Critical care medicine
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Critical care medicine · Apr 2012
The acute pulmonary inflammatory response to the graded severity of smoke inhalation injury.
To determine whether the graded severity of smoke inhalation is reflected by the acute pulmonary inflammatory response to injury. ⋯ These data reveal that the degree of inhalation injury has basic and profound effects on burn patient morbidity, evokes complex changes of multiple alveolar inflammatory proteins, and is a determinant of the pulmonary inflammatory response to smoke inhalation. Accordingly, future investigations should consider inhalation injury to be a graded phenomenon.
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Critical care medicine · Apr 2012
A mathematical model for simulating daily bed occupancy in an intensive care unit.
To develop a mathematical model for simulating the daily bed occupancy in an intensive care unit. ⋯ It is possible to develop simulation models that can be used to predict future intensive care unit resource needs.
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Critical care medicine · Apr 2012
Mild hypothermia decreases fentanyl and midazolam steady-state clearance in a rat model of cardiac arrest.
Therapeutic hypothermia is widely employed for neuroprotection after cardiac arrest. However, concern regarding elevated drug concentrations during hypothermia and increased adverse drug reaction risk complicates concurrent pharmacotherapy. Many commonly used medications in critically ill patients rely on the cytochrome P450 3A isoform for their elimination. Therefore, our study objectives were to determine the effect of mild hypothermia on the in vivo pharmacokinetics of fentanyl and midazolam, two clinically relevant cytochrome P450 3A substrates, after cardiac arrest and to investigate the mechanisms of these alterations. ⋯ Mild hypothermia reduces the systemic clearances of fentanyl and midazolam in rats after cardiac arrest through alterations in cytochrome P450 3a2 metabolic capacity rather than enzyme affinity as observed with other cytochrome P450s. Contrasting effects on blood and brain levels further complicates drug dosing. Consideration of the impact of hypothermia on medications whose clearance is dependent on P450 3A metabolism is warranted.