Critical care : the official journal of the Critical Care Forum
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The rate of oxygen consumption by certain tissues is impaired when mice or rats are injected with lipopolysaccharide. A similar change in the rate of oxygen consumption is observed when Caco-2 human enterocyte-like cells are incubated in vitro with cytomix, a cocktail of cytokines containing tumor necrosis factor, IL-1beta, and IFN-gamma. ⋯ Recently, however, our laboratory has obtained data to suggest that the most important mechanism underlying the development of cytopathic hypoxia is depletion of cellular stores of nicotinamide adenine dinucleotide (NAD+/NADH) as a result of activation of the enzyme, poly(ADP-ribose) polymerase-1. If cytopathic hypoxia is important in the pathophysiology of established sepsis and multiorgan dysfunction syndrome, then efforts in the future will need to focus on pharmacological interventions designed to preserve normal mitochondrial function and energy production in sepsis.
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The present review introduces nonparametric methods. Three of the more common nonparametric methods are described in detail, and the advantages and disadvantages of nonparametric versus parametric methods in general are discussed.
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Sepsis, the life-threatening illness that arises from innate immunity to overwhelming infection, is treated symptomatically at the start of the 21st century. Looking ahead 50 years, one can perhaps foresee profound changes in the way we manage this disorder. A shift from a focus on eradicating micro-organisms as universally inimical to one on supporting optimal host–microbial homeostasis will have a profound impact on how we treat infection, and will relegate antibiotics to a small, adjuvant role. ⋯ Rapid genetic profiling will permit pre-emptive gene therapy for some, and titration of specific therapies directed against fundamental intracellular processes in others. We will treat diseases, not syndromes, and guide therapy by molecular staging. A fanciful victim of sepsis in 2051 illustrates how future treatments might transform sepsis from a prolonged and morbid illness to a rapidly reversed acute disease.
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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.