Critical care medicine
-
Critical care medicine · May 1998
Comparative StudyIncreased circulating thrombomodulin in children with septic shock.
To test the hypothesis that children diagnosed with septic shock have increased plasma thrombomodulin values as a manifestation of microcirculatory dysfunction and endothelial injury; to determine whether plasma thrombomodulin concentrations are associated with the extent of multiple organ system failure and mortality. ⋯ Pediatric survivors and nonsurvivors of septic shock have circulating thrombomodulin concentrations 1.5 and 3 times greater than healthy control patients. These findings likely represent sepsis-induced endothelial injury. Patients with multiple organ system failure have circulating thrombomodulin concentrations which are associated with the extent of organ dysfunction. We speculate that measurement of plasma thrombomodulin concentrations in septic shock may be a useful indicator of the severity of endothelial damage and the development of multiple organ system failure.
-
Critical care medicine · May 1998
Randomized Controlled Trial Comparative Study Clinical TrialSynergistic sedation with propofol and midazolam in intensive care patients after coronary artery bypass grafting.
To evaluate and compare the clinical efficacy, impact on hemodynamics, safety profiles, and cost of combined administration of propofol and midazolam (synergistic sedation) vs. midazolam and propofol administered as sole agents, for sedation of mechanically ventilated patients after coronary artery bypass grafting. ⋯ In the study conditions, the new synergistic treatment with propofol and midazolam administered together is an effective and safe alternative for sedation, with some advantages over the conventional regimen with propofol or midazolam administered as sole agents, such as absence of hemodynamic impairment, >68% reduction in maintenance dose, and lower pharmaceutical cost.
-
Critical care medicine · May 1998
Review Comparative StudyComplications of sedation with midazolam in the intensive care unit and a comparison with other sedative regimens.
To describe the various complications that have been reported with use of midazolam for sedation in the intensive care unit (ICU). ⋯ Continuous infusion midazolam provides effective sedation in the ICU with few complications overall, especially when the dose is titrated.
-
Critical care medicine · May 1998
Comparative Study Clinical TrialGastric intramucosal acidosis in mechanically ventilated patients: role of mucosal blood flow.
To investigate whether gastric intramucosal acidosis is associated with a decreased gastric mucosal blood flow in mechanically ventilated patients. ⋯ Our results support the hypothesis that gastric mucosal hypoperfusion underlies the development of intramucosal acidosis in mechanically ventilated patients.
-
Critical care medicine · May 1998
Expiratory phase and volume-adjusted tracheal gas insufflation: a lung model study.
To evaluate in a lung model the effects of expiratory-phase tracheal gas insufflation (expiratory-phase TGI) with both volume and pressure control ventilation, and tidal volume-adjusted continuous flow TGI (volume-adjusted TGI) on system pressures and volumes. ⋯ The marked increases in system pressures and volumes observed with continuous-flow TGI can be avoided with expiratory-phase TGI and volume-adjusted TGI.