Abstract:
OBJECTIVE:In 2003, critical care and infectious disease experts representing 11 international organizations developed management guidelines for the use of corticosteroid therapy in patients with sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. DESIGN:The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. METHODS:The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along five levels to create recommendation grades from A to E, with A being the highest grade. Pediatric considerations to contrast adult and pediatric management are in the article by Parker et al. on p. S591. CONCLUSIONS:Low doses of corticosteroids are recommended in patients with septic shock. In the absence of vasopressor requirement, corticosteroids should not be used to treat sepsis. High-dose corticosteroids are not recommended in severe sepsis. The use of adrenal function tests to guide decisions on corticosteroid therapy, the weaning of steroids at the end of the treatment period, the decision to discontinue steroids earlier with resolution of shock, and the addition of oral fludrocortisone are considered optional approaches.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Keh D,Sprung CLdoi
10.1097/01.ccm.0000142983.15421.11subject
Has Abstractpub_date
2004-11-01 00:00:00pages
S527-33issue
11 Suppleissn
0090-3493issn
1530-0293pii
00003246-200411001-00008journal_volume
32pub_type
杂志文章,评审abstract:OBJECTIVE:To evaluate a novel combination of preoperative, intraoperative, and postoperative variables (including the Parsonnet, and the Acute Physiology and Chronic Health Evaluation II and III [APACHE II and III] scores) in cardiac surgery patients in order to predict hospital outcome, complications, and length of st...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199511000-00010
更新日期:1995-11-01 00:00:00
abstract:OBJECTIVE:To compare silver-coated and uncoated central venous catheters regarding bacterial colonization. To assess the relative contribution of catheter hub and skin colonization to catheter tip colonization. DESIGN:Prospective, randomized clinical trial. SETTING:Intensive care unit in a university hospital. PATIE...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199903000-00028
更新日期:1999-03-01 00:00:00
abstract:OBJECTIVES:To explore the effects of dobutamine and norepinephrine on the global cardiovascular response and on the relationship between oxygen uptake (VO2) and oxygen delivery (DO2) during an acute reduction in blood flow associated with tamponade. DESIGN:Prospective, randomized, controlled acute intervention study. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199402000-00022
更新日期:1994-02-01 00:00:00
abstract:OBJECTIVES:To determine whether relative hyperglycemia was associated with in-hospital mortality in critically ill patients independent of other prognostic variables and whether this association is affected by background glycemia. DESIGN:Prospective observational study. SETTING:Mixed medical-surgical ICU in a metropo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004133
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:To compare intraosseous with central venous blood samples for biochemical analyses and hemoglobin levels during cardiopulmonary resuscitation (CPR) and during cardiopulmonary resuscitation with infusion of sodium bicarbonate, epinephrine, and saline boluses through the intraosseous site. DESIGN:Prospective, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199906000-00039
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVE:To report a case of fatal hyperkalemia owing to succinylcholine administration in a patient with mucositis secondary to chemotherapy. DESIGN:Case report. SETTING:Adult intensive care unit (ICU) at Dartmouth-Hitchcock Medical Center. PATIENTS:One patient with mucositis secondary to chemotherapy. MEASUREMEN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200106000-00040
更新日期:2001-06-01 00:00:00
abstract:OBJECTIVE:Acute aneurysmal subarachnoid hemorrhage (SAH) is a complex multifaceted disorder that plays out over days to weeks. Many patients with SAH are seriously ill and require a prolonged intensive care unit stay. Cardiopulmonary complications are common. The management of patients with SAH focuses on the anticipat...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318195865a
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVE:To investigate, in restrictive patients, the influence of pressure ramp slope values on the efficacy of pressure support ventilation. DESIGN:Prospective study. SETTING:A university hospital medical intensive care unit. PATIENTS:Twelve intubated restrictive patients. INTERVENTIONS:Patients were randomly as...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199904000-00023
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVES:To determine whether pulse oximetry is accurate and if it correlates with arterial blood gas saturation in pediatric patients with sickle cell anemia. DESIGN:Prospective, comparative study using a convenience sample of patients with sickle cell anemia who had simultaneous arterial blood gas sampling and pul...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200109000-00025
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVE:To determine risk factors for nosocomial pneumonia in critically ill trauma patients. DESIGN:Prospective cohort study. SETTING:The trauma intensive care unit (ICU) of a 1500-bed tertiary-care hospital. PATIENTS:All critically ill trauma patients (n = 103) admitted consecutively between November 1995 and Oc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200102000-00015
更新日期:2001-02-01 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::Pulmonary artery wedge pressure (PAWP) will only reflect left atrial pressure (LAP) if continuity of fluid exists from the catheter tip to the left atrium. Either increased airway pressure or decreased hydrostatic pressure may lead to discontinuity of the fluid column and midinterpretation of PAWP. Simultaneous measur...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197801000-00009
更新日期:1978-01-01 00:00:00
abstract:OBJECTIVES:To evaluate the use of multifrequency bioelectrical impedance analysis to predict creatinine/urea clearance based on 24 hours urine collection. A practical formula was developed, and its performance was compared with that of established formulas such as Cockcroft-Gault, Modification of Diet in Renal Disease,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004033
更新日期:2019-12-01 00:00:00
abstract::In the last three decades, numerous articles on plasma catecholamine concentrations in various settings have been published in the medical literature. Despite this abundance of information, no summary article has analyzed the species variations in circulating catecholamine concentrations. In this paper, the plasma cat...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:
更新日期:1989-11-01 00:00:00
abstract::A new quantitative method for measuring the prognosis and severity of illness in terms of probability of survival was developed from 224 studies in an index population of 220 critically ill surgical patients. Patients were selected preoperatively to eliminate pre-existing cardiac disease, cirrhosis, nutritional debili...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198502000-00007
更新日期:1985-02-01 00:00:00
abstract:OBJECTIVE:To characterize the withholding or withdrawing of life support from patients with severe head injury. SETTING:San Francisco General Hospital, a city and county hospital with a Level I trauma center. DESIGN:A standardized questionnaire was used to collect data on demographics and functional outcome of severe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199509000-00018
更新日期:1995-09-01 00:00:00
abstract:OBJECTIVE:Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment. DESIGN:Mixed-methods study. SETT...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000002099
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:To determine if inhibition of nitric oxide synthase with NG-nitro-L-arginine-methyl-ester (L-NAME) potentiates endotoxin-induced cardiopulmonary dysfunction and release of cyclooxygenase products in a porcine model of endotoxemia. DESIGN:Prospective, multiple group, controlled experimental study. SETTING:Ph...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199706000-00024
更新日期:1997-06-01 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:OBJECTIVE:To examine the relationship between treatment-related variables for Candida bloodstream infection and hospital mortality. DESIGN:Retrospective cohort analysis. SETTING:Thousand two hundred-bed academic medical center. PATIENTS:A total of 245 consecutive patients with Candida bloodstream infections who rece...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31818b3477
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVES:The objectives of the present study were to evaluate, in patients with persistent arterial hypotension in the immediate postcardiac surgery period, the effects of norepinephrine infusion on ventriculo-arterial coupling, its determinants: arterial elastance and end-systolic ventricular elastance, and to test ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002772
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVES:To test the hypothesis that after cecal ligation and puncture in the rat, there is increased expression of the tumor necrosis factor (TNF)/interleukin-1-dependent, acute-phase reactant alpha 1-acid glycoprotein in the liver, and that this change correlates temporally with increased abundance of TNF-alpha in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199612000-00004
更新日期:1996-12-01 00:00:00
abstract:OBJECTIVE:After a stay in the intensive care unit, patients risk experiencing delusional memories, memory loss, and symptoms of posttraumatic stress. Since the 1990s, diaries have been kept for intensive care unit patients to help fill in memory gaps, aid psychosocial recovery, and improve health-related quality of lif...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e31821e89c8
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To determine if intracranial pressure monitor placement in patients with acute liver failure is associated with significant clinical outcomes. DESIGN:Retrospective multicenter cohort study. SETTING:Academic liver transplant centers comprising the U.S. Acute Liver Failure Study Group. PATIENTS:Adult critica...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000000144
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVES:Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. PICU mortality has dropped from 85% to 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regardi...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001085
更新日期:2015-09-01 00:00:00
abstract::Significant resistance was encountered when an attempt was made to withdraw a persistently wedged pulmonary artery catheter. A small amount of air was injected into the balloon lumen with great difficulty. This injection freed the catheter which was removed, but produced significant sudden hemoptysis and a pneumothora...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198106000-00013
更新日期:1981-06-01 00:00:00
abstract::Many clinical conditions are associated with an increase in abdominal pressure. While the effects on venous return have been studied in the past, little attention has been given to the effect of abdominal pressure on left-sided hemodynamic events. The effects of acute changes in abdominal pressure (Pab) on left ventri...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198510000-00006
更新日期:1985-10-01 00:00:00
abstract:OBJECTIVES:To examine whether niacin attenuates lung inflammation and improves survival during sepsis and to determine whether the beneficial effects of niacin are associated with downregulation of the nuclear factor (NF)-κB pathway. DESIGN:Prospective laboratory study. SETTING:University laboratory. SUBJECTS:Male S...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181feeae4
更新日期:2011-02-01 00:00:00
abstract::End tidal CO2 tension (PetCO2) and transcutaneous CO2 tension (PtcCO2) were compared with arterial CO2 (PaCO2) before and after withdrawal of mechanical ventilation in 20 patients predisposed to hypercarbia. With stable PaCO2 during mechanical ventilation, the correlation coefficient (r) between PaCO2 and PetCO2 was ....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198708000-00011
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:To determine if selective decontamination of the digestive tract (SDD) influences the proinflammatory immune response of the gut after hemorrhage. DESIGN:Random assignment to either unmanipulated control after 7 days of SDD or conventional rat chow, or hemorrhagic shock group after the same time of conventio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200206000-00030
更新日期:2002-06-01 00:00:00