Current opinion in critical care
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Trauma and infection elicit an acute inflammatory response. In certain circumstances the degree of the acute inflammatory response may result in pathologic manifestations, namely, sepsis and multiple organ failure. Despite an extensive series of clinical trials designed to modulate inflammation in sepsis, only one compound, activated protein C, has emerged from more than 250 failed trials. There is a growing recognition that the complexity of the acute inflammatory response precludes the efficient development of therapies for sepsis and multiple organ failure until systems approaches are brought to bear on this problem. ⋯ Simulations using various methods can shed insight into the pathophysiology of the acute inflammatory response and may lead to better design of clinical trials in sepsis and trauma.
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Curr Opin Crit Care · Oct 2004
ReviewAdvances in statistical methodology and their application in critical care.
To review some of the major advances in statistical methodology of the past two decades and their application to investigations in critical care. ⋯ By becoming familiar with advances in statistical methodology, researchers and clinicians can enhance collaboration with their statistical colleagues, toward the goal of better study design and analysis.
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Curr Opin Crit Care · Oct 2004
ReviewPostbypass arrhythmias: pathophysiology, prevention, and therapy.
To review the medical literature on new-onset arrhythmias after cardiac bypass surgery in adults, focusing on the most recent advances on this topic. ⋯ Recent studies demonstrate a continued effort to improve our knowledge about postbypass arrhythmias. New insights in the pathophysiology of postoperative cardiac arrhythmias and advances in prevention and therapy are rapid and results are heterogeneous, so it is difficult for the clinician to keep abreast with these new findings.
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This review discusses the physiology of natriuretic peptides as a group and brain natriuretic peptide (BNP) in more detail. It will also highlight implications for the use of the natriuretic peptides in the diagnosis and treatment of patients with cardiovascular disease. ⋯ Current data suggest that single and serial plasma measurement of BNP concentrations is a useful tool in the diagnosis and risk stratification of patients with heart disease. Nesiritide, the human recombinant form of BNP, is a new promising parenteral treatment in decompensated heart failure.