Critical care medicine
-
Critical care medicine · Jan 1999
Compositional, structural, and functional alterations in pulmonary surfactant in surgical patients after the early onset of systemic inflammatory response syndrome or sepsis.
Sepsis is one of the most important predisposing factors for the development of the acute respiratory distress syndrome (ARDS). Alterations of pulmonary surfactant contribute in the pathogenesis of ARDS. However, little is known about surfactant in patients with less severe grades of lung injury related to sepsis or systemic inflammatory response syndrome (SIRS). Therefore, the purpose of this study was to characterize endogenous surfactant in surgical intensive care patients with sepsis or SIRS. ⋯ These observations show that surgical patients with SIRS or sepsis who have mild-to-moderate lung injury develop surfactant dysfunction detectable within 7 days of onset. We propose, therefore, that therapeutic strategies to modulate these severe surfactant abnormalities should be considered, as these strategies may have the potential to reduce lung injury, which is associated with a high mortality in sepsis.
-
Critical care medicine · Jan 1999
Patient responses during rapid terminal weaning from mechanical ventilation: a prospective study.
To describe and analyze patient responses to rapid terminal weaning from mechanical ventilation. ⋯ Patients with altered consciousness or coma can be kept comfortable during a rapid terminal weaning procedure with morphine and benzodiazepines in low doses. Comfort can be reliably evaluated using subjective scales.
-
Critical care medicine · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical TrialEffects of prognosis, perceived benefit, and decision style on decision making and critical care on decision making in critical care.
To assess the effects of prognostic estimates, perceived benefit of treatment, and practice style on decision-making in critical care. ⋯ There is no evidence that erroneous or biased prognostic estimates affect intensive care unit treatment choices. Neither the principle of maximizing expected utility nor the Rule of Rescue appear to affect these decisions systematically, but practice style does.
-
Critical care medicine · Jan 1999
Randomized Controlled Trial Clinical TrialDistribution of normal saline and 5% albumin infusions in septic patients.
To determine the relative distribution of fluid within the extracellular fluid volume (ECFV) after infusing either normal saline or 5% albumin in septic, critically ill patients. ⋯ Expansion of the ECFV in excess of the volume of 5% albumin infused suggests that fluid may move from the intracellular fluid volume to the ECFV in septic patients who receive this fluid.
-
To determine the rationale for using stress ulcer prophylaxis (SUP) among clinicians; to assess criteria used to define failure of SUP; and to evaluate the decision-making process in the selection of a prophylactic agent. ⋯ This survey highlighted the lack of consensus in the use of SUP. Many patients receive SUP for an extended period, without clear-cut indications or documented benefit. The cost of unwarranted SUP in patients with low risk of stress ulcer gastrointestinal bleeding is prohibitive. Treatment algorithms or protocols for SUP based on prescribing patterns, hospital formulary restrictions, and cost-analysis should be considered for each institution to guide critical care physicians on the proper use of SUP therapies.