Critical care : the official journal of the Critical Care Forum
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Hypertension is an extremely common clinical problem, affecting approximately 50 million people in the USA and approximately 1 billion individuals worldwide. Approximately 1% of these patients will develop acute elevations in blood pressure at some point in their lifetime. ⋯ Immediate reduction in blood pressure is required only in patients with acute end-organ damage. This article reviews current concepts, and common misconceptions and pitfalls in the diagnosis and management of patients with acutely elevated blood pressure.
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Comparative Study
Does the tube-compensation function of two modern mechanical ventilators provide effective work of breathing relief?
An endotracheal tube (ETT) imposes work of breathing on mechanically ventilated patients. Using a bellows-in-a-box model lung, we compared the tube compensation (TC) performances of the Nellcor Puritan-Bennett 840 ventilator and of the Dräger Evita 4 ventilator. ⋯ Although both ventilators provided effective TC, even when set to 100% TC they could not entirely compensate for a ventilator and ETT-imposed work of breathing. The effect of TC is less than that of pressure support ventilation. Physicians should be aware of this when using TC in weaning trials.
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Apoptosis is a process of controlled cellular death whereby the activation of specific death-signaling pathways leads to deletion of cells from tissue. The importance of apoptosis resides in the fact that several steps involved in the modulation of apoptosis are susceptible to therapeutic intervention. ⋯ The second hypothesis, the 'epithelial hypothesis', suggests that epithelial injury in acute lung injury is associated with apoptotic death of alveolar epithelial cells triggered by soluble mediators such as soluble Fas ligand. We also review recent studies that suggest that the rate of clearance of apoptotic neutrophils may be associated with resolution of neutrophilic inflammation in the lungs, and data showing that phagocytosis of apoptotic neutrophils can induce an anti-inflammatory phenotype in activated alveolar macrophages.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of sufentanil with sufentanil plus magnesium sulphate for sedation in the intensive care unit using bispectral index.
In intensive care unit patients we assessed, using bispectral index (BIS) monitoring, whether the addition of magnesium sulphate infusion could decrease the sufentanil infusion required to maintain sedation. ⋯ This is the first clinical study to demonstrate that magnesium sulphate infusion decreases sufentanil requirements. Because of the limited number of patients included and the short period of observation, our findings must be confirmed by larger clinical trials of magnesium infusion titrated to achieve prespecified levels of sedation. Furthermore, randomized clinical studies are needed to determine the effects of magnesium infusion on opioids.
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Comparative Study Clinical Trial
Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients.
The increasing prevalence of multiresistant Gram-negative strains in intensive care units (ICUs) has recently rekindled interest in colistin, a bactericidal antibiotic that was used in the 1960s for treatment of infections caused by Gram-negative bacilli. We conducted the present observational study to evaluate the efficacy of intravenous colistin in the treatment of critically ill patients with sepsis caused by Gram-negative bacilli resistant to all other antibiotics. ⋯ The lack of a control group in the present study does not allow any definite conclusions to be drawn regarding the clinical effectiveness of colistin. On the other hand, this drug has an acceptable safety profile and its use should be considered in severe infections with multiresistant Gram-negative bacilli.