Critical care medicine
-
Critical care medicine · Nov 2008
Randomized Controlled TrialNitric oxide inhalation and glucocorticoids as combined treatment in human experimental endotoxemia.
Inhaled nitric oxide and glucocorticoids as a combination therapy may attenuate endotoxin-induced inflammatory responses in humans as indicated by levels of cytokines and clinical signs. Since other authors have shown that combined inhaled nitric oxide and steroids improved the histologic damage both in pulmonary and systemic organs in a porcine endotoxin model, we examined if an anti-inflammatory interaction could be demonstrated in humans. ⋯ In a human experimental inflammatory model using endotoxin, inhaled nitric oxide and glucocorticoids in low doses given after the endotoxin challenge did not modify the inflammatory cascade as monitored in this study.
-
Critical care medicine · Nov 2008
Multicenter StudyEarly intravenous unfractionated heparin and mortality in septic shock.
Sepsis and septic shock represent a systemic inflammatory state with substantial pro-coagulant elements. Unfractionated heparin is a known anticoagulant, which also possesses anti-inflammatory properties. Unfractionated heparin has been shown to increase survival in experimental models of septic shock. ⋯ Early administration of intravenous therapeutic dose unfractionated heparin may be associated with decreased mortality when administered to patients diagnosed with septic shock, especially in patients with higher severity of illness. Prospective randomized trials are needed to further define the role of this agent in sepsis and septic shock.
-
Critical care medicine · Nov 2008
ReviewExperimental and clinical use of ongoing mechanical cardiopulmonary resuscitation during angiography and percutaneous coronary intervention.
Coronary heart disease is the most frequent cause of cardiac arrest. Return of spontaneous circulation is often not achieved during resuscitation due to the inability to restore coronary blood flow. ⋯ Coronary angiography and percutaneous coronary intervention is feasible during continuous mechanical chest compressions. This could be an alternative approach in cardiac arrest patients with suspected myocardial infarction who do not achieve return of spontaneous circulation with traditional resuscitation techniques.
-
Critical care medicine · Nov 2008
B-type natriuretic peptide as a marker for sepsis-induced myocardial depression in intensive care patients.
In early stages of septic shock, impaired myocardial function plays an important prognostic role. In this context, B-type natriuretic peptide (BNP) has been shown to be a neurohumoral marker for left ventricular dysfunction, because myocardial strain and ischemia both increase BNP concentration. The present study was designed to test if BNP allows for identification of patients at risk for developing sepsis-induced myocardial depression and if an increased concentration of BNP is associated with an adverse outcome in patients with septic shock. ⋯ These results indicate that plasma BNP concentration represents a reliable marker for identification of patients developing sepsis-induced myocardial depression. In addition, BNP concentration on day 5 may be used as a prognostic marker to identify patients with an elevated risk for an adverse outcome.