Abstract:
OBJECTIVE:To evaluate the action of high-dose epinephrine by measuring simultaneously its vasopressor and norepinephrine releasing effects in humans during cardiac arrest. DESIGN:A prospective study on consecutive patients admitted with cardiac arrest. SETTING:Emergency Department in a large, urban hospital. PATIENTS:Eighteen patients with out-of-hospital cardiac arrest undergoing cardiopulmonary resuscitation (CPR). INTERVENTIONS:Catheterization of both the aorta and right atrium for the recording of pressure and collection of blood samples. Throughout the study period (12.5 mins), 18 patients received epinephrine at both the standard dose (1 mg, approximately 0.015 mg/kg) and high dose (0.2 mg/kg). Blood samples were drawn five times, every 2.5 mins. MEASUREMENTS AND MAIN RESULTS:Plasma epinephrine and norepinephrine concentrations; aorta, right atrial, and coronary perfusion pressures. Epinephrine concentrations (normal at rest = 160 +/- 10 [SEM] pmol/L) were increased at the time of the first sample (2.5 mins) by approximately 3,000-fold (to approximately 0.5 mumol/L), and, increased further to 12,000-fold (approximately 2.0 mumol/L) during the study. Aortic pressure increased from 20 +/- 3 to 28 +/- 3 mm Hg (p < .001), and coronary perfusion pressure increased from 4 +/- 3 to 10 +/- 3 mm Hg (p < .001). Simultaneous plasma norepinephrine concentrations were 30-fold higher than the normal resting value of 1.30 +/- 0.04 nmol/L, and increased by 90-fold during the study (p < .001). The spectral distributions of the individual correlations between plasma epinephrine and norepinephrine concentrations were segregated into high correlations (r > .83) in 12 of 18 patients and low r values (r = .29 to .79) in the remaining six patients. The distribution of the correlations was nonuniform by the Kolmogorov-Smirnov goodness-of-fit test with p < .001; this profile suggests that norepinephrine responsiveness to epinephrine can separate two populations, one of which (r > .83) would have preserved viability of the corresponding epinephrine receptors. The correlations between plasma epinephrine concentrations and coronary perfusion pressures were distributed more evenly, also in a nonuniform pattern (p < .02 by Kolmogorov-Smirnov goodness-of-fit test) and the relationship between the two sets of correlations was not significant. CONCLUSIONS:Despite the very high prevailing plasma epinephrine concentrations during cardiac arrest, further epinephrine increases still elicit biological responses. The present work provides physiologic support for the use of large doses of epinephrine during the course of CPR.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Wortsman J,Paradis NA,Martin GB,Rivers EP,Goetting MG,Nowak RM,Cryer PEdoi
10.1097/00003246-199305000-00012subject
Has Abstractpub_date
1993-05-01 00:00:00pages
692-7issue
5eissn
0090-3493issn
1530-0293journal_volume
21pub_type
杂志文章abstract:OBJECTIVES:This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subar...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199506000-00004
更新日期:1995-06-01 00:00:00
abstract:OBJECTIVES:: To determine the relationship between intra-abdominal sepsis-induced high mobility group-box 1 and diaphragm contractile performance and to determine the inhibitory effects of antibodies for high mobility group-box 1 and receptor for advanced glycation end-products on septic peritonitis-induced diaphragmat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a930f7
更新日期:2009-09-01 00:00:00
abstract:OBJECTIVE:To compare the effects of cardiac surgery with and without extracorporeal circulation on the mechanics of the respiratory system, lung, and chest wall. We also determined the time course of those effects. DESIGN:Prospective, controlled study. SETTING:An eight-bed, cardiac-surgical intensive care unit at a u...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200211000-00005
更新日期:2002-11-01 00:00:00
abstract:BACKGROUND:Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broa...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181eb3ccd
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:Resuscitation from hemorrhagic shock (HS) predisposes to subsequent infections. Susceptibility to infection following sepsis has been attributed to apoptosis. Interleukin (IL)-6 has been shown to have antiapoptotic properties and to decrease postresuscitation inflammation in rodent and porcine models of HS. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000201901.30292.c2
更新日期:2006-03-01 00:00:00
abstract:OBJECTIVE:To assess the feasibility and safety of delivering early goal-directed sedation compared with standard sedation. DESIGN:Pilot prospective, multicenter, randomized, controlled trial. SETTING:Six ICUs. PATIENTS:Critically ill adults mechanically ventilated for greater than 24 hours. INTERVENTIONS:Patients r...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0b013e31828a437d
更新日期:2013-08-01 00:00:00
abstract:OBJECTIVE:To investigate the effect of norepinephrine on static (right atrial pressure, pulmonary artery occlusion pressure ) and dynamic (pulse pressure variation and arterial systolic pressure variation) preload indicators in experimental hemorrhagic shock. DESIGN:Prospective controlled experimental study. SETTING:...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000182801.48137.13
更新日期:2005-10-01 00:00:00
abstract:OBJECTIVES:Interventions that reduce the generation or the effects of reactive oxygen species exert controversial effects in animal models of lung injury, and these could be secondary to the pro-oxidant effects of antioxidants generally by their interaction with iron. We here describe the effects of N-acetylcysteine, d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000199069.19193.89
更新日期:2006-02-01 00:00:00
abstract:OBJECTIVES:Regional tidal lung strain may trigger local inflammation during mechanical ventilation, particularly when additional inflammatory stimuli are present. However, it is unclear whether inflammation develops proportionally to tidal strain or only above a threshold. We aimed to 1) assess the relationship between...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000346
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES:To report on a 2-day Society of Critical Car...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318232da75
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVES:Ventilator-associated pneumonia diagnosis remains a debatable topic. New definitions of ventilator-associated conditions involving worsening oxygenation have been recently proposed to make surveillance of events possibly linked to ventilator-associated pneumonia as objective as possible. The objective of the...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0000000000000674
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVES:Clinical applications of inhaled nitric oxide (NO) therapy resulted in the development of delivery systems and monitoring devices applicable to routine clinical care. This article presents the various components necessary for an adequate clinical use of inhaled NO, and discusses the NO gas mixture cylinders,...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199804000-00033
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVE:One in five Americans dies following treatment in an intensive care unit (ICU), and evidence indicates the need to improve end-of-life care for ICU patients. We conducted this study to elicit the views and experiences of ICU directors regarding barriers to optimal end-of-life care and to identify the type, av...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000239233.63425.1D
更新日期:2006-10-01 00:00:00
abstract::The hemodynamic effects of digitalis were examined in ten patients with acute cardiac failure. Administration of 10 micrograms/kg of digoxin iv resulted in significant increases in cardiac index, stroke volume index, and left ventricular stroke work index within one hour in five patients with acute myocardial infarcti...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198711000-00002
更新日期:1987-11-01 00:00:00
abstract:OBJECTIVE:To assess survival after cardiac arrest and to determine whether age is an independent determinant of late mortality or poor neurologic outcome. DESIGN:Analyses using results of Brain Resuscitation Clinical Trial I (1979 to 1984) and Brain Resuscitation Clinical Trial II (1984 to 1989), two randomized, doubl...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199501000-00007
更新日期:1995-01-01 00:00:00
abstract::The venous-arterial PCO2 gradient may increase in certain low-flow states, such as CPR and canine endotoxemia. To determine whether venous hypercarbia also occurs in hemorrhagic shock, we studied 12 anesthetized, mechanically ventilated dogs. We performed laparotomies on the animals, inserting catheters into their ren...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198705000-00013
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVE:To assess whether the provision of computerized physiologic trend data could improve outcome in newborn infants requiring intensive care. DESIGN:Randomized, controlled trial, with subsidiary questionnaire studies. SETTING:Tertiary neonatal intensive care unit with 12 intensive care cots. PATIENTS:All infan...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199812000-00040
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:To determine whether preoperative plasma levels of B-type natriuretic peptide would allow for the prediction of perioperative and early postoperative cardiovascular support requirements and hospital bed usage after coronary artery surgery. DESIGN:A prospective observational cohort study. SETTING:A tertiary ...
journal_title:Critical care medicine
pub_type: 评论,杂志文章
doi:10.1097/01.ccm.0000150822.10160.0a
更新日期:2005-02-01 00:00:00
abstract::Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198512000-00004
更新日期:1985-12-01 00:00:00
abstract:OBJECTIVE:A hallmark of amniotic fluid embolism is the induction of coagulation defects. Little is known about the nature of these defects or the causative agent or agents. The purpose of this study was to assess the effects of meconium containing (native) meconium-amniotic-fluid infusion (MAFI) and meconium-free (cent...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199902000-00042
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVES:To determine the reliability of volitional and nonvolitional limb muscle strength assessment in critically ill patients and to provide guidelines for the implementation of limb muscle strength assessment this population. DATA SOURCES:The following computerized bibliographic databases were searched with MeSH...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0000000000000030
更新日期:2014-03-01 00:00:00
abstract:OBJECTIVE:To provide a meta-analysis of current literature concerning the validation of thoracic impedance cardiography (TIC) and to explain the variations in the reported results from the differences in the studies. DATA SOURCES:A computer-assisted search of English-language, German, and Dutch literature was performe...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-199906000-00053
更新日期:1999-06-01 00:00:00
abstract::Hemodynamic effects of iso-oncotic 3% dextran-60, 6% dextran-70, and Ringer's acetate were compared in 28 male pigs (25 to 30 kg) subjected to experimental trauma and hemorrhage. The animals were kept anesthetized with 75% N2O/25% O2, 0.8% halothane. Hemodynamic and respiratory conditions were allowed to stabilize for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198804000-00008
更新日期:1988-04-01 00:00:00
abstract:OBJECTIVE:Very elderly persons admitted to ICUs are at high risk of death. To document life-sustaining interventions (mechanical ventilation, vasopressors, renal replacement therapy) provided in the ICU and outcomes of care. DESIGN:Multicenter, prospective cohort study. SETTING:ICUs of 24 Canadian hospitals. PARTICI...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001024
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:Cytokines and adhesion molecules have a decisive role in the development of early inflammatory response as well as the late sequelae of sepsis. Because L-selectin-deficient mice are protected from lethal endotoxemia, blockade of L-selectin may provide a useful therapeutic option in human sepsis. Heparin has i...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.CCM.0000059441.70680.DC
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:Trauma induces a complex immune response that requires a systems biology research approach. Here, we used a novel technology, mass cytometry by time-of-flight, to comprehensively characterize the multicellular response to trauma. DESIGN:Peripheral blood mononuclear cells samples were stained with a 38-marker...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002577
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVES:To define a curriculum that outlines the core knowledge residents should possess upon completion of graduate training in order to be able to formulate and initiate a treatment plan for the critically ill patient. DATA SOURCES:Requirements for training program certification as outlined by the Accreditation C...
journal_title:Critical care medicine
pub_type: 指南,杂志文章
doi:10.1097/00003246-199511000-00020
更新日期:1995-11-01 00:00:00
abstract::The endothelium is a highly dynamic cell layer that is involved in a multitude of physiologic functions, including the control of vasomotor tone, the trafficking of cells and nutrients, the maintenance of blood fluidity, and the growth of new blood vessels. Over the past several decades, advances in basic research of ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000129669.21649.40
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVE:End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process. DESIGN:Secondary analysis of a prospective, observational study. SETTING:Thirty-seven i...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000295304.99946.58
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVE:Acute lung injury secondary to smoke inhalation is a major source of morbidity and mortality in burn patients. We tested the hypothesis that nebulized epinephrine would ameliorate pulmonary dysfunction secondary to acute lung injury by reducing airway hyperemia and edema formation and mediating bronchodilatat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318207ec52
更新日期:2011-04-01 00:00:00