ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo evaluate the safety and physiologic actions of ibuprofen in patients with severe sepsis.DesignRandomized, double-blind, placebo-controlled trial.SettingThree university hospital medical ICUs.PatientsTwenty-nine patients with clinical evidence of sepsis and the need for hemodynamic monitoring with a pulmonary artery flotation catheter.InterventionsThirteen patients received placebo and 16 received ibuprofen that consisted of 600 mg (n = 11) or 800 mg (n = 5) iv over 20 mins, followed by three 800-mg doses administered as a rectal solution every 6 hrs. The initial iv dose was given within 4 hrs of the presumptive diagnosis of sepsis.Measurements and Main ResultsThe peak circulating total ibuprofen concentration after the iv dose (49.4 ± 4.5 μg/mL, mean ± SEM) was higher than peak concentrations after the three rectal doses (17.0 ± 2.7, 16.4 ± 3.0, 16.0 ± 3.1 μg/ mL). Both routes of ibuprofen administration were well tolerated. Frequent monitoring for gastrointestinal bleeding and assessment of renal and hepatic function failed to demonstrate significant differences between ibuprofen and placebo. Because a trend for reduced creatinine clearance was observed at 8 hrs in the ibuprofen group, nephrotoxicity of this drug in sepsis cannot be excluded.Temperature decreased significantly within 4 hrs of the initial dose of investigational therapy in patients who received ibuprofen (38.5 ± 0.3° to 37.0 ± 0.2°C,p< .001). However, despite this significant change in temperature, we were unable to detect significant differences in hemodynamic and respiratory values or survival when ibuprofen-treated patients were compared with controls.ConclusionsIbuprofen was well tolerated when administered iv and rectally to patients with severe sepsis, although drug absorption was poor with the rectal route. Significant antipyretic effects of ibuprofen were demonstrated. Although an excellent safety profile characterized ibuprofen in this study, the absence of ibuprofen-associated toxicity may have been secondary to poor rectal absorption of the drug. Our results support the continued clinical investigation of ibuprofen in sepsis, using an all-intravenous route of administration.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectivesTo compare relative efficacies and complications associated with the use of double lumen vs. single lumen umbilical venous catheters in critically ill neonates.DesignProspective randomized control trial.SettingNeonatal ICU.PatientsForty-three critically ill neonates.InterventionsGroup 1 patients (n = 20) received single lumen umbilical venous catheters and group 2 patients (n = 23) received double lumen catheters. A record of the following information was kept: demographic data including diagnosis and indication for umbilical venous catheter insertion, catheter tip location, length of catheterization (days), number of additional iv catheters and complications (sepsis, hepatic necrosis, thrombosis, or mechanical complications).Measurements and Main ResultsDouble lumen umbilical venous catheters were well tolerated and were associated with no significant increased risk of mechanical complications when compared with single lumen umbilical venous catheters. The number of additional iv catheters required (0.8 ± 0.1 [SD]) was significantly (p < .05) less in the double lumen umbilical venous catheter group as compared with additional iv catheters required (2.3 ± 0.8) in the single lumen umbilical venous catheter group.ConclusionDouble lumen umbilical venous catheters are well tolerated for short-term use, decrease the need for additional venous catheters in critically ill neonates, and may not significantly increase the risk of mechanical complications when compared with single lumen umbilical venous catheters.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo determine whether correction of acidemia using bicarbonate improves hemodynamic variables and tissue oxygenation in patients with lactic acidosis.DesignProspective, randomized, blinded, cross over study. Each patient sequentially received sodium bicarbonate and sodium chloride. The order of the infusions was randomized.PatientsTen patients with metabolic acidosis, increased arterial plasma lactate concentrations (>2.45 mmol/L), and no severe renal failure (creatinine <250 μmol/L [<2.3 mg/dL]).MethodSodium bicarbonate (1 mmol/kg body weight) or equal volume of sodium chloride was injected iv at the beginning of two successive 1-hr study periods. Period order was randomized. Arterial and venous blood gas measurements, plasma electrolytes (sodium, potassium, chloride), osmolality and lactate, 2,3-diphosphoglycerate (DPG), and oxygen hemoglobin affinity, hemodynamic variables, oxygen delivery, and oxygen consumption measurements were obtained before and repeatedly during the 1-hr period after the injection of bicarbonate or sodium chloride.Measurements and Main ResultsSodium bicarbonate administration increased arterial and venous pH, serum bicarbonate, and the partial pressure of CO2in arterial and venous blood. Hemodynamic responses to sodium bicarbonate and sodium chloride were similar. Tissue oxygenation (as estimated by oxygen delivery, oxygen consumption, oxygen extraction ratio, and transcutaneous oxygen pressure) was not modified. No changes in serum sodium concentration, osmolality, arterial and venous lactate, red cell 2,3-DPG levels, or hemoglobin affinity for oxygen were observed.ConclusionAdministration of sodium bicarbonate did not improve hemodynamic variables in patients with lactic acidosis, but did not worsen tissue oxygenation.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectivesTo study the effect of pancuronium-induced muscle relaxation on circulating plasma volume.DesignA prospective, controlled study. Consecutive infants who were paralyzed with pancuronium and a comparative group who were not paralyzed during mechanical ventilation were studied.SettingNeonatal ICU of a regional referral university-affiliated hospital.PatientsNewborn infants weighing >1700 g who required respiratory assistance within 24 hrs of birth and who were free of congenital heart disease, sepsis, or blood loss were eligible for entry into the study. Infants who received colloid infusions during the study period were excluded. A total of 17 consecutive infants (nine paralyzed and eight nonparalyzed control infants) were studied. Four paralyzed infants and one nonparalyzed infant received colloid infusions before the completion of the study and were excluded from the final analysis.MeasurementsPlasma volume was measured three times in the paralyzed infants: a) immediately before the first dose of pancuronium, b) after 12 to 24 hrs, and c) ≥12 hrs after the return of muscle activity, but before extubation.Plasma volume in the nonparalyzed, control infants was measured at the time of intubation, 12 to 24 hrs after commencing mechanical ventilation, and 12 hrs after extubation. Plasma volume was measured using the Evans blue dye dilution technique.ResultsThere were no changes in the plasma volume or blood volume in the three measurements among both the paralyzed and nonparalyzed infants.ConclusionPancuronium-induced muscle relaxation in mechanically ventilated newborn infants weighing >1700 g did not alter circulating plasma volume in 24 hrs.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveA recent report suggested that, for hypotensive patients, tissue acidemia is best monitored by simultaneous estimates of arterial pH, mixed venous pH, and bicarbonate. This method of detecting tissue acidemia may therefore apply to fulminant hepatic failure patients, who are known to have a high frequency of covert tissue hypoxia. In the present study, both arterial pH and mixed venous pH and bicarbonate were compared in 22 patients with fulminant hepatic failure. Blood samples were drawn from the pulmonary artery and radial artery and this blood was analyzed to determine oxygen delivery and consumption. The arterial pH, mixed venous pH, and bicarbonate were compared using an oxygen flux test to determine the optimal method of demonstrating tissue hypoxia in this group of patients.DesignA prospective study.SettingThe Liver Unit of our institution.PatientsPatients (n = 22) with fulminant hepatic failure admitted between January 1989 and January 1990.InterventionsPatients were studied before and after an infusion of prostacyclin.Measurements and ResultsThe findings of this study suggest that pH and bicarbonate differences in arterial and mixed venous blood samples were not indicative of tissue hypoxia in patients with fulminant hepatic failure. By contrast, measurement of oxygen consumption after the infusion of prostacyclin, with the demonstrated increase in oxygen uptake, provided a more accurate indication of covert tissue hypoxia.ConclusionsIn critically ill patients with a hyperdynamic circulation, such as those patients with fulminant hepatic failure, an oxygen flux test remains the best method of determining the presence of covert tissue hypoxia.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID