Abstract:
OBJECTIVE:Significant mortality in patients with sepsis results from the development of multiple organ dysfunction syndrome. Small-volume resuscitation with 7.5% NaCl hypertonic saline has been proposed to restore physiologic hemodynamics in hemorrhagic shock. Therefore, we hypothesized that hypertonic saline resuscitation could alleviate the development of multiple organ dysfunction syndrome in sepsis induced by cecal ligation and puncture. DESIGN:Randomized, prospective animal experiment. SETTING:Academic research laboratory. SUBJECTS:Male Wistar rats. INTERVENTIONS:The animals were randomly allocated to one of four groups: 1) sham operation (0.9% NaCl, 4 mL/kg intravenously, at 3 hrs after laparotomy); 2) sham operation plus hypertonic saline (7.5% NaCl, 4 mL/kg intravenously, at 3 hrs after laparotomy); 3) cecal ligation and puncture (0.9% NaCl, 4 mL/kg intravenously, at 3 hrs after cecal ligation and puncture); and 4) cecal ligation and puncture plus hypertonic saline (7.5% NaCl, 4 mL/kg intravenously, at 3 hrs after cecal ligation and puncture). MEASUREMENTS AND MAIN RESULTS:Cecal ligation and puncture for 18 hrs was associated with circulatory failure (i.e., hypotension and vascular hyporeactivity to norepinephrine), multiple organ dysfunction syndrome (examined by biochemical variables and histologic studies), and 18-hr mortality. Hypertonic saline not only ameliorated the deterioration of hemodynamic changes but also attenuated neutrophil infiltration in the lung and the liver of septic animals. Hypertonic saline increased the survival rate at 9 and 18 hrs compared with the cecal ligation and puncture group. Moreover, hypertonic saline reduced plasma nitric oxide and interleukin-1beta and organ O2-* levels in rats that underwent cecal ligation and puncture. CONCLUSIONS:Hypertonic saline prevented circulatory failure, alleviated multiple organ dysfunction syndrome, and decreased the mortality rate in animals receiving cecal ligation and puncture. These beneficial effects of hypertonic saline may be attributed to reducing the plasma concentration of nitric oxide and interleukin-1beta as well as the organ O2-* level and decreasing lung neutrophil infiltration and liver necrosis. Our study suggests that hypertonic saline could be a potential and inexpensive therapeutic agent in the early sepsis of animals or patients.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Shih CC,Chen SJ,Chen A,Wu JY,Liaw WJ,Wu CCdoi
10.1097/CCM.0b013e318173f982subject
Has Abstractpub_date
2008-06-01 00:00:00pages
1864-72issue
6eissn
0090-3493issn
1530-0293journal_volume
36pub_type
杂志文章abstract:OBJECTIVE:Procalcitonin may be associated with reduced antibiotic usage compared to usual care. However, individual randomized controlled trials testing this hypothesis were too small to rule out harm, and the full cost-benefit of this strategy has not been evaluated. The purpose of this analysis was to evaluate the ef...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0b013e31821201a5
更新日期:2011-07-01 00:00:00
abstract:OBJECTIVE:To determine the sensitivity, specificity, and predictive values of cultures done with blood drawn through a central venous or arterial catheter compared with peripheral venipuncture. DESIGN:Retrospective cohort study of critically ill surgical patients in whom samples for paired cultures were drawn through ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200201000-00002
更新日期:2002-01-01 00:00:00
abstract:OBJECTIVE:Intracranial pressure (ICP) monitoring is frequently used in intensive care treatment of patients with intracranial hemorrhage. Data demonstrating an improved outcome from this intervention are lacking. We analyzed standardized mortality ratios in patients with and without ICP monitoring to determine its effi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000065270.53951.9E
更新日期:2003-05-01 00:00:00
abstract:OBJECTIVE:To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation. DESIGN:Serial prospective agreement cohort studies. SETTING:Twelve-bed pediatric intensive care unit in an urban academic teaching hospital. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199401000-00029
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVES:Postresuscitation care bundle treatment after return of spontaneous circulation in patients experiencing in-hospital cardiac arrest can improve patients' survival and quality of life. The aim of the study was to evaluate the efficacy and safety of combined therapy of Shenfu injection and postresuscitation ca...
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.0000000000002570
更新日期:2017-10-01 00:00:00
abstract:OBJECTIVE:Sepsis remains a major health threat in intensive care medicine. The renin-angiotensin system (ACE) affects inflammatory responses. In addition, angiotensin-converting enzyme inhibitors act to ameliorate lung injury. To investigate whether the widely used ACE inhibitor enalapril, used to treat hypertension, c...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181958d91
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:We have previously described a method for the precise delivery of inhaled nitric oxide (iNO) via a conventional, continuous-flow, pressure-limited, time-cycled ventilator. Because of the augmented effect of iNO decreasing pulmonary vascular resistance with high-frequency oscillatory ventilation (HFOV), we de...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00038
更新日期:1999-11-01 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 identify factors associated with granting or refusing intensive care unit (ICU) admission, to analyze ICU characteristics and triage decisions, and to describe mortality in admitted and refused patients. DESIGN:Observational, prospective, multiple-center study. SETTING:Four university hospitals and seven...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000157752.26180.f1
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVES:We recently reported that bacterial lipopolysaccharide stimulates release of tumor necrosis factor (TNF)-alpha from both human vascular tissue and cultured smooth muscle cells. In the current study, we tested the hypothesis that increased intracellular cyclic adenosine 3',5'-monophosphate (cAMP) could inhibi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199711000-00025
更新日期:1997-11-01 00:00:00
abstract:OBJECTIVE:To determine the activation of nuclear factor-[kappa]B in peripheral blood CD14+ monocyte/macrophages and CD3+, CD4+, and CD8+ T cells in children with sepsis. DESIGN:Observational study. SETTING:University hospital. PATIENTS:Twenty-six children with sepsis (nine females and 17 males, aged between 10 days ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000284502.38701.e6
更新日期:2007-10-01 00:00:00
abstract:OBJECTIVE:Sepsis and acute lung injury continue to be major causes of morbidity and mortality worldwide despite advances in our understanding of pathophysiology and the discovery of new management strategies. Recent investigations show that stem cells may be beneficial as prognostic biomarkers and novel therapeutic str...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181f96f5f
更新日期:2010-12-01 00:00:00
abstract:OBJECTIVES:To investigate attitudes and practices regarding oxygen therapy in intensive care units (ICUs) and to devise quantitative descriptive indices. SETTING:Canadian university-affiliated adult ICUs. PARTICIPANTS:Fifty-two medical directors of ICUs in 48 institutions. INTERVENTION:Structured postal questionnair...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199912000-00033
更新日期:1999-12-01 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:Anecdotal reports suggest that propofol (Diprivan) may stimulate mucus hypersecretion in patients without pulmonary disease. The purpose of this study was to evaluate the effect of methohexital or propofol anesthesia on the physical and transport properties of airway mucus in spontaneously breathing dogs. DE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200105000-00035
更新日期:2001-05-01 00:00:00
abstract:OBJECTIVE:Monitoring of ventilation performance during cardiopulmonary resuscitation would be desirable to improve the quality of cardiopulmonary resuscitation. To investigate the potential for measuring ventilation rate and inspiration time, we calculated the correlation in waveform between transthoracic impedance mea...
journal_title:Critical care medicine
pub_type: 评论,杂志文章
doi:10.1097/01.CCM.0000235666.40378.60
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVE:To evaluate partial occlusion in patients with pulmonary hypertension with regard to a) the degree to which it leads to overestimation of pulmonary artery occlusion pressure (Ppao) and b) identification of factors that could enhance its recognition. DESIGN:Observational descriptive study. SETTING:Medical in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200301000-00015
更新日期:2003-01-01 00:00:00
abstract::This study evaluates the recall of 100 patients after ICU admission. There was a wide spectrum of race, religion, occupation, and educational levels. The more common diagnoses included asthma, pneumonia, trauma, and adult respiratory distress syndrome. The average Acute Physiology and Chronic Health Evaluation (APACHE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199009000-00012
更新日期:1990-09-01 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:OBJECTIVE:To develop clinical practice guidelines for the use of restraining therapies to maintain physical and psychological safety of adult and pediatric patients in the intensive care unit. PARTICIPANTS:A multidisciplinary, multispecialty task force of experts in critical care practice was convened from the members...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000095463.72353.AD
更新日期:2003-11-01 00:00:00
abstract:OBJECTIVE:To define the impact of prehospital hypotension on the dynamic, systemic acute inflammatory response to blunt trauma. DESIGN:Retrospective study. SETTINGS:Tertiary care institution. PATIENTS:Twenty-two hypotensive blunt trauma patients matched with 28 normotensive blunt trauma patients. INTERVENTION:None....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000964
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:We studied the in-hospital course, long-term prognosis, and functional status of elderly patients with life-threatening cardiogenic pulmonary edema requiring mechanical ventilation. DESIGN:Semiprospective evaluation. SETTING:Twelve intensive care units and one emergency prehospital medical department in uni...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00042
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVE:The role of systemic corticosteroids in pathophysiology and treatment of acute respiratory distress syndrome is controversial. Use of prehospital systemic corticosteroid therapy may prevent the development of acute respiratory distress syndrome and improve hospital outcomes. DESIGN:This is a preplanned retro...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e31828a1fc7
更新日期:2013-07-01 00:00:00
abstract::The heart rate variability (HRV) of 82 patients exhibiting sinus rhythm and admitted for possible myocardial infarction (MI) was evaluated. Using a simple information entropy measure to quantify the HRV, patients subsequently diagnosed with MI or experiencing significant dysrhythmia (n = 35) exhibited less entropy (0....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198801000-00014
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:To investigate the optimal rewarming rate following therapeutic hypothermia in a rate model of cardiopulmonary resuscitation. Both clinical and laboratory studies have demonstrated that mild therapeutic hypothermia following cardiopulmonary resuscitation improves myocardial and neurologic outcomes of cardiac ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182a63fff
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:To determine which of a series of disposable or interchangeable positive end-expiratory pressure (PEEP) devices functions with the least imposition of inspiratory and expiratory work during continuous positive airway pressure. DESIGN:Prospective laboratory evaluation performed on a lung model. SETTING:Resea...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199408000-00004
更新日期:1994-08-01 00:00:00
abstract::Fifteen patients with septic shock and perfusion failure received a 20-min infusion of glucose-insulin-potassium (GIK, glucose 50%, 1 g/kg body weight; insulin 1.5 U/kg, potassium, 10 mMol) after volume loading and vasoactive medication had failed to eliminate hypotension and lactacidemia. Hemodynamic and oxygen measu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198507000-00012
更新日期:1985-07-01 00:00:00
abstract::A safe, simple, reliable technique for sampling uncontaminated peripheral bronchial secretions in patients with endotracheal tubes has been developed. It is easily performed and requires no special training or equipment. This report summarizes the techniques's usefulness in providing diagnostic samples of peripheral a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197703000-00003
更新日期:1977-03-01 00:00:00
abstract:OBJECTIVE:The emergency department (ED) often serves as the first site for the recognition and treatment of patients with suspected severe sepsis. However, few evaluations of the national epidemiology and distribution of severe sepsis in the ED exist. We sought to determine national estimates of the number, timing, ED ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000277043.85378.C1
更新日期:2007-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the hypothesis that splanchnic ischemia and mucosal hypoxia are responsible for lipopolysaccharide-induced intramucosal acidosis in pigs. DESIGN:Prospective, randomized, unblinded study. SETTING:Surgical research laboratory at a large, university-affiliated medical center. SUBJECTS:Anesthetized...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199507000-00011
更新日期:1995-07-01 00:00:00