Critical care medicine
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Critical care medicine · Feb 2003
Multicenter Study Comparative StudyInterhospital variability in satisfaction with withdrawal of life support: room for improvement?
To develop instruments to measure the current level of satisfaction with the withdrawal of life support among nurses and respiratory therapists and to use these instruments to determine whether differences in satisfaction levels with the withdrawal of life support could be found among different institutions. ⋯ Satisfaction levels of intensive care unit nurses and respiratory therapists with the process of withdrawing life support vary among institutions. This variation may represent an opportunity for improvement in the process of withdrawing life support within this region.
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Critical care medicine · Feb 2003
Imbalance between matrix metalloproteinases (MMP-9 and MMP-2) and tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) in acute respiratory distress syndrome patients.
Matrix metalloproteinases (MMPs) are known to be involved in degradation of extracellular matrix. We aimed to assess the role of MMPs and their natural inhibitors (TIMPs) in the genesis and the evolution of acute respiratory distress syndrome (ARDS). ⋯ These results suggest that the MMP-9 level and MMP-9/TIMP-1 ratio play a role in the pathogenesis of ARDS and, namely, the imbalance between MMP-9 and TIMP-1 would participate in airway remodeling leading to either short- or long-course ARDS. The ratio MMP-9/TIMP-1 could be a predictive factor of the ARDS evolution.
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Critical care medicine · Feb 2003
Arginine and nitric oxide metabolism in critically ill septic pediatric patients.
To investigate whole body, arginine metabolism and nitric oxide synthesis rates in septic, critically ill pediatric patients. ⋯ Homeostasis of plasma arginine in septic patients was impaired compared with reported adult values. The rates of arginine oxidation were increased whereas net arginine synthesis was unchanged, leading to a negative arginine balance. The rates of nitric oxide synthesis and the fraction of plasma arginine used for nitric oxide and urea formation were increased. These findings suggest that under condition of sepsis, arginine becomes essential in critically ill children.
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Critical care medicine · Feb 2003
Acute oxygenation response to inhaled nitric oxide when combined with high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome.
To prospectively evaluate the oxygenation effect of inhaled nitric oxide (INO) delivered during high-frequency oscillatory ventilation in adult patients with the acute respiratory distress syndrome and oxygenation failure. DESIGN Prospective, clinical study. ⋯ INO delivered at doses of 5 to 20 ppm during high-frequency oscillatory ventilation increases Pao2/Fio2 and may be a safe and effective rescue therapy for patients with severe oxygenation failure.
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Critical care medicine · Feb 2003
Comparative StudyGastric capnometry with air-automated tonometry predicts outcome in critically ill patients.
Contrary to tonometer gastric intramucosal pH, there is currently no validated threshold prognostic value for Pco2 gap (tonometer gastric mucosal Pco2 minus arterial Pco2) in the critically ill patient. ⋯ The Pco2 gap is a marker of mortality in ventilated patients in the intensive care unit.