Abstract:
OBJECTIVE:The purpose of this study was to determine the prognostic value of sublingual PCO2 (P(SL)CO2), lactate concentration, and mixed venous oxygen saturation (S(MV)O2) in hemodynamically unstable intensive care patients and, additionally, to compare the temporal changes of these variables in response to treatment. SETTING:Medical/surgical intensive care unit. SUBJECTS:Fifty-four patients, mean age 58 +/- 8 yrs. INTERVENTIONS:Oxyhemodynamic variables, arterial lactate concentration, and P(SL)CO2 were recorded in unselected sequential intensive care patients undergoing pulmonary artery catheterization. A data set was obtained immediately after insertion of the pulmonary artery catheter and repeated 4 and 8 hrs later. MEASUREMENTS AND MAIN RESULTS:Twenty-one patients had severe sepsis or septic shock. Twenty-seven (50%) patients died. The initial P(SL)CO2_PaCO2 gradient (P(SL)CO2-diff) and the initial P(SL)CO2 were highly predictive of outcome (p =.0004 and p =.004, respectively); however, there was no difference in the arterial lactate concentration and S(MV)O2 between the survivors and nonsurvivors. The P(SL)CO2-diff had the best receiver operator characteristic characteristics (area under the curve, 0.75), with a P(SL)CO2-diff >25 mm Hg being the best discriminator of outcome. With treatment, the P(SL)CO2-diff decreased in both survivors and nonsurvivors; however, the lactate and S(MV)O2 remained relatively unchanged during the study period. CONCLUSIONS:The baseline P(SL)CO2-diff and P(SL)CO2 were better predictors of outcome than traditional markers of tissue hypoxia and were more responsive to therapeutic interventions. The P(SL)CO2-diff and/or P(SL)CO2 may prove to be a useful marker for goal-directed therapy and for assessing the response to clinical interventions aimed at improving tissue oxygenation.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Marik PE,Bankov Adoi
10.1097/01.CCM.0000054862.74829.EAsubject
Has Abstractpub_date
2003-03-01 00:00:00pages
818-22issue
3eissn
0090-3493issn
1530-0293journal_volume
31pub_type
杂志文章abstract:BACKGROUND:Although survival is traditionally modeled using Cox proportional hazards modeling, this approach may be inappropriate in sepsis, in which the proportional hazards assumption does not hold. Newer, more flexible models, such as Gray's model, may be more appropriate. OBJECTIVES:To construct and compare Gray's...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000114819.37569.4b
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:This study determined the time course for inhibition of lipopolysaccharide-induced acute lung injury following a single dose of genistein. In addition, the study investigated whether a multiple dosing schedule with genistein retained the inhibitory effects on acute lung injury, nuclear factor-kappaB activatio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000049941.84695.BA
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:To analyze plasma interferon-gamma and interleukin-10 concentrations in patients with systemic meningococcal disease and patients with severe Gram-positive septic shock caused by Streptococcus pneumoniae or Staphylococcus aureus. To study the in vitro cytokine (interferon-gamma and interleukin-10) responses i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000104950.52577.97
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:To test the hypotheses that, for uncontrolled hemorrhagic shock (UHS) in rats, mild hypothermia, compared with normothermia, would increase long-term survival as well as moderate hypothermia, oxygen breathing would increase survival further, and hypothermia and oxygen would mitigate visceral ischemia (dysoxia...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00047
更新日期:2000-07-01 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:The aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium's multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units. DESIGN:A prospective active surveillance before-after study. The stud...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182657916
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:Prolonged stay in the intensive care unit (ICU) is associated with high mortality, morbidity, and costs. Identifying those patients who are most likely to benefit from an extended ICU stay would be helpful in guiding clinical decisions. We sought to describe the characteristics and outcomes for a heterogeneou...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000178184.97813.52
更新日期:2005-09-01 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:A 2400-mOsm/L hypertonic solution (isosal) with a lower sodium content, compared with conventional 7.5% hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199607000-00027
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVE:This report will describe the preparations for and the provision of care of two patients with Ebola virus disease in the biocontainment unit at the University of Nebraska Medical Center. DATA SOURCES:Patient medical records. STUDY SELECTION:Not applicable. DATA EXTRACTION:Not applicable. DATA SYNTHESIS:No...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000935
更新日期:2015-06-01 00:00:00
abstract:OBJECTIVES:To provide an overview of key elements of the Affordable Care Act. To evaluate ways in which the Affordable Care Act will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the Affordable Care A...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001431
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVES:: To characterize the epidemiology and burden of early-onset, nonnosocomial candidemia. DESIGN:: Retrospective review of Cardinal Health Outcomes Research Database, which comprises all acute care admissions at participating hospitals. SETTING:: A total of 176 acute care hospitals. PATIENTS:: All patients ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a0f95d
更新日期:2009-09-01 00:00:00
abstract::The Hemoccult slide test is used frequently to test for the presence of occult blood in samples of gastric juice obtained from critically ill patients. The purpose of this study was to investigate the accuracy of this test to determine the presence of blood in human gastric juice at various pH values. Gastric aspirate...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198210000-00016
更新日期:1982-10-01 00:00:00
abstract:OBJECTIVE:To determine alterations in intestinal epithelial permeability to solutes in burn injured rats with and without Enterococcus faecalis infection and the role of neutrophils in the intestinal permeability changes. DESIGN:Prospective sham-controlled animal study. SETTING:University research laboratory. SUBJEC...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000145579.66001.05
更新日期:2004-11-01 00:00:00
abstract:OBJECTIVE:To evaluate if the up-regulation of vascular endothelial growth factor strengthens the protective effect of amniotic fluid stem cells in a renal ischemia-reperfusion injury model. DESIGN:Randomized animal study. SETTINGS:University research laboratory. SUBJECTS:A total of 40 males 12-week-old Wistar rats w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002020
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVES:There is controversy regarding the benefits of N-acetylcysteine in acute kidney injury. This study was to compare three commonly used regimens and explore which regimen is best for the protection of acute kidney injury. DESIGN:Prospective experimental study. SETTING:University research laboratory. INTERVE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31822575fc
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. DESIGN:Forty advanced life-support providers leading a cardiac arrest team in a standardi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182591fda
更新日期:2012-09-01 00:00:00
abstract:OBJECTIVE:To evaluate factors which may influence the economic future of academic medical centers (AMCs). DATA SOURCE AND SELECTION:A literature search was performed to identify publications which reviewed the areas of revenue sources for AMCs, costs and expenses incurred by these institutions, and mechanisms for opti...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000199991.15912.45
更新日期:2006-03-01 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:Despite concern over the appropriateness and quality of care provided in an intensive care unit (ICU) at the end of life, the number of Americans who receive ICU care at the end of life is unknown. We sought to describe the use of ICU care at the end of life in the United States using hospital discharge data ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000114816.62331.08
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the effects of sympathetic and parasympathetic nervous system activity on the heart rate and other hemodynamic variables in acute emergency patients with mild to moderately severe trauma. DESIGN:Clinical study. SETTING:Level 1 university-run trauma service. PATIENTS:Fourteen trauma patients stu...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000127776.78490.e4
更新日期:2004-06-01 00:00:00
abstract::Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by intravascular fibrin formation occurring in the course of a variety of severe diseases. In gram-negative sepsis, endotoxin is the bacterial component eliciting a cascade of tissue factor dependent hypercoagulable reactions mediated b...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200009001-00003
更新日期:2000-09-01 00:00:00
abstract:OBJECTIVE:To delineate the frequency and causes of admission to a critical care environment for patients undergoing head and neck surgery at Memorial Sloan-Kettering Cancer Center. DESIGN:Retrospective clinical investigation. SETTING:Adult intensive care unit of a tertiary referral cancer center. PATIENTS:All head a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199901000-00033
更新日期:1999-01-01 00:00:00
abstract:OBJECTIVE:To determine whether a correlation exists between concentrations of intracellular and extracellular potassium and to determine the frequency of ventricular ectopy in patients after cardiac operations. DESIGN:Prospective, observational clinical evaluation. SETTING:Surgical-respiratory intensive care unit of ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00018
更新日期:1999-11-01 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:OBJECTIVES:Reviews of patient safety efforts suggest that technical/administrative change must be augmented by global factors such as organizational culture and climate. The objective was to outline a comprehensive model for healthcare climate and test one of its elements, the nursing subclimate, in terms of several pa...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000262404.10203.C9
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVES:In patients with acute hypoxemic respiratory failure, noninvasive ventilation and high-flow nasal cannula oxygen are alternative strategies to conventional oxygen therapy. Endotracheal intubation is frequently needed in these patients with a risk of delay, and early predictors of failure may help clinicians ...
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.0000000000002818
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to examine whether anandamide, an endogenous cannabinoid receptor ligand, is involved in the pathogenesis of septic encephalopathy. DESIGN:Prospective, controlled study. SUBJECTS:Male Wistar rats (7 wks old) were randomly divided into four groups as follows: group 1, control (...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000187010.14426.cc
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVE:The renal effects of dopamine in critically ill patients remain controversial. Low-dose dobutamine has been reported to improve renal function. We compared the effects of various doses of dopamine and dobutamine on renal function in critically ill patients. DESIGN:Prospective, single-blind, randomized study....
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200004000-00002
更新日期:2000-04-01 00:00:00
abstract:OBJECTIVE:To investigate whether inhibition of cyclooxygenase-2, a critical component of the inflammatory pathway, is neuroprotective in a neonatal rat model of cerebral hypoxia-ischemia. The development of brain inflammation largely contributes to neonatal brain injury that may lead to a lifetime of neurologic deficit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181cb1158
更新日期:2010-02-01 00:00:00