Abstract:
BACKGROUND:Adult studies evaluating corticosteroids have found varied efficacy. One study showing mortality benefit utilized fludrocortisone (FLU) and hydrocortisone (HC) (Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 288:862-871, 2002). Use of FLU in children has not been described. We developed a protocol using HC for systemic inflammatory response syndrome (SIRS) and shock with optional addition of FLU. HYPOTHESIS:Addition of FLU to a HC-based steroid protocol is associated with decreased vasopressor duration without adverse effects in hypotensive children with SIRS. METHODS:Retrospective review of low-dose HC and FLU supplementation in children with SIRS and fluid refractory shock. Patients receiving FLU in addition to HC were compared with patients receiving HC alone. RESULTS:Ninety-seven children with SIRS and shock received steroids. Sixty of 97 (62%) received FLU in addition to HC. Seventy-three children required dopamine (DA) infusion, and 56 received norepinephrine (NE). Overall mortality was 7/97 (7%), with 5/7 (71%) nonsurvivors receiving HC + FLU. Fifty of 97 (52%) children with SIRS met definition for sepsis. Septic children who received HC + FLU required NE for significantly shorter duration than those receiving HC alone (p = 0.011). Nineteen of 60 HC + FLU patients (32%) developed nonsymptomatic hypokalemia. Hypokalemia was significantly more common in HC + FLU patients compared with those receiving HC alone (p = 0.05). CONCLUSIONS:Overall, addition of FLU in children with SIRS was not associated with decreased vasopressor duration or vasopressor score. However, HC + FLU was associated with shorter duration of NE support in the septic subgroup. Hypokalemia was a frequent adverse finding with HC + FLU (p = 0.05). Use of FLU should be considered in further studies evaluating the role of steroids in refractory pediatric septic shock.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Hebbar KB,Stockwell JA,Fortenberry JDdoi
10.1007/s00134-010-2090-3subject
Has Abstractpub_date
2011-03-01 00:00:00pages
518-24issue
3eissn
0342-4642issn
1432-1238journal_volume
37pub_type
杂志文章abstract:PURPOSE:We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units. METHODS:Prospective nationwide before-after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24 h in 20 French inte...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-017-4764-6
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:To investigate whether the respiratory variation in inferior vena cava diameter (DeltaD(IVC)) could be related to fluid responsiveness in mechanically ventilated patients. DESIGN:Prospective clinical study. SETTING:Medical ICU of a non-university hospital. PATIENTS:Mechanically ventilated patients with sep...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2233-5
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVES:To compare the effects of norepinephrine and dobutamine to epinephrine on hemodynamics, lactate metabolism, and gastric tonometric variables in hyperdynamic dopamine-resistant septic shock. DESIGN:A prospective, intervention, randomized clinical trial. SETTING:Adult medical/surgical intensive care unit in ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340050329
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:Erythrocytes influence the magnitude of hypoxia-induced pulmonary artery pressure increase. It is, however, unknown to what extent haemoconcentration and haemodilution affect this response and whether intrapulmonary blood volume (and thus vessel dimensions) alters the magnitude of pressure increase. Furthermo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051327
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To determine the effects of increasing dosages of continuously infused arginine-vasopressin (AVP) on mucosal tissue oxygen tension and oxygen supply in an auto-perfused, innervated jejunal segment in an acute endotoxic porcine model. DESIGN:Prospective, randomized, experimental study. SETTING:University hos...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2858-z
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:To test the feasibility of the transcardiac conductance (TCC) method for continuous, on-line measurement of absolute left ventricular (LV) volume and to validate the method by comparison with biplane angiography. DESIGN AND SETTING:Prospective clinical feasibility and validation study in a cardiac catheteriz...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-004-2300-y
更新日期:2004-07-01 00:00:00
abstract:PURPOSE:To test the hypothesis that RNA editing is altered in pediatric patients with cyanotic congenital heart disease (CHD) and to determine whether A-to-I RNA editing is associated with the postoperative course following cardiac surgery. Cyanotic CHD is associated with a unique pathophysiology caused by chronic hypo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2296-z
更新日期:2011-10-01 00:00:00
abstract::We studied the effect of thiopental loading during resuscitation of 53 patients following cardiopulmonary arrest and compared the outcome with that found in 54 patients treated conventionally in the 30 previous months. Thiopental therapy (10 mg/kg i.v.) was begun within 30 min of the arrest once hemodynamic stability ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF00265112
更新日期:1987-01-01 00:00:00
abstract::The effects of continuous and supplementary bolus dose administration of etomidate have been investigated in ten artificially ventilated patients in traumatic coma. Continuous infusion of etomidate (5-25 micrograms/kg/min) proved to be a practical and safe means of sedating these patients and appeared to control moder...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01692549
更新日期:1983-01-01 00:00:00
abstract::A 63-year-old man underwent distal oesophagectomy and proximal gastrectomy. Postoperatively, controlled ventilation was necessary for 53 days because of anastomotic leakage. Multiple sedative regimens proved to be inadequate. By contrast, a fentanyl-midazolam combination with continuous supplementation of clonidine 0....
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01705163
更新日期:1990-01-01 00:00:00
abstract:PURPOSE:Sepsis and its progression are known to have a major influence on the coagulation system. Current coagulation tests are of limited use when assessing coagulation in sepsis patients. This study aims to assess the potential for a new functional biomarker of clot microstructure, fractal dimension, to identify chan...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-016-4496-z
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To assess the effects of intravenous fish oil fat emulsion on the metabolic alterations induced by lipopolysaccharide (LPS) challenge in healthy volunteers. DESIGN:Two groups of eight healthy subjects were randomized to receive either two pharmacological doses of intravenous FO fat emulsion or no treatment. ...
journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-007-0591-5
更新日期:2007-05-01 00:00:00
abstract::A 16-month old baby developed severe respiratory failure because of acute laryngitis and required mechanical ventilation. Intubation was complicated by aspiration and development of chemical pneumonia. Following 4 days of treatment the child was successfully extubated. Thirty six hours after extubation the patient aga...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00256065
更新日期:1985-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the physiological effects of decannulation on breathing patterns and respiratory mechanics by comparing mouth breathing (MB) to tracheal breathing (TB) in tracheostomized patients. DESIGN AND SETTING:Prospective cross-over study in a critical and neuromuscular care unit. PATIENTS AND METHODS:Nin...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1545-6
更新日期:2002-12-01 00:00:00
abstract:OBJECTIVE:Pulmonary hypertension is a characteristic feature of acute respiratory distress syndrome (ARDS) and contributes to mortality. Administration of sildenafil in ambulatory patients with pulmonary hypertension improves oxygenation and ameliorates pulmonary hypertension. Our aim was to determine whether sildenafi...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1007/s00134-010-1754-3
更新日期:2010-05-01 00:00:00
abstract::Status epilepticus is one of the most frequent neurological emergencies in the intensive care unit. Standard treatment includes intravenous barbiturates, benzodiazepines and phenytoin. However, drug coma is sometimes necessary to control refractory status epilepticus. We report such a case, successfully treated by int...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01707672
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To assess the role of antipseudomonal agents on Pseudomonas aeruginosa colonization and acquisition of resistance. DESIGN:Prospective cohort study. SETTING:Two medical intensive care units. PATIENTS AND PARTICIPANTS:346 patients admitted for >or= 48 h. INTERVENTION:Analysis of data from an 8-month study c...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-008-1326-y
更新日期:2009-03-01 00:00:00
abstract:OBJECTIVE:To determine the cell content and purity of Ficoll-separated peripheral blood mononuclear cells and granulocyte isolates in sepsis patients compared to healthy controls. DESIGN AND SETTING:Prospective study in the adult and pediatric intensive care departments of the Erasmus University Medical Center in the ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0989-0
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVE:To investigate the morphological changes in the liver in patients with organ failure and hyperbilirubinemia and to correlate them to the outcome. DESIGN:A case series prospective study. SETTING:Intensive care units of two general hospitals. PATIENTS:Twelve patients in organ failure with predominant hepatic...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01708095
更新日期:1996-06-01 00:00:00
abstract::Acute renal failure in critically ill patients is seldom an isolated problem but is more usually associated with multiple organ failure. When choosing an extracorporeal kidney replacement therapy, these other failing organs must be taken into account. Therefore the choice of an artificial kidney in patients requiring ...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF00261492
更新日期:1989-01-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-018-5063-6
更新日期:2018-12-01 00:00:00
abstract::Paediatric admissions to a general ITU are briefly reviewed. Although it may not be an ideal arrangement it is suggested that children can be safely cared for in such a unit. The problems created by the child with acute upper airway obstruction are discussed to demonstrate the way in which the unit is organized to rec...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00260356
更新日期:1985-01-01 00:00:00
abstract::We report a clinical observation of acute pancreatitis due to severe hypertriglyceridemia in a pregnant woman. In order to decrease the serum triglyceride level rapidly, two lipaphereses were undertaken using the double-filtration technique. This lipoprotein apheresis technique is briefly described and the efficacy in...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709884
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Trustworthy clinical practice guidelines (CPGs) require identification and careful management of conflicts of interest (COIs) among all participants in the guideline development. Furthermore, COIs are more common than anticipated. However, there are no universally accepted methods to identify and manage COIs...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-018-5367-6
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To examine the attitudes of the general public regarding who should decide about the withdrawal of life support and to compare these attitudes with those of intensive care personnel. DESIGN:Nationwide postal questionnaire survey. SETTING:Sweden. PARTICIPANTS:One thousand one hundred ninety-six randomly sel...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050987
更新日期:1999-09-01 00:00:00
abstract:OBJECTIVE:Definition of the changes in the activators of plasminogen, u-PA and t-PA, and examination of the possible generation of plasmin in the circulation in overwhelming sepsis. DESIGN:Serial blood analysis starting 4 h after development of symptoms of toxic shock syndrome. SETTING:Intensive care unit. PATIENT:A...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050561
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:To evaluate compliance with recommended patient-care practices for the prevention of hospital-acquired infections (HAI) in the intensive care unit (ICU). DESIGN:European descriptive survey by questionnaire mailed to all the directors of ICUs. PATIENTS AND PARTICIPANTS:A total of 1642 general ICUs with more ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF02044110
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVE:To analyze the effects of polymyxin B-immobilized fiber (PMX-F) on bone resorption in septic patients. DESIGN AND SETTING:Observational prospective study in intensive care units of a general hospital. PATIENTS AND PARTICIPANTS:25 patients with severe sepsis and 20 healthy controls. MEASUREMENTS AND RESULTS...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-004-2357-7
更新日期:2004-09-01 00:00:00
abstract::The Limulus amoebocyte lysate assay was used as one of a series of laboratory and clinical investigations on a group of 31 patients suffering from septic shock in order to assess the clinical significance of this assay for the detection of circulating endotoxin in clinical gram-negative sepsis. Four patients with card...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01772577
更新日期:1983-01-01 00:00:00
abstract:OBJECTIVE:Measurement of functional residual capacity (FRC) during controlled and especially during assisted ventilation remains a challenge in the physiological evaluation of ventilated patients. To validate a bag-in-box closed helium dilution technique allowing measurements both during pressure-controlled (PCV) and p...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0833-6
更新日期:2007-12-01 00:00:00