Swiss medical weekly
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For supportive therapy in sepsis adequate volume loading is probably the first, and possibly the most important step in the treatment of patients with septic shock. An elevated global O2-supply (DO2) may be necessary and beneficial in most of these patients, but the increase in DO2 should be guided by measurement of parameters assessing global and regional oxygenation. Routine strategies for elevating DO2 by the use of very high dosages of catecholamines cannot be recommended. ⋯ Dopexamine has been suggested for improvement of splanchnic perfusion, but since these effects remain somewhat controversial there are no current grounds for a general recommendation in favour of dopexamine in septic patients. These recommendations are currently limited by the lack of sufficient outcome studies and studies evaluating regional perfusion. Until the various catecholamine regimes are more fully examined, recommendations for catecholamine support in sepsis must be considered "conditional".
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Swiss medical weekly · Dec 2000
ReviewNon-conventional vasopressors in septic shock: effects on hepatosplanchnic blood flow.
Vasopressors are necessary to treat the vasodilation characteristic of hypotension in septic shock. In addition to noradrenaline, the reference vasopressor, various drugs, including dopamine, adrenalin, phenylephrine, L-NMMA (a nitric oxide synthase inhibitor), and vasopressin have been used in clinical septic shock. ⋯ All these drugs can modify the perfusion and metabolism of splanchnic organs, changes which cannot be predicted from changes in systemic circulation or metabolism. Due to the complexity of actions and the high potential for severe adverse effects, "compassionate" use of unconventional vasopressors to treat hypotension in septic shock should be abandoned outside the scope of controlled clinical trials.
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Swiss medical weekly · Dec 2000
Review[Role of noninvasiveness ventilation in the weaning phase of mechanical ventilation].
During the last decade, noninvasive ventilation has proved to be a valuable alternative to endotracheal intubation in many patients with acute respiratory failure, allowing a reduction in morbidity, mortality and length of intensive care and hospital stay compared to conventional mechanical ventilation. Recent data from clinical studies suggest that these beneficial effects could also be extended to the weaning phase of mechanical ventilation, by reducing, in some patients at any rate, its duration and complication rate. The present paper focuses on some of these promising new aspects of noninvasive ventilation and attempts to define the possible indications and limits of this technique in the context of weaning.
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Swiss medical weekly · Dec 2000
Comparative Study[Evaluation of antibiotic prophylaxis in neutropenic patients with hematologic malignancies].
The benefits of oral prophylaxis for neutropenia have remained controversial up to now. We evaluated retrospectively the effect of antibiotic prophylaxis with ciprofloxacin and penicillin on the prevention of bacterial infections in 112 cases of prolonged neutropenia in adult patients treated for haematological malignancies. 41 patients received prophylaxis between December 1993 and November 1994 while 71 patients did not receive prophylaxis between December 1994 and November 1995. There were no significant differences between groups in age, sex, type or stage of haemopathy, type of chemotherapy and duration of neutropenia. ⋯ The prophylaxis did not reduce the overall incidence of bacteraemia, of clinically documented infections or of fever of unknown origin. This retrospective study confirms that oral prophylaxis with ciprofloxacin and penicillin decreases the incidence of infections and, in particular, of gram-negative bacteraemia, but does not modify the overall morbidity and mortality in our patients. In view of the risk of emergence of bacterial resistance, these data do not support the routine use of oral antibiotic prophylaxis in neutropenic patients with haematological malignancies.