Abstract:
OBJECTIVE:Mannitol is widely used in hospitals worldwide to treat patients with high intracranial pressure and/or cerebral edema. One of the mechanisms by which mannitol is thought to affect intracranial pressure is by increasing the patient's serum osmolarity, but not the osmolarity in the brain or cerebrospinal fluid. In this way, mannitol is thought to increase the osmolarity gap between the brain and the blood, which in turn leads to removal of excess water from the brain. However, relatively little is known regarding long-term effects of mannitol on osmolarity of cerebrospinal fluid. We therefore sought to determine the effects of mannitol administration on the osmolarity of cerebrospinal fluid. DESIGN:Controlled trial. SETTING:University teaching hospital. PATIENTS:Patients with severe head injury and patients with subarachnoid bleeding who required insertion of an intracranial probe. MEASUREMENTS AND MAIN RESULTS:Serum and cerebrospinal fluid osmolarity were measured before and during mannitol administration in ten patients treated with mannitol for >or=72 hrs (group 1), ten patients treated for 24 to 48 hrs (group 2), and ten controls (group 3). Serum osmolarity increased quickly in all patients receiving mannitol (groups 1 and 2), whereas remaining constant in controls. Average cerebrospinal fluid osmolarity slowly increased in all patients receiving mannitol; cerebrospinal fluid osmolarity increased from (mean +/- sd) 291.5 +/- 4.0 to 315.5 +/- 4.5 mOsm/kg after 96 hrs in group 1 (p <.01), and from 288.9 +/- 3.5 to 296.9 +/- 6.2 mOsm/kg after 48 hrs in group 2 (p <.01). Cerebrospinal fluid osmolarity remained constant in controls (p <.01 for group 1 vs. group 3 and for group 2 vs. group 3, respectively). In group 1, the gap between serum and cerebrospinal fluid osmolarity initially increased (which was the desired effect), but later decreased first to baseline values and then to below-normal levels. CONCLUSIONS:Long-term administration of mannitol can induce significant increases in cerebrospinal fluid osmolarity in patients with subarachnoid hemorrhage or severe head injury. This may be an undesirable and potentially dangerous effect. Therefore, cerebrospinal fluid osmolarity should be measured regularly in all patients receiving mannitol for longer than 24 hrs. If cerebrospinal fluid osmolarity increases, discontinuation or tapering of mannitol therapy should be considered.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Polderman KH,van de Kraats G,Dixon JM,Vandertop WP,Girbes ARdoi
10.1097/01.CCM.0000050287.68977.84subject
Has Abstractpub_date
2003-02-01 00:00:00pages
584-90issue
2eissn
0090-3493issn
1530-0293journal_volume
31pub_type
临床试验,杂志文章abstract:OBJECTIVE:Intensive care unit (ICU) length of stay (LOS) and hospital LOS are common indices used to compare performance of hospitals and are yardsticks used in efforts to contain costs, yet there is no standardized method of quantitating this outcome variable. Attempts have been made to correct LOS according to diseas...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00071
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN:Blinded, concurrent data collection, retrospective chart review. SETTING:Surgical ICU. PATIENTS:All patients (n = 308) for whom a surgical ICU...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199203000-00016
更新日期:1992-03-01 00:00:00
abstract:OBJECTIVES:To evaluate the cardiovascular response and acute stress reaction after arousal induced by a benzodiazepine antagonist, flumazenil, in patients sedated with midazolam. DESIGN:Prospective study. SETTING:Emergency center in a university hospital. PATIENTS:A total of 12 patients were ventilated mechanically ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200002000-00005
更新日期:2000-02-01 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::The ability of ACTH-(1-24) to prolong survival and to extend the deadline for effective blood reinfusion has been studied in a model of lethal hypovolemic shock in the rat. Anesthetized rats were bled to a mean arterial pressure of 18 to 25 mm Hg and then subjected to one of the following iv treatments: a) saline; b) ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199008000-00014
更新日期:1990-08-01 00:00:00
abstract::Position of the CVP port on a flow-directed balloon-tip pulmonary arterial catheter affects the accuracy of both thermodilution cardiac output determinations and CVP measurements. Systemic allometry (the study of the growth of a part in relation to the total organism) has been used to determine an easily measured inde...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198611000-00013
更新日期:1986-11-01 00:00:00
abstract::We investigated clinically the differences in respiratory work of patients imposed by three modes of one ventilator: the flow-by system, the demand valve system, and the pressure support system. Inspiratory work using flow-by and pressure support systems was reduced sufficiently when compared to the demand valve syste...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199006000-00016
更新日期:1990-06-01 00:00:00
abstract::Although ICUs generate attention as consumers of resources, no national data on utilization and costs were available in Canada. U.S. estimates are too old for current comparison. Based on national hospital survey data from Statistics Canada, we calculated the utilization of ICUs in all Canadian general hospitals from ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199011000-00020
更新日期:1990-11-01 00:00:00
abstract:OBJECTIVE:Review data obtained from high-frequency oscillatory ventilation (HFOV) and mechanical test lung models with respect to delivered tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical conditions. DESIGN:Review of selected studies from PubMed, published abstracts, an...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000155924.74942.7f
更新日期:2005-03-01 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:OBJECTIVE:The Sequential Organ Failure Assessment (SOFA) score was developed to quantify the severity of patients' illness, based on the degree of organ dysfunction. This study aimed to evaluate the accuracy and the reliability of SOFA scoring. DESIGN:Prospective study. SETTING:Adult intensive care unit (ICU) in a te...
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.0000178178.02574.ab
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:Anesthetic preconditioning appears to be a viable strategy to treat ischemic cerebral injury. Here we investigated 1) whether the protection conferred by sevoflurane preconditioning sustains in time; 2) whether sevoflurane preconditioning diminishes mitochondrial dysfunction following cerebral ischemia; and 3...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318258fb90
更新日期:2012-09-01 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:OBJECTIVE:In rodent models, enhanced formation of nitric oxide and formation of peroxynitrite have been implicated in the pathogenesis of various forms of shock. Here we examined the effect of mercaptoethylguanidine (MEG), an inducible nitric oxide synthase inhibitor and peroxynitrite scavenger, in a severe hemorrhagic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199907000-00027
更新日期:1999-07-01 00:00:00
abstract:OBJECTIVE:Inotropic and vasopressor drugs are routinely used in critically ill patients to maintain adequate blood pressure and cardiac output in patients with cardiogenic shock although potentially at the expense of increasing myocardial oxygen demand. Pacing optimization has been demonstrated as effective in reducing...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001655
更新日期:2016-08-01 00:00:00
abstract:CONTEXT:Reducing aspiration of gastric contents by placing mechanically ventilated patients in a semirecumbent position has been associated with lower incidences of ventilator-associated pneumonia (VAP). The feasibility and efficacy of this intervention in a larger patient population, however, are unknown. OBJECTIVE:A...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/01.ccm.0000198529.76602.5e
更新日期:2006-02-01 00:00:00
abstract::Foreign-body aspiration in adults is usually associated with asphyxiation after aspiration of food particles. The present report documents a case of foreign-body aspiration that resulted from poor tracheostomy care in an alcoholic patient, and caused fulminant pneumonitis. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198408000-00020
更新日期:1984-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10-15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using gr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000084856.00372.CE
更新日期:2003-09-01 00:00:00
abstract:OBJECTIVE:During cardiopulmonary bypass, inflammation and immunosuppression is present. We measured circulating mediators and monocyte-based functions and tested the hypothesis that these variables are influenced by methylprednisolone (MP) or tirilazad mesylate (TM) treatment. DESIGN:Randomized, controlled, double-bli...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200111000-00015
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVES:To assess the variability in short-term sepsis mortality by hospital among Centers for Medicare and Medicaid Services beneficiaries in the United States during 2013-2014. DESIGN:A retrospective cohort design. SETTING:Hospitalizations from 3,068 acute care hospitals that participated in the Centers for Medi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003324
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:The objective of this study was to test the hypothesis that cocaine-induced cerebral vasodilation in newborn sheep is mediated via beta-adrenergic receptor activation. DESIGN:The cerebral effects of a single intravenous injection of cocaine (4 mg/kg) given 30 mins after pretreatment with propranolol (1 mg/kg...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199904000-00036
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVES:To characterize the landscape of process of care and safety outcomes for tracheal intubation across pediatric intensive care units BACKGROUND:Procedural process of care and safety outcomes of tracheal intubation across pediatric intensive care units has not been described. We hypothesize that the novel Nati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182746736
更新日期:2013-03-01 00:00:00
abstract::Percutaneous cholecystostomy was employed successfully as an alternative to cholecystectomy for the treatment of acute cholecystitis with perforation in an elderly woman. The procedure, performed portably in the cardiac care unit, was selected because progressive cardiac and renal decompensation made the patient an ex...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198508000-00017
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVE:To determine the role of toll-like receptor 2 in cardiac dysfunction during polymicrobial sepsis. DESIGN:Controlled animal study. SETTING:University hospital research laboratory. SUBJECTS:Male C57BL/6, wild-type, toll-like receptor 2-/-. INTERVENTION:Polymicrobial peritonitis, a clinically relevant model ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181d99e67
更新日期:2010-05-01 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:OBJECTIVE:To study the rate of elimination of ethanol after a major burn trauma. DESIGN:Prospective, controlled study. SETTING:National burns unit in a Swedish university hospital. PATIENTS AND SUBJECTS:Eight consecutive patients suffering from 18%-72% total burned surface area and nine healthy male control subjects...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-199912000-00003
更新日期:1999-12-01 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:We hypothesized that deficiency in 25-hydroxyvitamin D before hospital admission would be associated with all-cause mortality in the critically ill. DESIGN:Multicenter observational study of patients treated in medical and surgical intensive care units. SETTING:A total of 209 medical and surgical intensive ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318206ccdf
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVES:To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model. DESIGN:Prospective observational study. SETTING:Medical ICU of a tertiary care academic medical center du...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003773
更新日期:2019-07-01 00:00:00
abstract::The Pediatric Risk of Mortality (PRISM) score was developed from the Physiologic Stability Index (PSI) to reduce the number of physiologic variables required for pediatric ICU (PICU) mortality risk assessment and to obtain an objective weighting of the remaining variables. Univariate and multivariate statistical techn...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/00003246-198811000-00006
更新日期:1988-11-01 00:00:00