Abstract:
OBJECTIVES:Although studies have indicated that adrenal insufficiency occurs after severe trauma and hemorrhagic shock, it remains controversial whether adrenal function is depressed during the late stage of polymicrobial sepsis. DESIGN:Prospective, controlled animal study. SETTING:A university research laboratory. SUBJECTS:Male rats (275-325 g) were subjected to polymicrobial sepsis by cecal ligation and puncture (CLP) or sham operation followed by the administration of normal saline solution. MEASUREMENTS AND MAIN RESULTS:Systemic blood samples were taken at 20 hrs after CLP (i.e., a late stage of sepsis) or sham operation to measure plasma levels of corticosterone and corticotropin as well as adrenal contents of corticosterone. Additional groups of animals were utilized to examine corticotropin-stimulated plasma corticosterone release as well as adrenal levels of cyclic adenosine monophosphate (cAMP, the second messenger of corticotropin action). The results indicate that despite a 75% (p < .05) higher concentration in plasma corticotropin at 20 hrs after the onset of sepsis, plasma corticosterone levels were similar to those in sham-operated animals. In addition, adrenal contents of corticosterone were reduced by 42% (p < .05) in septic animals. Moreover, the plasma corticosterone and adrenal cAMP responses to corticotropin were reduced by 53% and 27% (p < .05), respectively, at 20 hrs after CLP. CONCLUSIONS:These findings suggest that, despite high plasma levels of endogenous corticotropin, adrenal dysfunction, as indicated by the reduction of corticotropin-induced plasma corticosterone release and adrenal contents of cAMP as well as the decreased adrenal levels of corticosterone, occurs during the late stage of polymicrobial sepsis. Therefore, the recognition of adrenal insufficiency and interventions to improve adrenal responsiveness may be beneficial in improving the outcome during late sepsis.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Koo DJ,Jackman D,Chaudry IH,Wang Pdoi
10.1097/00003246-200103000-00026subject
Has Abstractpub_date
2001-03-01 00:00:00pages
618-22issue
3eissn
0090-3493issn
1530-0293journal_volume
29pub_type
杂志文章abstract:OBJECTIVE:The aim of this study is to test the hypothesis that recruitment maneuvers (RMs) might act differently in models of pulmonary (p) and extrapulmonary (exp) acute lung injury (ALI) with similar transpulmonary pressure changes. DESIGN:Prospective, randomized, controlled experimental study. SETTING:University r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181760e5d
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVES:Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, there has been little systematic study of the impact of patient preferences on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199611000-00009
更新日期:1996-11-01 00:00:00
abstract::The authors determined the correction factor (Ct) for three sizes of commonly available central venous catheters. These catheters are used as the injectate catheter when a 2.5 Fr transthoracic thermistor is used to determine cardiac output by thermodilution. The valves for Ct were highly reproducible. These determinat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198112000-00014
更新日期:1981-12-01 00:00:00
abstract:OBJECTIVE:To determine whether four stages of weaning (acute, prewean, wean, and outcome) could be identified by using clinical instruments designed to quantify severity of illness, patient stability, or weaning readiness. The instruments used were the Acute Physiology and Chronic Health Evaluation (APACHE III), the Th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00013
更新日期:2000-07-01 00:00:00
abstract::Ethical decision-making for the care of the critically ill and injured has never been more difficult than it is today. Major technologic advances prolong life but often provide questionable benefit in human terms. Both the ethical commitment to the individual patient and the competition for access to expensive and sca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198806000-00015
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:Resuscitation of hemorrhagic hypotension after traumatic brain injury is challenging. A hemoglobin-based oxygen carrier may offer advantages. The novel therapeutic hemoglobin-based oxygen carrier, polynitroxylated pegylated hemoglobin (PNPH), may represent a neuroprotective hemoglobin-based oxygen carrier for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318206b1fa
更新日期:2011-03-01 00:00:00
abstract::Critical care clinicians no longer consider family members as visitors in the intensive care unit. Family-centered care has emerged from the results of qualitative and quantitative studies evaluating the specific needs of families of patients dying in the intensive care unit. In addition, interventional studies have e...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000237049.44246.8C
更新日期:2006-11-01 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::Given the limitations of high-dose diuretics and vasodilators and the increasing literature showing that inotropes, regardless of the dose used, have a detrimental effect on mortality, a variety of new agents are under investigation for the treatment of pulmonary and systemic congestion and restoration of cardiac outp...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000296810.74724.8D
更新日期:2008-01-01 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:OBJECTIVES:To describe the impact of choice of therapy on renal recovery. DESIGN:Literature review. MAIN RESULTS:Randomized controlled trials conducted have not shown a benefit of continuous renal replacement therapy in mortality over intermittent renal replacement therapy. However, renal recovery is another importan...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318168e4a8
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:To investigate the effect of early administration of granulocyte colony-stimulating factor (G-CSF) on hospital mortality in nonneutropenic patients with septic shock, excluding patients with melioidosis. DESIGN:A randomized, placebo-controlled, double-blinded clinical trial. SETTING AND PATIENTS:Adult patie...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.CCM.0B013E318161E480
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:Although the development of ventilator-associated pneumonia (VAP) is assumed to increase costs of intensive care unit stay, it is unknown whether prevention of VAP by means of oropharyngeal decontamination is cost-effective. Because of wide ranges of individual patient costs, crude cost comparisons did not sh...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000104111.61317.4B
更新日期:2004-01-01 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:OBJECTIVE:To review the history and development of critical care nurses, the supply and demand issues related to critical care nursing, critical care nursing's contribution to patient outcomes, and recommendations to ensure a steady and strong workforce. DATA SOURCE AND SELECTION:Information presented in this article ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000203087.42439.53
更新日期:2006-03-01 00:00:00
abstract::Thromboembolic disease ranks among the most dangerous and common complication in the postoperative or post-traumatic patient. As previously mentioned, the incidence is increasing and fatalities from this complication have also risen substantially. The pathogenesis of thromboembolic disease and the predictability of it...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197603000-00004
更新日期:1976-03-01 00:00:00
abstract:BACKGROUND:Early excision with autograft-allograft closure is standard in severe burn management. Cadaver skin is associated with risks such as antigenicity, infection, and limited availability and shelf life. Previous studies have shown that Integra is safe to use in burns of <20% total body surface area. However, the...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.CCM.0000285991.36698.E2
更新日期:2007-11-01 00:00:00
abstract:OBJECTIVES:Less than half of the thousands of children who suffer in-hospital cardiac arrests annually survive, and neurologic injury is common among survivors. Hemodynamic-directed cardiopulmonary resuscitation improves short-term survival, but its impact on longer term survival and mitochondrial respiration-a potenti...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003620
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVES:Measurement of blood lactate concentration in the early management of sepsis is an important step in severity assessment. High blood lactate levels in the early phase of sepsis have classically been thought to be related to tissue hypoxia, but other factors could intervene. We hypothesized that the activatio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001308
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:A hallmark of amniotic fluid embolism is the induction of coagulation defects. Little is known about the nature of these defects or the causative agent or agents. The purpose of this study was to assess the effects of meconium containing (native) meconium-amniotic-fluid infusion (MAFI) and meconium-free (cent...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199902000-00042
更新日期:1999-02-01 00:00:00
abstract:OBJECTIVES:To determine whether excessive alcohol consumption increases the risk for intensive care unit (ICU)-acquired bacterial infection, especially ventilator-associated pneumonia (VAP), in nontrauma patients. DESIGN:Prospective observational cohort study. SETTING:A 21-bed polyvalent ICU in a university hospital....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318174dd75
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillat...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001278
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVE:Heptafluoropropane is an inert gas commercially used as propellant for inhalers. Since heptafluoropropane can be detected in low concentrations, it could also be used as a tracer gas to measure functional residual capacity and ventilation homogeneity. The aim of the present study was to validate functional re...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000220065.93507.AB
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:To determine whether the energy expenditure of mechanically ventilated multiple trauma patients correlates with the severity of injury and illness indices before important systemic infection has complicated the clinical course, and to compare the energy expenditure with the energy expenditure expected from th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199912000-00013
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVES:Sepsis, a life-threatening organ dysfunction caused by a dysregulated host response to infection, is a leading cause of death and disability among children worldwide. Identifying sepsis in pediatric patients is difficult and can lead to treatment delay. Our objective was to assess the host proteomic response...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004083
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVES:To measure total serum nitrite and nitrate concentrations in children with the sepsis syndrome as an indicator of endogenous nitric oxide production. To determine if there is an association between total serum nitrite and nitrate concentrations and vascular responsiveness to norepinephrine. DESIGN:A prospec...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199505000-00010
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVES:The purposes of this report are to a) describe the University of Michigan experience with venoarterial or venovenous extracorporeal life support for severe pediatric pulmonary rescue therapy, and b) examine survivors and nonsurvivors for differences that might be useful for examination in future, prospective...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199208000-00008
更新日期:1992-08-01 00:00:00
abstract:OBJECTIVE:The objective of the present study was to determine whether selective inflammatory cytokine concentrations within cerebrospinal fluid are useful markers for the differential diagnosis of aseptic and bacterial meningitis within neurosurgical patients. DESIGN:Prospective, open-label, observational, cohort stud...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001188
更新日期:2015-11-01 00:00:00
abstract::Critically ill patients who fear impending death may die suddenly. We studied prospectively the incidence of death in critically ill surgical patients who articulated the fear that they were about to die. Physiologic, environmental, and behavioral correlates which might influence perceptions of impending death were ex...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198607000-00005
更新日期:1986-07-01 00:00:00
abstract:OBJECTIVE:To determine if autopsies performed on patients who die in the medical intensive care unit (ICU) provide clinically important new information. DESIGN:Retrospective review. SETTING:A 16-bed medical-coronary ICU. PATIENTS:Patients who underwent autopsy during a 1-yr period. INTERVENTIONS:Pre mortem diagnose...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199808000-00015
更新日期:1998-08-01 00:00:00