Critical care medicine
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Critical care medicine · Jan 2002
Randomized Controlled Trial Clinical TrialNo effect of preoperative selective gut decontamination on endotoxemia and cytokine activation during cardiopulmonary bypass: a randomized, placebo-controlled study.
Cardiopulmonary bypass predisposes the splanchnic region to inadequate perfusion and increases in gut permeability. Related to these changes, circulating endotoxin has been shown to rise during cardiac surgery, and may contribute to cytokine activation, high oxygen consumption, and fever ("postperfusion syndrome"). To a large extent, free endotoxin in the gut is a product of the proliferation of aerobic gram-negative bacteria and may be reduced by nonabsorbable antibiotics. ⋯ SGD effectively reduces the aerobic gram-negative bowel flora in cardiac surgery patients but fails to affect the incidence of perioperative endotoxemia and cytokine activation during cardiopulmonary bypass and the occurrence of a postperfusion syndrome.
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Critical care medicine · Jan 2002
ReviewInterleukin-10: a complex role in the pathogenesis of sepsis syndromes and its potential as an anti-inflammatory drug.
Interleukin (IL)-10 is a pleiotropic cytokine produced by both T cells and macrophages and possesses both anti-inflammatory and immunosuppressive properties. IL-10 circulates in the blood of patients with sepsis syndromes, and increased concentrations of IL-10 have been associated with an adverse clinical outcome. ⋯ Targeted delivery of IL-10 to individual tissues may obviate the adverse effects of systemic delivery. The potential anti-inflammatory properties of IL-10 will have to be carefully weighed against its immunosuppressive properties when considering its use in patients with acute inflammation and sepsis syndromes.
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Endotoxin tolerance was initially described when it was observed that animals survived a lethal dose of bacterial endotoxin if they had been previously treated with a sublethal injection. In animal models, two phases of endotoxin tolerance are described, an early phase associated with altered cellular activation and a late phase associated with the development of specific antibodies against the polysaccharide side chain of Gram-negative organisms. ⋯ The "lipopolysaccharide-tolerant" phenotype is characterized by inhibition of lipopolysaccharide-stimulated tumor necrosis factor production, altered interleukin-1 and interleukin-6 release, enhanced cyclooxygenase-2 activation, inhibition of mitogen-activated protein kinase activation, and impaired nuclear factor-kappa B translocation. Human monocytes and macrophages can be induced to become tolerant, and there is increasing evidence that monocytic cells from patients with systemic inflammatory response syndrome and sepsis have many characteristics of endotoxin tolerance.
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Critical care medicine · Jan 2002
Crystalloid strong ion difference determines metabolic acid-base change during in vitro hemodilution.
To determine the relationship between the strong ion difference (SID) of a diluting crystalloid and its metabolic acid-base effects on in vitro blood dilution. ⋯ On in vitro hemodilution, there is a simple linear relationship between diluent crystalloid SID and the rate and direction of change of plasma SID and whole blood base excess. Direct extrapolation to in vivo situations such as acute normovolemic hemodilution and large volume correction of extracellular fluid deficits requires experimental confirmation.