Critical care medicine
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Critical care medicine · Jun 1995
Randomized Controlled Trial Multicenter Study Clinical TrialA second large controlled clinical study of E5, a monoclonal antibody to endotoxin: results of a prospective, multicenter, randomized, controlled trial. The E5 Sepsis Study Group.
To evaluate the safety and efficacy of E5, a murine, monoclonal antibody directed against endotoxin, in the treatment of patients with Gram-negative sepsis. ⋯ In this study, E5 did not reduce mortality in nonshock patients with Gram-negative sepsis whether or not those patients also had organ failure. However, E5 did result in greater resolution of organ failure in patients with Gram-negative sepsis. This benefit extended to those patients with suspected Gram-negative etiology. This finding is important because patients with suspected Gram-negative sepsis and organ failure can be identified without waiting for culture results. In addition, E5 resulted in the prevention of adult respiratory distress syndrome and central nervous system organ failure. However, more studies are needed to determine if this result can be extended to organ failure in general. E5 is safe as a treatment for patients with Gram-negative sepsis.
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Critical care medicine · Jun 1995
Multicenter StudyProbability of survival after prolonged extracorporeal membrane oxygenation in pediatric patients with acute respiratory failure. Extracorporeal Life Support Organization.
Extracorporeal membrane oxygenation (ECMO) has been used with increasing frequency for respiratory failure that is unresponsive to conventional therapy. We examined the relationship between duration of ECMO and outcome to understand whether prolonged ECMO (duration of the procedure for > 14 days) was more commonly associated with futile therapy or eventual recovery. ⋯ While the survival rate in pediatric patients receiving ECMO appears related to the severity of lung disease and to the occurrence of ECMO complications, the survival rate in patients treated with ECMO courses of > 2 wks was similar to the survival rate of patients treated for shorter periods of time. ECMO was terminated in some patients for pulmonary futility at durations of ECMO associated with survival in substantial numbers of patients in whom ECMO was continued.
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Critical care medicine · Jun 1995
Randomized Controlled Trial Clinical TrialFrequency of mortality and myocardial infarction during maximizing oxygen delivery: a prospective, randomized trial.
To determine the frequency of myocardial infarction and mortality during treatment that increased oxygen delivery (DO2) to > or = 600 mL/min/m2. To define the characteristics of patients achieving a high DO2 without inotropes in order to guide future studies. ⋯ The group that required catecholamines to achieve a DO2 of > or = 600 mL/min/m2 had a lower mortality rate, with no increase in the frequency of myocardial infarction. Future prospective, controlled trials examining select groups of patients (age > or = 50 yrs) may demonstrate a difference between control and treatment groups by eliminating the majority of patients who generate the high DO2 with only preload augmentation.
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Critical care medicine · Jun 1995
Comparative StudyIncreasing organ blood flow during cardiopulmonary bypass in pigs: comparison of dopamine and perfusion pressure.
To determine whether low-dose dopamine infusion (5 micrograms/kg/min) during cardiopulmonary bypass selectively increases perfusion to the kidney, splanchnic organs, and brain at low (45 mm Hg) as well as high (90 mm Hg) perfusion pressures. ⋯ These data indicate that the lower autoregulatory limits of perfusion to the kidneys and splanchnic organs differ from those limits to the brain during normothermic bypass. Selective vasodilation from low-dose dopamine was not found in renal, splanchnic, or cerebral vascular beds. Increasing the perfusion pressure by pump flow, rather than by the addition of low-dose dopamine, enhanced renal and splanchnic but not cerebral blood flows during cardiopulmonary bypass.
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Critical care medicine · Jun 1995
Variability of intrinsic positive end-expiratory pressure in patients receiving mechanical ventilation.
Since variations in breathing pattern may affect the level of intrinsic positive end-expiratory pressure (PEEP), breath-to-breath variation of intrinsic PEEP was assessed. ⋯ We conclude that the occurrence rate of intrinsic PEEP in mechanically ventilated patients is high. The degree of variability in intrinsic PEEP on a breath-to-breath basis is also high. It may be difficult to find a specific level of intrinsic PEEP. Addition of external positive end-expiratory pressure without considering the breath-to-breath variability may lead to overdistention of the lung.