ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo evaluate the influence of the methylxanthine derivative, pentoxifylline, on plasma levels of tumor necrosis factor (TNF)-alpha, interleukin (IL)-1, and IL-6 in prematurely delivered infants with generalized bacterial infections and to assess the effect of this immunomodulating drug on the clinical outcome in newborns with sepsis.DesignA prospective, randomized, double-blind trial.SettingThe neonatal intensive therapy units in university teaching hospitals.PatientsOne hundred patients with sepsis admitted during a 1.5-yr period.InterventionsPatients were randomly assigned to receive pentoxifylline (pentoxifylline group) in a dose of 5 mg/kg/hr for 6 hrs on 6 successive days or an identically presented placebo (placebo group).Measurements and Main ResultsOnly infants with sepsis confirmed by positive blood culture were recruited into the study. There were no significant differences at randomization between the pentoxifylline and placebo groups with regard to the birth weight, gestational age, gender, Apgar score, hypotension, neutropenia, thrombocytopenia, metabolic acidosis, plasma levels of cytokines, and occurrence of shock. Plasma levels of TNF, IL-1, and IL-6 were evaluated before and after the drug or placebo administration on the first, third, and sixth days of therapy. Cytokines were determined by immunoenzymetric test EASIA (TNF) and Endogen Interleukin-Elisa (IL-1, IL-6). The frequency of Gram-negative sepsis was similar in both groups (37.5% and 36.8%). Pentoxifylline significantly diminished plasma TNF levels (p = .009) but had no effect on plasma IL-1 levels. Mean plasma IL-6 levels, which were measured in the pentoxifylline group on the 6th day of the study, were significantly lower compared with respective data obtained in the placebo group. Only 1 of 40 infants with sepsis in the pentoxifylline group died, whereas 6 of 38 infants in the placebo group did not survive (p = .046). An increased incidence of disordered peripheral circulation and metabolic acidosis (p = .048), anuria or oliguria (p = .03), disseminated intravascular coagulation (p = .043), and the occurrence of clinical symptoms of necrotizing enterocolitis (p = .025) was observed in the course of sepsis in infants in the placebo group.ConclusionPentoxifylline significantly affects the synthesis of TNF and IL-6 as well as reduces the mortality rate in premature infants with sepsis. The dosage and schedule of drug administration in this study attenuated the severity of the clinical course of sepsis in this group of patients. (Crit Care Med 1999; 27:807-814)

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo investigate the association of clinical workload and the decision to perform procedures on infants in the neonatal intensive care unit (NICU).DesignProspective cohort study over one academic year, observing infants exposed to housestaff working under various levels of clinical workload.SubjectsAll 31 housestaff rotating on the NICU service during the academic year 1993 to 1994 were observed. A total of 785 infants were admitted to these housestaff.SettingOne academic Level III intensive care nursery.Measurements and Main ResultsClinical workload was operationalized as number of NICU infants cared for by the individual houseofficer on-call each night. The procedures of interest were number of umbilical artery catheters (UACs), intubations, lumbar punctures (LPs), and peripheral phlebotomy performed by the houseofficer on-call.Using multiple linear regression approaches, controlling for the average severity-of-illness of each of the NICU infants, the experience and residency program of the houseofficer on-call, and the individual attending, we found that increased clinical workload (number of NICU infants) resulted in a significantly greater probability that an admitted infant received an umbilical artery catheter (p = .02), but resulted in less probability that any NICU infant received a lumbar puncture (p = .0001) or peripheral phlebotomy (p = .0002). The decision to intubate an infant was not affected by the workload in the NICU.ConclusionsThe clinical workload of housestaff in the NICU can affect decisions to perform procedures on infants in the NICU. For equivalently severely ill infants, there is a greater chance of receiving a UAC and less chance of being phlebotomized or receiving an LP when workload is high. Attending neonatologists need to be sensitive to possible effects of workload on patient care in the NICU. (Crit Care Med 1999; 27:815-820)

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectiveTo determine whether an advanced cardiac life support (ACLS) computer simulation program improves retention of ACLS guidelines more effectively than textbook review.DesignRandomized, controlled trial.SettingAcademic medical center.ParticipantsForty-five anesthesia residents and faculty tested 10 to 11 months after ACLS provider course training.InterventionParticipants were randomized and asked to prepare for a mock resuscitation (Mega Code) with either textbooks or a computerized ACLS simulation program.Main Outcome MeasurePerformance on a standardized Mega Code examination that required application of supraventricular tachycardia, ventricular fibrillation, and second-degree Type II atrioventricular block algorithms. Mega Code sessions were administered by an instructor who was blinded as to the subject group. The sessions were videotaped and scored by two evaluators who also were blinded as to the subject group.ResultsParticipants who used the ACLS simulation program scored significantly higher (mean 34.9 +/- 5.0 [SD] of 47 possible points) than participants who reviewed using a textbook (29.2 +/- 4.9); p < .001. Pass-fail rates for the algorithms were also higher for the group that reviewed with the simulator (mean 2.5 +/- 0.5 of 3 possible passes) than the group that used the textbook (1.6 +/- 1.0); p = .001.ConclusionsUse of a computerized ACLS simulation program improves retention of ACLS guidelines better than textbook review. (Crit Care Med 1999; 27:821-824)

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The past few years have seen a profound revolution in biological sciences.The enormous advances in molecular biology are providing novel insights into the etiology and treatment of human disease. These insights will undoubtedly have implications for intensive care research and practice. In this first of two articles, the basic principles and techniques of molecular biology are discussed to provide the intensive care physician with background information on the subject. (Crit Care Med 1999; 27:825-831)

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

ObjectivesTo review the diagnosis and management of overwhelming postsplenectomy infection and to discuss various preventative measures.Data SourcesData used to prepare this article were drawn from published articles and work in progress.Study SelectionArticles were selected for relevance to the subject after location by a MEDLINE key word search.Data ExtractionThe literature was reviewed to summarize the etiology and pathophysiology of postsplenectomy sepsis. Preventative strategies were outlined with a particular emphasis on education, immunoprophylaxis, and chemoprophylaxis.Data SynthesisAlthough physicians have become increasingly aware of overwhelming postsplenectomy infection in children, many remain unaware of the risk to asplenic or hyposplenic adults who may have no underlying medical problems. Recent studies have shown that many patients who have had splenectomies have had neither appropriate vaccinations nor teaching that would explain the lifelong nature of their risk. The increasing incidence of penicillin-resistant pneumococci represents a major area of therapeutic and prophylactic concern. The identification of Howell-Jolly bodies on a peripheral blood smear should alert physicians to the need for follow-up to document possible hyposplenism. Attention has focused on a three-pronged attack to this problem, including education, immunoprophylaxis, and chemoprophylaxis.ConclusionsOverwhelming postsplenectomy infection should be largely preventable if appropriate precautions are taken. Physicians need to know of the spectrum of diseases associated with hyposplenism and how patients noted to have Howell-Jolly bodies should be investigated. They should also be aware of appropriate guidelines for management of patients with asplenia or hyposplenism. (Crit Care Med 1999; 27:836-842)

ISSN:0090-3493    

出版商:OVID    

年代:1999

数据来源: OVID