摘要:

ObjectiveLisofylline is an enantiomer-specific, alkyl-substituted methylxanthine, which has specific and potent activity in down-regulating leukocyte activation. This study was designed to test the efficacy of lisofylline in the resuscitation of rats subjected to experimental hemorrhagic shock.DesignProspective, randomized, and blinded survival studies were performed with two lisofylline dosing regimens added to fluid resuscitation in a shock model. In addition, white cell adhesiveness was measured to assess the effects of lisofylline.SettingAnimal laboratory.SubjectsSixty Sprague-Dawley rats.InterventionsLisofylline or placebo was added to the resuscitation regimen, either as a single dose or over 24 hrs.Measurements and Main ResultsThe 72-hr survival rate, white blood cell count, and platelet adhesiveness were determined. When a single, 1-hr infusion of lisofylline was added to the initial resuscitation regimen, the 72-hr survival rate increased from 20% in controls to 50% (p < .009). When repeated doses of lisofylline were given over 24 hrs, the 72-hr survival rate increased from 40% in controls to 70% (p < .02). Control animals significantly increased leukocyte adhesiveness after shock and resuscitation. This increased adhesiveness was completely eliminated by lisofylline infusion. Platelet adhesiveness was not affected by lisofylline.ConclusionsLisofylline improves survival in this model of hemorrhagic shock. Its beneficial effect may be related to down-regulation of leukocyte adhesiveness.(Crit Care Med 1996; 24:1724-1728)

ISSN:0090-3493    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectivesTo review the diagnosis and management of vertebrobasilar thrombosis and to discuss the use of thrombolytics in the treatment of this disease.Data SourcesSelected references discussing epidemiology, anatomy, pathophysiology, diagnosis, therapy, and rehabilitation of vertebrobasilar occlusive disease.Study SelectionStudies addressing acute intervention and outcome in the therapy of vertebrobasilar thrombosis were reviewed.Data ExtractionOnly those studies with angiographic documentation of arterial thrombosis and, in the case of thrombolysis, recanalization, were considered valid.Data SynthesisThrombosis of the vertebrobasilar system is a highly fatal disease and should be treated as a neurologic emergency. The key to effective management depends on early recognition of the symptom complex and a thorough understanding of the anatomy and pathophysiology of the disease process.ConclusionsA timely, integrated, multidisciplinary approach to the patient with vertebrobasilar thrombosis can improve outcome. The use of thrombolytics in the treatment of vertebrobasilar occlusion holds promise but the benefits have not yet been proven in a controlled, randomized study.(Crit Care Med 1996; 24:1729-1742)

ISSN:0090-3493    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo study the current intensive care management of patients with severe head injury (defined as a Glasgow Coma Scale score of <or=to8) in neurosurgical referral centers in the United Kingdom (UK) and Ireland.Data CollectionA questionnaire was sent to the directors of the 44 neurosurgical referral units identified from the UK Medical Directory. After 4 wks, a copy of the questionnaire was sent to all nonresponders, with a cover letter urging them to respond. The aim was to collect data regarding the characteristics of the intensive care units (ICU), sedation, monitoring modalities used, the treatment of intracranial hypertension, and general care of severely head-injured patients.Data Extraction100 patients with severe head injury.50% of the patients in 94% and 77% of the centers, respectively, intracranial pressure was only monitored routinely in 57% of the centers. Jugular venous bulb oximetry, transcranial Doppler ultrasonography, electroencephalography, and near-infrared spectroscopy were rarely used.Nearly all centers used propofol and midazolam for sedation, with morphine, fentanyl, and alfentanil as the main analgesics.Muscle relaxation was commonly used, with 40% of the centers employing it in 100% of their patients. Atracurium and vecuronium were the most commonly used agents.Only 68% of the centers had a protocol for the treatment of intracranial hypertension.Although hyperventilation to a PaCO2of 26 to 30 torr (3.5 to 4.0 kPa) was the norm in the majority of centers (56%), two centers aimed for PaCO260 mm Hg. Mild hypothermia was rarely used and 14% of the centers continued to use corticosteroids for the treatment of intracranial hypertension as a result of head trauma.ConclusionWe conclude that there are wide variations in the management of the severely head-injured patient in the UK and Ireland. Some of the therapies employed are not supported by available research findings. Rationalization (using rational management, i.e., based on good evidence) of the intensive care management of severe head injury with the development of widely accepted guidelines may result in an improvement in the quality of care of the head-injured patient.(Crit Care Med 1996; 24:1743-1748)

ISSN:0090-3493    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveWe compared a case-series of ten patients who developed prolonged neuromuscular weakness after continuous, nondepolarizing, neuromuscular blockade with a group of controls without neuromuscular weakness to determine the economic impact of the neuromuscular weakness.DesignFrequency-matched case control trial.SettingMedical and surgical intensive care units of a 937-bed tertiary care, university-affiliated teaching hospital.PatientsTen patients developed prolonged neuromuscular weakness after continuous administration of nondepolarizing neuromuscular blockers. Ten patients from a 1994 drug utilization database who did not develop motor weakness after paralysis were identified to serve as controls.Measurements and Main ResultsThe medical and accounting records of the patients were retrospectively reviewed. Charge data were obtained from patient accounts. Institutional ratios to convert charges to full costs and marginal costs were obtained from the Hospital Finance Department of Henry Ford Hospital. The economic impact of the diagnosis and recovery of the motor weakness was estimated for the intensive care unit (ICU) and hospital stays and compared with those values for control patients. Median hospital charges (excluding rehabilitation), totaling $91,476, were attributed to the patients who developed neuromuscular weakness and included charges for neuromuscular blocking agents, continuous mechanical ventilation, ICU and hospital beds, neurologic studies, and physical therapy services. In the control patients, median charges were $22,191 (p = .001). The total median cost differential for a patient in the neuromuscular weakness group was in excess of $66,713 (95% confidence interval $23,485 to $189,214, p = .001). Significant differences were also found for patient charges, full costs, and marginal costs for mechanical ventilation (p = .002), neurologic studies (p = .014), as well as ICU (p = .002) and hospital (p = .001) stays.ConclusionsThe development of motor weakness was associated with an increase in ICU and hospital stays, continued mechanical ventilation, and disproportionate healthcare expenditures in excess of $66,000 per patient. A prospective evaluation of the true prevalence of neuromuscular weakness after neuromuscular blockade and of the costs to the healthcare system is needed.(Crit Care Med 1996; 24:1749-1756)

ISSN:0090-3493    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

ObjectiveTo provide practical suggestions for accessing, utilizing, and storing the rapidly expanding literature on critical care.Data SourcesOriginal research on information sources for clinicians and techniques for keeping up with the literature, found through bibliographic searches, our personal files, and consultation with critical care colleagues.Data SynthesisSuggestions for keeping up with the critical care literature include: 1) focus the clinical question; 2) locate literature using bibliographic databases; 3) use original journal articles; 4) use systematic reviews with confidence; 5) use textbooks with caution; 6) read the preappraised literature; 7) abandon advertisements; 8) throw away the throwaways; 9) teach yourself critical appraisal; 10) be wary of overinterpretation of substitute end points; 11) teach yourself basic clinical statistics; 12) engage in effective browsing; 13) store useful articles; 14) invest in informatics; and 15) implement evidence-based practice guidelines.ConclusionEfficient access, appraisal, and application of the literature on intensive care are basic skills for intensivists, who have adopted a variety of resourceful and pragmatic methods for "keeping up."(Crit Care Med 1996; 24:1757-1768)

ISSN:0090-3493    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1996

数据来源: OVID