provides insight into the bioenergetic status of the brain. Increased lactate and decreased glucose, indicating accelerated glycolysis, commonly occurred with cerebral ischemia or hypoxia, and increased anaerobic glycolysis in this setting is associated with a poor outcome.
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Critical care medicine · Sep 1999
Randomized Controlled Trial Clinical TrialAntihistamine prophylaxis permits rapid vancomycin infusion.
To determine whether pretreatment with intravenous antihistamines attenuates the symptoms of red-man syndrome associated with rapid vancomycin administration. ⋯ Pretreatment with intravenous H1 and H2 antihistamines permitted rapid vancomycin administration in 89% of treated patients. Although protection was incomplete, rash did not predict a need to stop the rapid infusion of vancomycin in our patients.
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Critical care medicine · Sep 1999
ReviewIncorporating palliative care into critical care education: principles, challenges, and opportunities.
To identify the goals and methods for medical education about end-of-life care in the intensive care unit (ICU). ⋯ Teaching care of the dying in the ICU should emphasize the following: a) the goals of care should guide the use of technology; b) understanding of prognostication and treatment withholding and withdrawal is essential; c) effective communication and trusting relationships are crucial to good care; d) cultural differences should be acknowledged and respected; and e) the delivery of excellent palliative care is appropriate and necessary when patients die in the ICU.