Articles: critical-illness.
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Randomized Controlled Trial Clinical Trial
Glutamine dipeptide-supplemented parenteral nutrition maintains intestinal function in the critically ill.
Long-term total parenteral nutrition is accompanied with mucosal atrophy and subsequent malabsorption syndrome. Current information attests the important role of glutamine in maintaining intestinal structure and function. The aim of this study was to investigate the effect of glutamine dipeptide supplementation on small intestinal absorption capacity during critical illness. ⋯ The results strongly suggest that glutamine dipeptide-containing total parenteral nutrition prevents intestinal atrophy and increased permeability associated with glutamine-free parenteral nutrition.
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Recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for the triage and resuscitation of critically ill patients during the 'golden hour' in the emergency department. Vital signs, shock index and invasive monitoring of mean arterial pressure and central venous pressure have limited roles in evaluating cumulative oxygen debt and systemic oxygen balance in an acute critical illness. ⋯ Organ-specific oxygenation indices such as gastric tonometry and renal function can supplement indicators of systemic oxygen balance to detect ischaemia-hypoxia of non-vital organs. Systemic oxygenation and organ-specific indices can guide the choice of therapy to optimize resuscitation of the macro- and microcirculation in critically ill patients in the emergency department.
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To describe the pharmacokinetics of midazolam, a water-soluble benzodiazepine with a short half-life, in critically ill neonates. ⋯ The mean midazolam doses required for critically ill neonates are lower than those required for older infants.
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Semin Respir Infect · Dec 1994
ReviewEffect of manipulating dietary constituents on the incidence of infection in critically ill patients.
Nutrition status has major implications for the incidence of infectious complications in critically ill patients. Providing macronutrients and micronutrients in appropriate amounts consistent with the metabolism present during the inflammatory response can significantly reduce the incidence of infectious complications. Current data would indicate that the enteral route of nutrition is more effective in this regard when it is used within 3 to 4 days after injury. ⋯ Despite these effects, infectious complications remain a common problem in critically ill patients. Based on the anti-inflammatory and lymphoproliferative properties of specific nutrients, enteral products have been formulated with increased amounts of these nutrients. The results of current studies with these products indicate a further reduction in infectious complications and length of hospital stay.
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Critical care medicine · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialRenal support in critically ill patients: low-dose dopamine or low-dose dobutamine?
Low-dose dopamine has been used in critically ill patients to minimize renal dysfunction without sufficient data to support its use. The aim of this study was to determine whether low-dose dopamine improves renal function, and whether dobutamine, a nondopaminergic inotrope, improves renal function. ⋯ In stable critically ill patients, dopamine acted primarily as a diuretic and did not improve creatinine clearance. Dobutamine improved creatinine clearance without a significant change in urine output.