Abstract:
OBJECTIVES:Preliminary studies have suggested that low doses of corticosteroids might rapidly improve hemodynamics in late septic shock treated with catecholamines. We examined the effect of hydrocortisone on shock reversal, hemodynamics, and survival in this particular setting. DESIGN:Prospective, randomized, double-blind, placebo-controlled study. SETTING:Two intensive care units of a University hospital. PATIENTS:Forty-one patients with septic shock requiring catecholamine for >48 hrs. INTERVENTIONS:Patients were randomly assigned either hydrocortisone (100 mg i.v. three times daily for 5 days) or matching placebo. MEASUREMENTS AND MAIN RESULTS:Reversal of shock was defined by a stable systolic arterial pressure (>90 mm Hg) for > or =24 hrs without catecholamine or fluid infusion. Of the 22 hydrocortisone-treated patients and 19 placebo-treated patients, 15 (68%) and 4 (21%) achieved 7-day shock reversal, respectively, a difference of 47% (95% confidence interval 17% to 77%; p = .007). Serial invasive hemodynamic measurements for 5 days did not show significant differences between both groups. At 28-day follow-up, reversal of shock was higher in the hydrocortisone group (p = .005). Crude 28-day mortality was 7 (32%) of 22 treated patients and 12 (63%) of 19 placebo patients, a difference of 31% (95% confidence interval 1% to 61%; p = .091). Shock reversal within 7 days after the onset of corticosteroid therapy was a very strong predictor of survival. There were no significant differences in outcome in responders and nonresponders to a short corticotropin test. The respective rates of gastrointestinal bleeding and secondary infections did not differ between both groups. CONCLUSIONS:Administration of modest doses of hydrocortisone in the setting of pressor-dependent septic shock for a mean of >96 hrs resulted in a significant improvement in hemodynamics and a beneficial effect on survival. These beneficial effects do not appear related to adrenocortical insufficiency.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Bollaert PE,Charpentier C,Levy B,Debouverie M,Audibert G,Larcan Adoi
10.1097/00003246-199804000-00010subject
Has Abstractpub_date
1998-04-01 00:00:00pages
645-50issue
4eissn
0090-3493issn
1530-0293journal_volume
26pub_type
临床试验,杂志文章,多中心研究,随机对照试验abstract:OBJECTIVE:To examine the hypothesis that heat stress applied after the administration of bacterial endotoxin is protective. DESIGN:Prospective, randomized, laboratory study. SETTING:University research laboratory. SUBJECTS:One hundred eleven adult male Sprague-Dawley rats (weight range 250 to 400 g). INTERVENTIONS:...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199710000-00025
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVES:Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of death and disability among children worldwide. Identifying sepsis in pediatric patients is difficult and can lead to treatment delay. Our objective was to assess the host proteomic response...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004083
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVES:To describe the impact of choice of therapy on renal recovery. DESIGN:Literature review. MAIN RESULTS:Randomized controlled trials conducted have not shown a benefit of continuous renal replacement therapy in mortality over intermittent renal replacement therapy. However, renal recovery is another importan...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318168e4a8
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:To compare two forms of continuous renal replacement therapy, continuous venovenous hemofiltration (CVVH) vs. continuous venovenous hemodialysis (CVVHD), in terms of the removal of inflammatory mediators from the blood of patients with systemic inflammatory response syndrome and acute renal failure. DESIGN:R...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199812000-00027
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:To determine if autopsies performed on patients who die in the medical intensive care unit (ICU) provide clinically important new information. DESIGN:Retrospective review. SETTING:A 16-bed medical-coronary ICU. PATIENTS:Patients who underwent autopsy during a 1-yr period. INTERVENTIONS:Pre mortem diagnose...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199808000-00015
更新日期:1998-08-01 00:00:00
abstract::Healthcare systems spend considerable resources collecting and processing blood cultures for the detection of blood stream pathogens. The process is initiated with the collection of blood cultures that depend upon proper skin disinfection, collection of an adequate number of specimens and volume of blood, and prompt p...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318270e771
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that therapeutic hypercapnia enhances the proinflammatory responses to endotoxemia in the lung and spleen of rats. DESIGN:Prospective randomized study. SETTINGS:Hospital research institute. SUBJECTS:Forty-eight adult male rats. INTERVENTIONS:Rats were randomly assigned for a 24-hr p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820ee1f2
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVES:The purposes of this report are to a) describe the University of Michigan experience with venoarterial or venovenous extracorporeal life support for severe pediatric pulmonary rescue therapy, and b) examine survivors and nonsurvivors for differences that might be useful for examination in future, prospective...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199208000-00008
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVE:Hematopoietic stem cell transplant (HSCT) recipients admitted to the intensive care unit (ICU) have high mortality. The prognostic importance of peripheral blood stem cell source in critically ill HSCT recipients and the performance of Acute Physiology and Chronic Health Evaluation (APACHE) III have not been ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000065761.51367.2D
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:We tested whether mild hypothermia impacts on circulatory and respiratory dysfunction during experimental endotoxemia. DESIGN:Randomized controlled prospective experimental study. SETTING:Large animal facility, Medical University of Graz, Austria. SUBJECTS:Thirteen anesthetized and mechanically ventilated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31829791da
更新日期:2013-12-01 00:00:00
abstract:OBJECTIVE:Persistent pulmonary hypertension of the newborn is characterized by the presence of intense vasoconstriction and vascular remodeling. Protein tyrosine phosphorylation has been recognized as a critical regulatory element in signal transduction, because it is dynamically regulated by the opposing actions of pr...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200106000-00030
更新日期:2001-06-01 00:00:00
abstract::Utilizing a well-established porcine model of cardiac arrest, we found that end-tidal CO2 concentration (ETCO2) strikingly decreased to approximately 24% of control levels, immediately after cardiac arrest and before precordial compression. During precordial compression, ETCO2 progressively increased to 46% of control...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198511000-00012
更新日期:1985-11-01 00:00:00
abstract:OBJECTIVE:To determine whether the absence or presence of clinical pharmacists in intensive care units (ICUs) results in differences in mortality rates, length of ICU stay, and ICU charges for Medicare patients with nosocomial-acquired infections, community-acquired infections, and sepsis. DESIGN, SETTING, AND PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31818f2269
更新日期:2008-12-01 00:00:00
abstract::A high rate of death from septic shock persists despite general improvements in care. The relative failure of mechanistically based therapies in various clinical trials should also trigger a reconsideration of such mechanistic approaches. Despite reversion of shock by hydrocortisone, the similar death rate compared wi...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181f23dc4
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVES:To synthesize the literature describing interventions to improve hand hygiene in ICUs, to evaluate the quality of the extant research, and to outline the type, and efficacy, of interventions described. DATA SOURCES:Systematic searches were conducted in November 2016 using five electronic databases: Medline,...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000002691
更新日期:2017-11-01 00:00:00
abstract:OBJECTIVE:The equipment, monitor alarms, and acuity of patients in ICUs make it one of the loudest patient care areas in a hospital. Increased sound levels may contribute to worsened outcomes in these particularly vulnerable patients. Our objective was to determine whether ambient sound levels in surgical ICUs comply w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001378
更新日期:2016-01-01 00:00:00
abstract::Sequential assessment of renal function in 50 critically ill postoperative patients was done by simultaneous determinants of osmolar, free water, creatinine and sodium clearances, and fractional excretion of sodium. The traumatic and nontraumatic critically ill surgical patients had a characteristic pattern of creatin...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198002000-00004
更新日期:1980-02-01 00:00:00
abstract:OBJECTIVES:To assess the impact of the percentage of fluid infused as Lactated Ringer (%LR) during the first 2 days of ICU admission in hospital mortality and occurrence of acute kidney injury. DESIGN:Retrospective cohort. SETTING:Analysis of a large public database (Multiparameter Intelligent Monitoring in Intensive...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001948
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the performance at admission to the pediatric intensive care unit (PICU) of five severity scores, two general (the Pediatric Risk of Mortality [PRISM] II and III scores) and three specific for meningococcal septic shock (Leclerc, Glasgow Meningococcal Septicemia Prognostic Score [GMSPS], and Gedde...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-200008000-00047
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To assess the prevalence of acute kidney injury in patients with subarachnoid hemorrhage patients. DESIGN:Retrospective analysis of all subarachnoid hemorrhage admissions. SETTINGS:Neurocritical care unit. PATIENTS:All patients with a diagnosis of subarachnoid hemorrhage between 2009 and 2014. INTERVENTIO...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002497
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:Intensive care unit (ICU) length of stay (LOS) and hospital LOS are common indices used to compare performance of hospitals and are yardsticks used in efforts to contain costs, yet there is no standardized method of quantitating this outcome variable. Attempts have been made to correct LOS according to diseas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00071
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVES:Delirium occurs in approximately 30% of critically ill patients, and the risk of dying during admission doubles in those patients. Molecular mechanisms causing delirium are largely unknown. However, critical illness and the ICU environment consistently disrupt circadian rhythms, and circadian disruptions are...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003077
更新日期:2018-06-01 00:00:00
abstract:OBJECTIVE:Pulmonary air embolism, causing vessel obstruction and primary or secondary reactions of blood, can lead to acute lung injury. In addition, nitric oxide has been known to play a key role in various causes of lung injury. In this study we employed the isolated rat lung model to investigate the effects of l-arg...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000178175.54354.ea
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:To review current knowledge about cell-free hemoglobin solutions. DATA SOURCES:All studies involving cell-free hemoglobin were retrieved from a computerized MEDLINE search from 1980 to 1998. We also reviewed the reference lists of all available review articles and primary studies to identify references not f...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200008000-00058
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:The objective of the present study was to determine whether selective inflammatory cytokine concentrations within cerebrospinal fluid are useful markers for the differential diagnosis of aseptic and bacterial meningitis within neurosurgical patients. DESIGN:Prospective, open-label, observational, cohort stud...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001188
更新日期:2015-11-01 00:00:00
abstract::Computers are commonly used to serve many functions in today's modern intensive care unit. One of the most intriguing and perhaps most challenging applications of computers has been to attempt to improve medical education. With the introduction of the first computer, medical educators began looking for ways to incorpo...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200108001-00006
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVE:To investigate if prone position delays the progression of experimental ventilator-induced lung injury, possibly due to a more homogeneous distribution of strain within lung parenchyma. DESIGN:Prospective, randomized, controlled trial. SETTING:Animal laboratory of a university hospital. SUBJECTS:Thirty-fiv...
journal_title:Critical care medicine
pub_type: 评论,杂志文章
doi:10.1097/01.ccm.0000150660.45376.7c
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the pathophysiology involved in hypocalcemia in septic shock and to investigate the value of calcium administration. DESIGN:Prospective, randomized placebo-controlled trial with parallel groups. SETTING:Animal research laboratory at the University Hospital of Uppsala. SUBJECTS:Twenty-four pigs ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200008000-00037
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To describe the experience of pediatric intensive care hospitalization from the perspective of a parents of children with severe, antecedent disability. DESIGN:Qualitative analysis of data obtained through semistructured interviews. SETTING:Pediatric intensive care unit (PICU) in a children's hospital. SUB...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a00578
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVES:Hyperammonemia is a key contributing factor for cerebral edema in acute liver failure. Continuous renal replacement therapy may help reduce ammonia levels. However, the optimal timing, mode, intensity, and duration of continuous renal replacement therapy in this setting are unknown. We aimed to study continu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004153
更新日期:2020-02-01 00:00:00