ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The multiorgan failure that is the hallmark of severe sepsis results from the activation of a very wide range of mediator cascades, including cytokines, complement, coagulation factors and others. Recently, nitric oxide has emerged as yet another component of this highly complex system. Knowledge of the basic pathophysiological processes involved in sepsis continues to grow, although the clinical applications remain uncertain.

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

When the intestinal flora is susceptible, selective decontamination of the digestive tract (SDD) reduces colonization of the alimentary tract by aerobic Gram-negative bacilli, and ventilator-associated pneumonia is seen in units with a high rate of nosocomial infection. Although mortality is generally unaltered in studies of SDD, a number of deaths can be directly attributed to ventilator-associated pneumonia; no study has yet had sufficient power to demonstrate a reduction in mortality. Reasons for failure of SDD include infections by organisms that are acquired directly into the trachea thus bypassing the digestive tract, and failure to prevent colonization of the alimentary tract by resistant micro-organisms. As with any excessive antibiotic usage, prolonged use of SDD is likely to have an impact on the microbial ecology of an intensive care unit, thus making microbiological surveillance essential. The role of SDD at present remains controversial, but may be helpful in intensive care units where there is a high incidence of secondary infection.

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Optimum management of the circulation and oxygen delivery, and avoiding the complications of mechanical ventilation, drugs or devices that increase the risk of nosocomial infection, help prevent secondary organ damage in critically ill patients. Treatments acting on inflammatory mediators associated with the pathophysiology of secondary organ damage have been disappointing.

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Pancreastasis,a metabolic blockade to exocytosis, seems to provoke pancreatitisthrough a reversal in secretory polarity. Oxidative stress appears to be seminal in each phase of this evolution, such that inflammation is intrinsically oriented towards the systemic inflammatory response syndrome. Therefore a parenteral cocktail of antioxidants to include components and refurbishers of the intracellular methionine transsulfuration pathway is poised to offer first-line medical treatment to every patient with pancreatitis. Until the efficacy of this approach is proved, the provision of antioxidant supplements should logically be part and parcel of standard damage-limiting measures when multiple organ dysfunction occurs.

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The advances in pulmonary support over the past year have focused on newer, alternative modes of mechanical ventilation in the patient with acute respiratory failure. This has been influenced by the recent data showing that significant damage to the lung results from mechanical ventilation itself. The focus has been in the area of decreasing the large tidal volumes and high airway pressures usually required for ventilation of the poorly compliant lung. These alternative modes of ventilation form a spectrum from simple changes in the ventilator settings all the way to liquid breathing. Other advances in pulmonary support include further experience in use of noninvasive ventilation, weaning from mechanical ventilation, and medication delivery systems.

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In this review, recent advances pertaining to the intensive care management of subarachnoid hemorrhage are discussed. The calcium channel blocker nimodipine has become a cornerstone of therapy for the prevention of ischemic deficits resulting from vasopasm. Recent trials suggest that nicardipine confers siimilar clinical benefits, but with more side effects. Transcranial Doppler sonography is widely used to diagnose and monitor cerebral vasopasm, but is of limited value for predicting which patients will develop ischemic deficits. Imaging modalities that reflect the adequacy of tissue perfusion or autoregulation, such as magnetic resonance spectroscopy and single photon emisson computed tomography, may eventually provide a more accurate means of identifying patients at risk for delayed ischemia. Hypertensive-hypervolemic hemodilution is widely employed to reverse cerebral ischemia from vasopasm but further studies are needed to elucidate the relative effects of hypertension, cardiac output augmentation, and hemodilution on cerebral blood flow. Neurogenic cardiac injury has become an increasingly recognized complication of acute, severe subarachnoid hemorrhage. Although significant hemodynamic instability can result, good outcomes can be achieved with aggressive intensive care unit management.

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

The use of modern medical technology has enabled the field of critical care medicine to experience remarkable growth as a specialty. The goal of this review is to examine various ethical issues, such as euthanasia, rationing, cost containment, and end of life decisions with regard to the ethical ramifications imposed by their implementation.

ISSN:0952-7907    

出版商:OVID    

年代:1995

数据来源: OVID