Critical care medicine
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Critical care medicine · Feb 1995
Relationship between blood lactate concentrations and ionized calcium, glucose, and acid-base status in critically ill and noncritically ill patients.
To determine the relationships between circulating blood lactate concentrations and several biochemical variables including ionized calcium, glucose, pH, and acid-base status in critically ill and noncritically ill patients. ⋯ a) There is neither a statistically significant nor clinically relevant relationship between whole blood lactate concentrations and ionized calcium concentrations when studying patients with or without hyperlactatemia. b) Although there is a statistically significant correlation between circulating lactate concentrations and blood glucose concentrations, arterial pH or arterial base deficit, such associations do not appear to be clinically important.
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Critical care medicine · Feb 1995
Pressure-controlled, inverse ratio ventilation that avoids air trapping in the adult respiratory distress syndrome.
To investigate physiologic and outcome data in patients switched from volume-cycled conventional ratio ventilation to pressure-controlled inverse ratio ventilation that did not produce air trapping and intrinsic positive end-expiratory pressure (PEEP). ⋯ These data demonstrate that oxygenation is primarily a function of mean airway pressure, and that longer inspiratory times can be used as an alternative to applied PEEP to increase this oxygenation. If no air trapping develops, lung inflation pressures and delivered volumes remain constant with this approach. Because the technique was used only in patients refractory to conventional techniques, the poor outcome is not surprising.
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Critical care medicine · Feb 1995
Beneficial effects of combined thromboxane and leukotriene receptor antagonism in hemorrhagic shock.
Both thromboxane A2 and peptide leukotrienes D4/E4 have been implicated in the pathophysiology of circulatory shock. In the present study, we evaluated the effect of thromboxane A2 and leukotriene D4/E4 receptor antagonism in circulatory shock. ⋯ The present findings support a role for thromboxane A2 and peptide leukotrienes D4/E4 as important mediators in circulatory shock and suggest that combined thromboxane/leukotriene receptor antagonism may have superior therapeutic efficacy to leukotriene receptor antagonism.
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Critical care medicine · Feb 1995
Round table conference on clinical trials for the treatment of sepsis.
Using an evidence-based approach for a round table conference, to discuss sepsis according to its current epidemiology and clinical management, lessons which we feel can be learned by investigators from the design and conduct of previous clinical trials of drug therapy, and to describe the "optimum" clinical trials design for treatments of this syndrome. ⋯ Recommendations for the design, conduct and analysis of future trials of sepsis therapies were summarized.
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Critical care medicine · Feb 1995
Attenuation of shock-induced hepatic microcirculatory disturbances by the use of a starch-deferoxamine conjugate for resuscitation.
To determine the effects of a hydroxyethyl starch-deferoxamine conjugate on hepatic microcirculation in an isobaric, anesthetized rat model of hemorrhagic shock and asanguineous resuscitation. ⋯ Asanguineous resuscitation with conventional hydroxyethyl starch failed to restore hepatic microvascular blood flow, despite otherwise effective resuscitation. In contrast, the starch-deferoxamine conjugate improved volumetric blood flow and attenuated leukocyte margination in hepatic sinusoids compared with starch-vehicle, suggesting involvement of iron-dependent, oxygen-derived radicals in shock-induced hepatic microcirculatory disturbances.