Critical care medicine
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Critical care medicine · Aug 2003
Multicenter Study Clinical Trial Controlled Clinical TrialResults of a clinical trial on care improvement for the critically ill.
To develop, deploy, and evaluate an intervention designed to identify and mitigate conflict in decision making in the intensive care unit. ⋯ Although there was no impact on patient or surrogate satisfaction with care provided in the intensive care unit, the intervention did facilitate deliberative decision making in cases deemed at high risk for conflict. The lessons learned from the experience with this intervention should be helpful in ongoing efforts to improve care and to achieve outcomes desired by critically ill patients, their families, and critical care clinicians.
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Critical care medicine · Aug 2003
Randomized Controlled Trial Clinical TrialEffects of glucose-insulin-potassium solution on myocardial salvage and left ventricular function after primary angioplasty.
To evaluate the effects of glucose-insulin-potassium (GIK) therapy on infarct size and left ventricular function when used as an adjuvant therapy to primary angioplasty. ⋯ GIK solution did not improve LVEF or decrease the infarct size among patients undergoing primary angioplasty.
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Critical care medicine · Aug 2003
ReviewMolecular diagnostics of injury and repair responses in critical illness: what is the future of "monitoring" in the intensive care unit?
To identify potential future means of monitoring injury and repair in critical illness. ⋯ The rapidly evolving sciences of genomics, proteomics, computational biology, and complex system theory can be used a) to model critical illness; b) to model adaptive and maladaptive responses to critical illness; c) to tailor treatments to create an ideal inflammatory environment for repair and regeneration, taking into account the individual genetic contribution; and d) to monitor the progress of repair. The major obstacles to reaching these goals are technological, and experience suggests that they will be overcome.
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Initially after injury, the innate/proinflammatory and some aspects of the acquired immune response are up-regulated to maintain a defense against foreign pathogens, clear tissue debris present at the wound site, and orchestrate aspects of tissue remodeling, cell proliferation and angiogenic process, associated with the wound response. However, for proper wound healing to progress, this initial inflammatory response has to be regulated or shut down so as to allow for the reestablishment of matrix, recellularization, and tissue remodeling. Inability to properly resolve the extent of innate/acquired response at a site of injury can lead to poor wound healing, immune suppression, and recurrent infectious episodes. This review attempts to summarize information on regulatory mechanisms that are thought to be involved in controlling/resolving innate or acquired immune responses so as to provide a framework for use in thinking about the impact these processes and their manipulation may have on wound healing and its potential management.
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Critical care medicine · Aug 2003
Randomized Controlled Trial Clinical TrialBacterial filters in respiratory circuits: an unnecessary cost?
To evaluate the efficacy of bacterial filters (BF) to decrease pneumonia associated with mechanical ventilation (MV). ⋯ Bacterial filters in ventilation circuits neither reduce the prevalence of respiratory infections associated with MV nor decrease exogenous infectious events; thus, their usage is not necessary.