Critical care : the official journal of the Critical Care Forum
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A number of issues concerning stress ulcer prophylaxis remain unresolved despite numerous randomized, controlled trials and several meta-analyses. The role of stress ulcer prophylaxis, particularly in trauma patients, is further complicated by the lack of trials utilizing clinically important bleeding as an endpoint. Given the lack of consensus regarding stress ulcer prophylaxis in trauma patients, prescribing practices at Level I trauma centers in the United States were assessed. ⋯ The lack of consensus with regards to appropriate stress ulcer prophylaxis is apparent in this survey of Level I trauma centers. For those institutions with a preferred agent, histamine-2-blockers were most common.
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We wished to determine whether cholestasis induced by total parenteral nutrition (TPN) in preterm newborn infants is associated with increased oxidative stress secondary to increased reactive oxygen intermediates. We hypothesized that elevated urinary thiobarbituric-acid-reacting substances (TBARS), a marker of oxidative stress, would be associated with hepatocellular injury as measured by serum alanine transaminase (ALT) and aspartate transaminase (AST) levels. ⋯ Our findings suggest that oxidant stress is associated with hepatocellular injury in preterm infants. This effect is not correlated with the degree of cholestasis.
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Under conditions of shock, bacteria and endotoxins in the intestines can traverse the mucosal barrier by translocation and enter the blood and lymphatic system. Immunoglobulins and lactoferrin have been reported to neutralize endotoxins and bacteria. We studied the essential therapeutic factors of colostrum products in an animal experiment. ⋯ Both gammaglobulin and lactoferrin may help to eliminate endotoxins when bovine colostrum is administered into the gut in conditions of septic shock.