Critical care medicine
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Critical care medicine · Apr 2000
Comparative StudyEffects of propofol on hemodynamic and inflammatory responses to endotoxemia in rats.
To document the effects of propofol on the hemodynamic and inflammatory responses to endotoxemia in an animal model. ⋯ Propofol attenuated cytokine responses, base deficit, and activation of neutrophils to endotoxemia. These findings suggest that propofol may inhibit inflammatory response and prevent the development of metabolic acidosis during endotoxemia.
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Critical care medicine · Apr 2000
Comparative StudyCalcitonin precursors are reliable markers of sepsis in a medical intensive care unit.
The diagnosis of infection in critically ill patients is challenging because traditional markers of infection are often misleading. For example, serum concentrations of calcitonin precursors are increased in patients with infections. However, their predictive accuracy for the diagnosis of sepsis in unselected patients in a medical intensive care unit (ICU) is unknown. Therefore, we compared the usefulness of serum concentrations of calcitonin precursors, C-reactive protein, interleukin-6, and lactate for the diagnosis of sepsis in consecutive patients suffering from a broad range of diseases with an anticipated stay of > or =24 hrs in a medical ICU. ⋯ In a medical ICU, serum calcitonin precursor concentrations are more sensitive and are specific markers of sepsis as compared with serum C-reactive protein, interleukin-6, and lactate levels.
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Critical care medicine · Apr 2000
Randomized Controlled Trial Comparative Study Clinical TrialAcute detoxification of opioid-addicted patients with naloxone during propofol or methohexital anesthesia: a comparison of withdrawal symptoms, neuroendocrine, metabolic, and cardiovascular patterns.
Mu-Opioid receptor blockade during general anesthesia is a new treatment for detoxification of opioid addicted patients. We assessed catecholamine plasma concentrations, oxygen consumption, cardiovascular variables, and withdrawal symptoms after naloxone and tested the hypothesis that variables are influenced by the anesthetic administered during detoxification. ⋯ Naloxone treatment, in opioid-addicted patients, induced a marked increase in catecholamine plasma concentrations, metabolism, and cardiovascular stimulation during anesthesia with both propofol and methohexital. Although both anesthetics appear suitable for detoxification treatment, the use of propofol is associated with earlier extubation and, surprisingly, a shortened period of long-term withdrawal symptoms during detoxification.
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Critical care medicine · Apr 2000
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialEarly identification of patients at risk for symptomatic vasospasm after aneurysmal subarachnoid hemorrhage.
To develop a scheme for early identification of individuals at risk for symptomatic vasospasm after subarachnoid hemorrhage (SAH). ⋯ Patients at high risk for symptomatic vasospasm can be identified early in the course of SAH using a risk index. A risk index based on a combination of variables may represent a predictive paradigm superior to conventionally used criteria based on clot thickness or MCA-MFV criteria.
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To measure energy expenditure in critically ill children and compare it with the energy expenditure predicted by recommended formulas, and relate the measured energy expenditure to nutritional and clinical indices. ⋯ Recommended daily allowances and energy expenditure predicted by using a stress-related correction to the resting energy expenditure grossly overestimate MEE. MEE is close to PBMR and in many patients, it is lower than PBMR. MEE that is lower than PBMR is associated with a higher morbidity. Nutritional repletion should thus be based on MEE to avoid the problems of over- or underfeeding.