Critical care medicine
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Critical care medicine · Nov 1997
Comparative StudyPatterns of cytokine evolution (tumor necrosis factor-alpha and interleukin-6) after septic shock, hemorrhagic shock, and severe trauma.
To compare the patterns of evolution of two proinflammatory cytokines (tumor necrosis factor [TNF]-alpha and interleukin-6 [IL-6]) in two major clinical entities associated with systemic inflammatory response: septic shock and multiple trauma (with and without hemorrhagic shock). ⋯ In septic shock patients, high amounts of circulating TNF-alpha and IL-6 are found and then correlate with fatal outcome. In trauma patients (even those patients resuscitated from hemorrhagic shock), much less increased concentrations of IL-6 are detected while normal TNF-alpha circulating concentrations are measured. In these patients, cytokine concentrations do not correlate with outcome. This finding suggests a much higher degree of activation of the immunoinflammatory cascade in septic shock than in multiple trauma patients. Increased IL-6 values are an indicator of the development of a nosocomial infection in trauma patients.
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Critical care medicine · Nov 1997
Comparative Study Clinical TrialEffect of antihypertensive agents on the arterial partial pressure of oxygen and venous admixture after cardiac surgery.
To determine whether stopping nitroglycerin and sodium nitroprusside (both vasodilators) infusions in hypertensive, postcardiac surgical patients requiring a high FIO2 improves PaO2 and venous admixture. ⋯ Substituting labetalol for nitroglycerin and sodium nitroprusside improves arterial oxygenation and venous admixture in hypertensive postcardiac surgical patients who require a high FIO2. This change in therapy may allow patients to be weaned from mechanical ventilation sooner.
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Critical care medicine · Nov 1997
Comparative StudyParticipation of tissue factor and thrombin in posttraumatic systemic inflammatory syndrome.
To determine the roles of tissue factor and thrombin on the systemic inflammatory response syndrome (SIRS) in posttrauma patients, as well as to investigate the relationship between SIRS and sepsis. ⋯ Sustained SIRS is the main determinant for ARDS, multiple organ dysfunction syndrome, and outcome in posttrauma patients. Disseminated intravascular coagulation associated with massive thrombin generation and its activation is involved in the pathogenesis of sustained SIRS. Sepsis has a small role in early posttrauma multiple organ dysfunction syndrome.
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Critical care medicine · Nov 1997
Comparative Study Clinical TrialLithium dilution cardiac output measurement: a comparison with thermodilution.
To compare the results of cardiac output measurements obtained by lithium dilution and thermodilution. ⋯ The overall agreement between the two methods was good. The variability of the thermodilution measurements was greater than that of the lithium dilution measurements. The lithium dilution method is at least as accurate as bolus thermodilution and, since pulmonary artery catheterization is not needed, it has the advantages of being safe and quick to perform.
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Critical care medicine · Nov 1997
Survival in patients with nosocomial pneumonia: impact of the severity of illness and the etiologic agent.
To assess the impact of severity of illness at different times, using the Mortality Probability Models (MPM II), and the impact of etiologic agent on survival in patients with nosocomial pneumonia. ⋯ Severity of illness when pneumonia is diagnosed is the most important predictor of survival, and this determination should be used for therapeutic and prognostic stratification. In addition, the presence of P. aeruginosa contributed to an excess of mortality that could not be measured by MPM II alone, suggesting the importance of the pathogen in prognosis.