Articles: critical-care.
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Nephrol. Dial. Transplant. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialThe effect of sodium and ultrafiltration modelling on plasma volume changes and haemodynamic stability in intensive care patients receiving haemodialysis for acute renal failure: a prospective, stratified, randomized, cross-over study.
Haemodynamic stability in intensive care unit (ICU) patient with acute renal failure (ARF) during intermittent dialytic support has been the focus for several variations to dialysis delivery. Indeed this has been noted by many as a possible cause for prolonged renal dysfunction created by repeated hypotensive renal insult, as well as a reason for the lower delivered dialysis dose afforded. End-stage renal failure patients supported by intermittent dialysis have benefitted from variable sodium dialysate and variable ultrafiltration rate protocols. The current study has focused upon the response to these dialysis variations in the ICU ARF patient. ⋯ Haemodynamic stability was greater during Protocol B than during Protocol A in all patients. Significantly less intervention was noted during Protocol B, despite the same dialysis delivery during both Protocols. Relative Blood volume changes were less during Protocol B, despite a greater total ultrafiltration. Variable sodium dialysate coupled with a variable ultrafiltration rate seems to be the preferred dialysis prescription for ICU ARF patients undergoing intermittent haemodialysis.
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Sepsis and septic shock continue to be the most common causes of death and multiple organ failure among patients in intensive care units. The standard therapeutic regimens include surgical removal of the source of sepsis, antimicrobial therapy, optimizing oxygenation, volume resuscitation, and treatment with catecholamines. ⋯ New therapeutic approaches have become available, including the administration of high doses immunoglobulins, monoclonal antibodies against endotoxin, pentoxilfyline and nitrous oxide inhibitors. Based on the encouraging findings, controlled clinical studies are undertaken to assay with precision their clinical efficacy.
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Acta neurochirurgica · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialKetamine for analgosedative therapy in intensive care treatment of head-injured patients.
Ketamine was supposed to be contra-indicated in head injured patients although it possesses numerous advantages over other commonly used analgosedative drugs. Referring to these potential advantages and the lack of definitive data about its effect upon ICP, CPP or neurological development, we conducted a prospective study in which moderate or severely head injured patients (n = 35) were prospectively allocated to receive treatment either with a combination of ketamine or midazolam or fentanyl and midazolam. The initial dose was 6.5 mg/kg/day midazolam, 65 mg/kg/day ketamine or 65 micrograms/kg/day fentanyl and was later adjusted due to clinical requirements for a period of 3 to 14 days. ⋯ A comparison of the remaining patients revealed a lower requirement of catecholamines (significant on first day, p<0.05), an on average 8 mm Hg higher cerebral perfusion pressure and a 2 mm Hg higher intracranial pressure in the study [corrected] group. Enteral food intake was better in the study group. The outcome was comparable in both groups with or without inclusion of withdrawn patients.
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Wien. Klin. Wochenschr. · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialSafety and efficacy of increasing dosages of glycyl-glutamine for total parenteral nutrition in polytrauma patients.
Supplementation of parenteral nutrition with glutamine (GLN) has been suggested to improve the efficacy of nutritional support by stimulating protein synthesis and improving immunocompetence. In the present study we investigated the impact of infusing the dipeptide glycyl-glutamine (GLY-GLN) at increasing dosages on plasma amino acid concentrations in patients with polytrauma. Nine polytraumatized patients were randomly assigned according their age and their trauma score to three experimental groups. ⋯ We conclude from this first available dose finding study on glutamine-containing dipeptides that in polytraumatized patients infusion of 570 mg/kg/day of GLY-GLN (corresponding to 28 g glutamine or 40 g dipeptide/70 kg, respectively) is necessary to induce a sustained effect on plasma glutamine concentrations. No pathological accumulation of free glycine or of the dipeptide was seen with any of the three dosage steps of GLY-GLN. Thus, the administration of even high doses of GLY-GLN is feasible and safe in patients with polytrauma and is not associated with any relevant renal substrate loss.
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Acute respiratory distress syndrome (ARDS) is rare but beset with a high mortality rate. In recent years, however, a trend towards higher survival rates has been observed. High inspiratory oxygen concentrations, large tidal volumes, and high peak inspiratory airway pressures applied during mechanical ventilation have been identified as harmful to the lung and can contribute to the progression of ARDS. ⋯ Should these procedures fail to improve impaired gas exchange, extracorporeal membrane oxygenation is an additional therapeutic option. None of these therapeutic procedures, however, has been tested against traditional standard treatment in a classical randomised controlled trial. The following review focuses on the latest insights into the pathophysiology, diagnosis, and treatment of ARDS.