Critical care medicine
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Critical care medicine · Aug 2000
Comparative Study Clinical TrialNoninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients.
To evaluate the reliability of whole-body impedance cardiography with two electrodes on either both wrists or one wrist and one ankle for the measurement of cardiac output compared with the thermodilution method. ⋯ Agreement between whole-body impedance cardiography and thermodilution in the measurement of cardiac output was unsatisfactory. Factors that can explain these differences are differences between the populations used for calibration of nCO and the study population, the influence of changing peripheral perfusion, and the effect of a supranormal hemodynamic state on the bioimpedance signal. Whole-body impedance cardiography cannot be recommended for assessing the hemodynamic state of high-risk surgical patients as studied in this investigation.
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Critical care medicine · Aug 2000
Randomized Controlled Trial Clinical TrialResponse of erythropoiesis and iron metabolism to recombinant human erythropoietin in intensive care unit patients.
Critically ill patients often are anemic, which may impair oxygen delivery. Transfusion of red cells and supplementation with vitamins or iron are the usual therapeutic strategies, whereas only sporadic data are available on the use of epoetin alfa in these patients. We investigated endogenous erythropoietin (EPO) production and the response to epoetin alfa in anemic intensive care unit (ICU) patients. ⋯ Endogenous EPO concentrations are low in critically ill patients. The bone marrow of these patients is able to respond to exogenous epoetin alfa, as shown by elevated concentrations of reticulocytes and serum transferrin receptors.
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Critical care medicine · Aug 2000
Clinical TrialEffect of norepinephrine on the outcome of septic shock.
Despite increasingly sophisticated critical care, the mortality of septic shock remains elevated. Accordingly, care remains supportive. Volume resuscitation combined with vasopressor support remains the standard of care as adjuvant therapy, and many consider dopamine to be the pressor of choice. Because of fear of excessive vasoconstriction, norepinephrine is considered to be deleterious. The present study was designed to identify factors associated with outcome in a cohort of septic shock patients. Special attention was paid to hemodynamic management and to the choice of vasopressor used, to determine whether the use of norepinephrine was associated with increased mortality. ⋯ Our results indicate that the use of norepinephrine as part of hemodynamic management may influence outcome favorably in septic shock patients. The data contradict the notion that norepinephrine potentiates end-organ hypoperfusion, thereby contributing to increased mortality. However, the present study suffers from some limitation because of its nonrandomized, open-label, observational design. Hence, a randomized clinical trial is needed to clearly establish that norepinephrine improves mortality of patients with septic shock, as compared with high-dose dopamine or epinephrine. Pneumonia as the cause of septic shock, high blood lactate concentration, and low urine output on admission are strong indicators of a poor prognosis. Multiple organ failure is confirmed as a reliable predictor of mortality in septic patients.
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Critical care medicine · Aug 2000
Kinetics and dynamics of lorazepam during and after continuous intravenous infusion.
To evaluate the kinetics and dynamics of lorazepam during administration as a bolus plus an infusion, using electroencephalography as a pharmacodynamic end point. ⋯ Despite the delay in effect onset, continuous infusion of lorazepam, preceded by a bolus loading dose, produces a relatively constant sedative effect on the central nervous system, which can be utilized in the context of critical care medicine.
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Critical care medicine · Aug 2000
Multicenter Study Comparative StudyComparison of the performance of two general and three specific scoring systems for meningococcal septic shock in children.
To evaluate the performance at admission to the pediatric intensive care unit (PICU) of five severity scores, two general (the Pediatric Risk of Mortality [PRISM] II and III scores) and three specific for meningococcal septic shock (Leclerc, Glasgow Meningococcal Septicemia Prognostic Score [GMSPS], and Gedde-Dahl's MOC score) in children with this condition. ⋯ The specific GMSPS and the general pediatric severity system PRISM II performed better than the other three scores, being appropriate tools to assess severity of illness at admission to the PICU in children with presumed meningococcal septic shock.