Critical care medicine
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Critical care medicine · Apr 1996
Comparative StudyNonrespiratory predictor of mechanical ventilation dependency in intensive care unit patients.
To determine the role of serum albumin concentration as a predictor of mechanical ventilation dependency. ⋯ Initial serum albumin concentration did not necessarily predict weaning success. However, when serum albumin concentration was assessed on a daily basis, its trend was important in determining the relative chance of being successfully weaned from the ventilator. This finding suggests that albumin may be an index of the metabolic status of the patient, which could be important in determining the weanability of the patients who are mechanically ventilated for prolonged periods of time.
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To analyze the status of the teaching of critical care at the postgraduate and undergraduate levels in Europe. ⋯ The standardization of curriculum content on critical care medicine, the clear definition of competence (the combination of knowledge, attitudes, skills, and judgment necessary to practice) in medical schools, and better coordinated postgraduate training are needed to clarify an educational approach in the field. Practitioners of critical care medicine will have to participate actively on curriculum committees. The recognition of critical care medicine as a specialty or subspecialty and as an academic discipline will facilitate the achievement of a comprehensive critical care education program.
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Critical care medicine · Apr 1996
Randomized Controlled Trial Comparative Study Clinical TrialCapnography facilitates tight control of ventilation during transport.
We tested the hypothesis that Paco2 would be more tightly controlled if end-tidal CO2 monitoring was used during hand ventilation for transport of intubated patients. ⋯ These data do not support routine monitoring of end-tidal CO2 during short transport times in adult patients requiring mechanical ventilation. However, the monitor may prevent morbidity in patients requiring tight control of Paco2.
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Critical care medicine · Apr 1996
Randomized Controlled Trial Comparative Study Clinical TrialThyrotropin-releasing hormone in critical illness: from a dopamine-dependent test to a strategy for increasing low serum triiodothyronine, prolactin, and growth hormone concentrations.
The aim of this study was to examine the effect of dopamine infusion on the thyrotropin (TSH), thyroid hormone, prolactin, and growth hormone responses to thyrotropin-releasing hormone (TRH) in critically ill patients. ⋯ The TSH response to TRH administration in critical illness presents a striking interindividual variation and dopamine dependent. Repeated TRH administration results in a repetitive increase of TSH, prolactin, growth hormone, T4, and T3, without increasing reverse T3. These observations point toward a potential for TRH as a strategy for reversing the euthyroid sick syndrome, growth hormone deficiency, and immune dysfunction associated with critical illness.
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Critical care medicine · Apr 1996
Randomized Controlled Trial Comparative Study Clinical TrialLow lipid concentrations in critical illness: implications for preventing and treating endotoxemia.
To determine the prevalence and clinical significance of hypolipidemia found in critically ill patients, and whether the addition of a reconstituted lipoprotein preparation could inhibit the generation of tumor necrosis factor-alpha (TNF-alpha) in acute-phase blood taken from these patients. ⋯ Patients who are critically ill from a variety of causes have extremely low cholesterol and lipoprotein concentrations. Correction of the hypolipidemia by a reconstituted high-density lipoprotein preparation offers a new strategy for the prevention and treatment of endotoxemia.