Abstract:
:The leukotrienes are a group of biologically active products of arachidonic acid metabolism that have been demonstrated to possess the capability to alter vascular reactivity as well as vascular permeability when applied topically to tissues or infused into the vascular bed of various organs. These biologic effects of the exogenous leukotrienes have led to the speculation that these arachidonic acid metabolites could be important mediators in the pathophysiologic events that culminate in the development of acute lung injury and MSOF. Increased production of inflammatory mediators is undoubtedly a contributing factor to the pathophysiologic events that culminate in MSOF. LTB4 has been shown to be a potent stimulator of neutrophil chemotaxis and adhesion. It is possible that LTB4 may be responsible for initiation or amplification of the inflammatory response in this syndrome. The sulfidopeptide leukotrienes have profound effects on cardiac function, which may be mediated through effects on both coronary blood flow and cardiac contractility. These arachidonic acid metabolites are also capable of altering blood flow to several vascular beds and, when synthesized endogenously and released, may be important in the regulation of the peripheral circulation. Endogenous leukotrienes may have physiologic or pathophysiologic effects on cardiac output and its distribution to peripheral vascular beds or on systemic blood pressure. In view of the observations that alterations in cardiac output, blood pressure, and individual organ blood flow have been demonstrated in the clinical setting of ARDs and MSOF, it is attractive to suggest that the leukotrienes may contribute to the hemodynamic alterations observed in these clinical conditions. In addition to their effects on vascular smooth muscle and the myocardium, the leukotrienes have been shown to increase the permeability of blood vessels. In the case of the sulfidopeptide leukotrienes, the enhanced vascular permeability appears to be a direct effect of these lipoxygenase metabolites. Although LTB4 may directly increase vascular permeability, several lines of evidence suggest that the recruitment and activity of neutrophils is required for edema formation to develop following application of this leukotriene. Enhanced capillary permeability, at least in the pulmonary circulation, is a hallmark of ARDS and is also frequently present in MSOF. The leukotrienes, either through direct effects on vessels or through recruitment of inflammatory cells, are likely contributors to the nonhydrostatic edema associated with these syndromes.
journal_name
Crit Care Clinjournal_title
Critical care clinicsauthors
Sprague RS,Stephenson AH,Dahms TE,Lonigro AJsubject
Has Abstractpub_date
1989-04-01 00:00:00pages
315-29issue
2eissn
0749-0704issn
1557-8232journal_volume
5pub_type
杂志文章,评审abstract::Proper care of the severely injured patient will require the development of a new anesthesia specialist. The trauma anesthesiologist, like the cardiovascular anesthesiologist, must become thoroughly familiar with one disease. The anesthesiologist who manages patients with traumatic disease must become an expert in cri...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1990-01-01 00:00:00
abstract::Nutritional support of the burn patient is essential to optimize host immune defenses and to promote prompt wound healing. The interdependent relationship between metabolism, nutrition, and infection is discussed, followed by an extensive description of the various means of determining the appropriate type, form, and ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1995-07-01 00:00:00
abstract::This article documents the role of hypothalamic hypothyroidism and decreased T4-->T3 conversion as the cause of low T4 and T3 in non-thyroidal illness syndrome (NTIS). This article also presents the arguments for administration of replacement triiodothyronine (T3) and thyroxine (T4) hormone in patients who have NTIS. ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2005.10.001
更新日期:2006-01-01 00:00:00
abstract::It is as important to monitor the passage of time in the resuscitation effort as it is to follow the physiologic parameters. The goals in resuscitation are based on restoring cellular metabolism to a level consistent with optimum survival. The level of invasiveness of monitoring is dictated by the extent to which the ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1992-04-01 00:00:00
abstract::Approximately 20% of all mechanically ventilated patients fail their first attempt to wean. Prolonged mechanical ventilation increases morbidity, mortality, and costs. No single weaning parameter predicts patient ability to wean. Weaning studies suggest that daily trials of spontaneous breathing for appropriate patien...
journal_title:Critical care clinics
pub_type: 杂志文章
doi:10.1016/j.ccc.2006.12.002
更新日期:2007-04-01 00:00:00
abstract::There are numerous mechanisms of hypoxemia and hypercapnia during the perioperative period. Mechanisms of hypoxemia include oxygen delivery problems, decreased FAC-CC relationship, hypoventilation, decreased cardiac output, increased oxygen consumption, decreased hypoxic pulmonary vasoconstriction, and increased nonal...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-04-01 00:00:00
abstract::Medication errors are a significant public health problem in United States hospitals. Patients in the ICU are at particular risk for medication errors because of the characteristics of an ICU and the nature of its patients. This article reviews the principles of medication safety and applies these principles to the IC...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2006.02.005
更新日期:2006-04-01 00:00:00
abstract::Improving the course and outcome of patients with ARDS presents a considerable challenge. An important component of meeting this challenge is a more comprehensive understanding of the heterogeneous pathophysiology of ARDS and the biologic response of the individual patient. This understanding may be developed through ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(03)00072-1
更新日期:2002-01-01 00:00:00
abstract::Clinicians are confronted with a complex challenge when a patient is admitted to a critical care unit (CCU) with a significant chest roentgenography (CXR) abnormality. The etiology of a new infiltrate seen on CXR in a patient already in the CCU is more difficult to establish, but is of equal concern. ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70383-3
更新日期:1998-01-01 00:00:00
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journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2006.03.008
更新日期:2006-07-01 00:00:00
abstract::In this review, the various interactions between heart and lung that occur during positive-pressure ventilation are contrasted with spontaneous ventilation. Based on this analysis, appropriate ventilator management directed at optimizing oxygen delivery to the tissues can be employed in the treatment of the critically...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1985-11-01 00:00:00
abstract::Septic shock is a common clinical problem in the intensive care setting. The high mortality rate associated with septic shock, regardless of age, reflects the inadequacy of available therapeutic approaches. The purpose of this article is to review the current pharmacologic approaches to the treatment of septic shock w...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1989-01-01 00:00:00
abstract::Patients with CCI have continuing profound medical needs, poor prognosis for significant functional recovery, and a high mortality rate. Nonetheless, some survive for months or years, but unfortunately, often with functional skills and quality of life lower than need be. Careful evaluation of each patient's medical co...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(02)00011-8
更新日期:2002-07-01 00:00:00
abstract::This article summarizes the biomechanical relationship of the spinal column to load stresses with respect to column failure, and the resulting associated central nervous system injury. In addition, it presents pertinent animal research, which has focused onto the development standardized animal spinal cord injury mode...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-07-01 00:00:00
abstract::The recent development of valid and reliable assessment tools to monitor agitation, sedation, analgesia, and delirium in the ICU represents an essential first step in the provision of patient comfort and the development of preferred treatment strategies. To make the ICU a more humane healing environment, these assessm...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70189-5
更新日期:2001-10-01 00:00:00
abstract::The role of the fiberscope in the management of difficult and failed intubations has been well established and the importance of learning this valuable skill has been emphasized. Nonetheless, the fiberscope is underutilized in anesthesia and critical care practices because of a high rate of intubation failure. The mai...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1995-01-01 00:00:00
abstract::Invasive fungal infections (IFI) and fungal sepsis in the intensive care unit are increasing and are associated with considerable morbidity and mortality. In this setting, IFI are predominantly caused by Candida species. Outcomes continue to be suboptimal; however, there are a few key clinician modifiable factors. PK-...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2010.11.001
更新日期:2011-01-01 00:00:00
abstract::Acute renal failure continues to be a common occurrence in critically ill cancer patients. It frequently results from a combination of risk factors, which include the following: hemodynamic alterations associated with renal ischemia; exposure to nephrotoxic drugs; urinary tract obstruction; and specific abnormalities ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1988-01-01 00:00:00
abstract::Blunt thoracic trauma can result in significant morbidity in injured patients. Both chest wall and the intrathoracic visceral injuries can lead to life-threatening complications if not anticipated and treated. Pain control, aggressive pulmonary toilet, and mechanical ventilation when necessary are the mainstays of sup...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(03)00098-8
更新日期:2004-01-01 00:00:00
abstract::More than one-half million patients are hospitalized annually for traumatic brain injury (TBI). One-quarter demonstrate sleep-disordered breathing, up to 50% experience insomnia, and half have hypersomnia. Sleep disturbances after TBI may result from injury to sleep-regulating brain tissue, nonspecific neurohormonal r...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2015.03.012
更新日期:2015-07-01 00:00:00
abstract::Infectious complications are common occurrences in end-stage liver disease (ESLD). Frequent infections precipitate decompensation of liver disease leading to acute or chronic liver failure, organ dysfunction, de-listing from transplant, and major morbidity and mortality. The spectrum of microorganisms has shifted with...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2016.03.006
更新日期:2016-07-01 00:00:00
abstract::Venous thromboembolic disease is a very common complication in the ICU. This article reviews incidence, prevention, and therapy related to venous thromboembolism, including both deep venous thrombosis and pulmonary embolism. Special diagnostic and treatment considerations in the ICU setting are highlighted. The increa...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2005.05.004
更新日期:2005-07-01 00:00:00
abstract::To be in respiratory distress is to be anxious. To be mechanically ventilated is to be grossly uncomfortable at best. To undergo weaning in the presence of possible severe respiratory compromise, again, inevitably is anxiety provoking. Assessment of the contributing causes of agitation is essential if patients are to ...
journal_title:Critical care clinics
pub_type: 杂志文章
doi:
更新日期:1994-10-01 00:00:00
abstract::Metabolic acid-base disturbances commonly and predictably complicate the course of many intensive care unit patients and plague the intensivists, surgeons, and anesthesiologists beset with the task of caring for them. In this article, we offer a systematic approach to the patient with the metabolic acid-base disorders...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1987-10-01 00:00:00
abstract::Renal failure continues to cause a major burden of morbidity and mortality in both its acute and chronic forms, regardless of advances in current renal replacement therapies. A bioartificial kidney that includes a conventional dialysis filter and a renal tubule assist device containing approximately 10(8) renal proxim...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2005.01.006
更新日期:2005-04-01 00:00:00
abstract::Severe viral pneumonia is an increasing problem among adults. The incidence and number of viruses known to cause pneumonia and respiratory failure have also expanded in recent years. This article provides an overview of severe respiratory disease caused by coronavirus, respiratory syncytial virus, adenovirus, and hant...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2013.07.003
更新日期:2013-10-01 00:00:00
abstract::Significant advances have been made in the management of cardiac arrhythmias. New technology has enhanced the ability to understand and treat a variety of tachycardias. Excitement and caution surround ablative approaches for atrial fibrillation. The role of ICDs and class III antiarrhythmic drugs in the management of ...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(05)70171-8
更新日期:2001-04-01 00:00:00
abstract::Despite great improvement in patient and graft survival, the long-term morbidity and mortality in renal transplant recipients are still significant. Cardiovascular disease accounts for much of the mortality in long-term survivors; screening before the transplant procedure and adequate control of hypertension should he...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:
更新日期:1990-10-01 00:00:00
abstract::Dyspnea is a subjective experience that can be reported by the patient. Respiratory distress is an observable corollary, and represents the physical or emotional suffering that results from the experience of dyspnea. Recognizing and understanding this subjective phenomenon poses a challenge to intensive care unit (ICU...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/j.ccc.2004.03.015
更新日期:2004-07-01 00:00:00
abstract::Acute arthritis in critically ill patients may be caused by local or systemic infection, by a flare of chronic joint disease such as rheumatoid or crystal-associated arthritis, or by less common entities such as hemarthrosis. Diagnosis requires analysis of synovial fluid, and appropriate treatment is based on its find...
journal_title:Critical care clinics
pub_type: 杂志文章,评审
doi:10.1016/s0749-0704(02)00021-0
更新日期:2002-10-01 00:00:00