Critical care medicine
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Critical care medicine · Nov 2002
Marked activation of complement and leukocytes and an increase in the concentrations of soluble endothelial adhesion molecules during cardiopulmonary resuscitation and early reperfusion after cardiac arrest in humans.
Animal studies have demonstrated that reperfusion disorders occurring after cardiac arrest affect outcome. Reperfusion injury can be caused by activation of complement, polymorphonuclear leukocytes (PMN), and PMN-endothelial interaction. We studied different specific markers of these processes during and after cardiopulmonary resuscitation in humans. ⋯ Our data clearly demonstrate a marked activation of complement and PMN and an increased PMN-endothelial interaction during cardiopulmonary resuscitation and early reperfusion after cardiac arrest in humans. These changes are known to induce reperfusion disorders and tissue injury and point to new therapeutic options to improve outcome after cardiac arrest.
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Drowning and other asphyxial injuries are important causes of childhood morbidity and mortality. In this review, the epidemiology, pathophysiology, and treatments applied to near-drowning victims are discussed, with an emphasis on the difficulties encountered attempting to predict outcome using current methods.
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Critical care medicine · Nov 2002
Lessons learned from the Marmara disaster: Time period under the rubble.
To investigate the effect of the time period under the rubble on morbidity and mortality of the crush-syndrome patients after the catastrophic Marmara earthquake that struck northwestern Turkey in August 1999. ⋯ Rescue efforts should continue at least for 5 days after the disaster. Time under the rubble is not an adverse prognostic indicator of survival or renal dysfunction for the patients of crush syndrome, probably because only the victims with mild or moderate injuries can survive under the rubble for longer durations.
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Critical care medicine · Nov 2002
Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome.
To describe clinical characteristics associated with analgesia utilization in the intensive care unit. ⋯ Intensive care unit patients for whom analgesics were prescribed have a higher frequency of hemodynamic monitoring and use of sedative and neuromuscular blocking agents, more mechanical ventilation days, and longer intensive care unit and hospital lengths of stay.
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Critical care medicine · Nov 2002
Comparative StudyDirect comparison of the effects of nebulized nitroprusside versus inhaled nitric oxide on pulmonary and systemic hemodynamics during hypoxia-induced pulmonary hypertension in piglets.
To test the hypothesis that nebulized nitroprusside and inhaled nitric oxide would not differ in producing selective pulmonary vasodilation during hypoxia-induced pulmonary hypertension in piglets. ⋯ Both inhaled nitric oxide and nebulized nitroprusside produced prompt, significant, selective reduction of pulmonary artery pressure and pulmonary vascular resistance in piglets with hypoxia-induced pulmonary hypertension, without apparent effects on systemic hemodynamics or pulmonary gas exchange. The equivalence of the two effects in this animal model suggests that cautious extrapolation of the use of nebulized nitroprusside as a convenient bridge to inhaled nitric oxide in selected clinical contexts for human infants may be warranted.