Critical care medicine
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Critical care medicine · Jul 1994
ReviewBiology of proinflammatory cytokines and their antagonists.
To review the role of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 (IL-1) in the proinflammatory cascade, with particular emphasis on the association between increased concentrations of these cytokines and the sepsis-associated shock syndrome. Data that support the role of these cytokines as proinflammatory mediators provide a rationale for specific anticytokine therapies. ⋯ Induction of inflammation during sepsis is a complex biological cascade that may be effectively attenuated by novel anticytokine biotherapies.
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Critical care medicine · Jul 1994
Comparative StudyThermodilution right ventricular ejection fraction measurements: room temperature versus cold temperature injectate.
To compare thermodilution right ventricular ejection fraction measurements using 10 mL room temperature injectate vs. 10 mL cold temperature injectate. ⋯ The results suggest that room temperature injectate may be used for right ventricular ejection fraction measurements in critically ill adult surgical patients. Utilizing room temperature injectate for right ventricular ejection fraction measurements may save time and costs in the critical care unit.
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Critical care medicine · Jul 1994
ReviewDoes the formulation of enteral feeding products influence infectious morbidity and mortality rates in the critically ill patients? A critical review of the evidence.
To examine the relationship between the formulation of enteral nutrition and nosocomial infection in critical illness. ⋯ Insufficient experimental data exist to permit conclusions that enteral nutrition formulations or supplements reduce infectious morbidity and mortality rates, but results are promising enough to warrant further research.
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To review the role of antimediator therapy in the inflammatory cascade associated with sepsis, and to review the status of animal and clinical studies being conducted on novel therapies for septic shock. ⋯ Clinical trials of antiendotoxin antibodies have not shown them to have therapeutic benefit. New agents that neutralize or antagonize the cellular effects of endotoxin may provide an alternative means to inhibit endotoxin effects during severe Gram-negative infections. Anti-interleukin-1 and antitumor necrosis factor-alpha therapies have demonstrated efficacy in animal models, but the results have been inconsistent in human trials. Preliminary results from clinical trials of cytokine antagonists suggest that these therapies may be effective in the most severely ill patients. Further clinical trials will be required to determine the therapeutic role of these agents in septic shock.
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Critical care medicine · Jul 1994
Comparative StudyWomen are at greater risk than men for malpositioning of the endotracheal tube after emergent intubation.
To investigate the occurrence of endotracheal tube malpositioning after emergent intubation in critically ill adults and to determine the need for a routine postintubation chest radiography to assess endotracheal tube position. ⋯ Emergent endotracheal intubations result in a significant occurrence of malpositioned endotracheal tubes that are undetected by clinical evaluation. Malpositioning is not detected by routine clinical assessment, but only by chest radiograph. Women are at greater risk than men for endotracheal tube malpositioning after emergent intubation; in women, the endotracheal tube is more likely to be positioned too close to the carina. A chest radiograph for confirmation of endotracheal tube position after emergent intubation should remain the standard of practice.