Abstract:
OBJECTIVE:To study the natural evolution of systemic oxygen delivery (Do2) and oxygen consumption (Vo2) in sheep infused with low or high doses of endotoxin. DESIGN:Prospective, controlled experimental study. SETTING:Animal research laboratory at a medical university. SUBJECTS:Twenty-nine chronically instrumented awake sheep (25-35 kg). INTERVENTIONS:Awake animals were continuously infused with saline (n = 8) or two doses of Escherichia coli endotoxin (20 or 40 ng/kg/min; n = 21) for 72 hrs. No attempt was made to increase Do2, but respiratory failure was treated by mechanical ventilation and metabolic acidosis was corrected. MEASUREMENTS AND MAIN RESULTS:The mortality rate was 25% in the group infused with the low dose and 89% in the group infused with the high dose of endotoxin. During the first 12 hrs of endotoxemia, both surviving (S group; n = 10) and nonsurviving (NS group; n = 11) sheep developed similar pulmonary hypertension, left ventricular failure, and hypotension with low systemic vascular resistance. However, S sheep had less interstitial lung edema (pulmonary lymph protein clearance at 8 hrs was 13+/-3 mL/hr vs. 27+/-6 mL/hr in the NS group and 4+/-1 mL/hr in the control group). During this early phase of endotoxemia, Do2, Vo2, and oxygen extraction ratio did not change significantly in any group. After this phase, animals that ultimately survived had a persistent hyperdynamic syndrome with high cardiac output and hypotension. In this group, the Do2 increase was greater than the Do2 measured in controls and remained steady up to 48 hrs after the start of the endotoxin infusion. Because systemic Vo2 did not change significantly, oxygen extraction ratio decreased progressively to values less than those measured in controls. In contrast, animals that ultimately died had a hypotensive and normokinetic syndrome associated with pulmonary hypertension, persistent depressed left ventricular function, hypothermia, and a progressive deterioration of gas exchange. Systemic Do2 was not significantly different from that in the control group. In contrast, Vo2 decreased progressively to values significantly lower than those measured in controls and remained low until death. CONCLUSIONS:Our results indicate that in the absence of treatment such as fluid challenge or inotropic drugs in sheep infused with endotoxin, the occurrence of spontaneous hyperdynamic syndrome and high Do2 improves the survival rate.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Pittet JF,Pastor CM,Morel DRdoi
10.1097/00003246-200002000-00035subject
Has Abstractpub_date
2000-02-01 00:00:00pages
496-503issue
2eissn
0090-3493issn
1530-0293journal_volume
28pub_type
杂志文章abstract::Seizures in the neonatal period are usually concomitants of serious neurological disease. The convulsive phenomena take certain distinctive and often subtle forms because of the status of the neuroanatomical and neurophysiological development of the neonatal brain. The predominant etiological process is hypoxic-ischem...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197701000-00008
更新日期:1977-01-01 00:00:00
abstract:OBJECTIVE:To systematically investigate the effect of altering release time during airway pressure release ventilation in a neonatal animal model before and after oleic acid-induced acute lung injury. DESIGN:Prospective, nonrandomized, controlled study with repeated measures. SETTING:University research laboratory. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199403000-00020
更新日期:1994-03-01 00:00:00
abstract:OBJECTIVE:This article analyzes, from a legal perspective, a recent phenomenon involving a clash between the values of attending medical personnel and the instructions of surrogate decision-makers acting on behalf of incompetent patients. Some hospitals have gone to court to challenge decisions by surrogates to continu...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199605000-00026
更新日期:1996-05-01 00:00:00
abstract::Accurate assessment and rapid decision-making are essential to save lives and improve performance in critical care medicine. Real-time point-of-care ultrasound has become an invaluable adjunct to the clinical evaluation of critically ill and injured patients both for pre- and in-hospital situations. However, a high le...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000260680.16213.26
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the ability of two prognostic systems to predict hospital mortality in adult intensive care patients. DESIGN:Prospective cohort study. SETTING:A mixed medical and surgical intensive care unit (ICU) in the United Kingdom. PATIENTS:A total of 1,144 patients consecutively admitted to the study. I...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199701000-00006
更新日期:1997-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the cardiopulmonary effects of the novel endothelin receptor antagonist tezosentan in endotoxin-induced lung injury in sheep and to assess the dose response to tezosentan and endothelin-1 in healthy sheep. DESIGN:Prospective, randomized, controlled experimental study. SETTING:University animal l...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000114575.08269.f6
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with c...
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.0b013e3181f265ba
更新日期:2010-11-01 00:00:00
abstract::The clearance of amikacin during hemodialysis (HD) was determined in eight critically ill patients. The dialysis period averaged 3.4 h with a blood flow of 200 ml/min. The average amikacin clearance between dialysis was 7.30 +/- 4.78 (SD) ml/min which increased to 37.5 +/- 8.01 ml/min during dialysis. The average seru...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198805000-00010
更新日期:1988-05-01 00:00:00
abstract:OBJECTIVE:To determine whether chest wall vibration with tracheal gas insufflation during bronchoconstriction maintains gas exchange at lower airway and intrathoracic pressures than those that occur during positive pressure ventilation. DESIGN:Prospective study. SETTING:Experimental laboratory. SUBJECTS:Six anesthet...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200007000-00057
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that hyperbaric oxygen therapy ameliorates delayed cognitive impairment after acute carbon monoxide poisoning by promoting neurogenesis through upregulating the brain-derived neurotrophic factor in the hippocampus. DESIGN:Laboratory animal experiments. SETTING:University/Medical cente...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001299
更新日期:2016-01-01 00:00:00
abstract::A computer program is presented which analyzes acid-base and respiratory variables. This program's advantages include limited data input, hand-held portability, error identification, and succinct analysis statements. It is a useful adjunct to daily care of the critically ill. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198601000-00015
更新日期:1986-01-01 00:00:00
abstract:OBJECTIVES:Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN:Experimental study. SE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001822
更新日期:2016-11-01 00:00:00
abstract:OBJECTIVE:To review current knowledge about the impact of prolonged mechanical ventilation on diaphragmatic function and biology. MEASUREMENTS:Systematic literature review. CONCLUSIONS:Prolonged mechanical ventilation can promote diaphragmatic atrophy and contractile dysfunction. As few as 18 hrs of mechanical ventil...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181b6e760
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:Prognostic information is important to the family members of incapacitated, critically ill patients, yet little is known about what prognostic information physicians provide. Our objectives were to determine the types of prognostic information provided to families of critically ill patients when making major ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000254723.28270.14
更新日期:2007-02-01 00:00:00
abstract:OBJECTIVE:This study tested the hypothesis that interruption of the renin-angiotensin system with either an angiotensin-converting enzyme inhibitor or a mineralocorticoid receptor antagonist will decrease the prevalence of atrial fibrillation after cardiac surgery. DESIGN:Randomized double-blind placebo-controlled stu...
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.0b013e31825b8be2
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVE:Acute renal failure can be treated with continuous renal replacement therapy (CRRT) or intermittent hemodialysis. There is no difference in mortality, although patients treated with CRRT may have a higher rate of renal recovery. Given these considerations, an estimate of the costs by modality may help in choo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000045182.90302.B3
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:To cost adult intensive care by determining inputs to production, resource consumption per patient, and total cost per intensive care unit (ICU) stay. DESIGN:Prospective cost-accounting analysis of each patient stay in the ICU, over a 1-yr period. SETTING:An 11-bed, medical/surgical adult ICU, in a 932-bad ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199607000-00017
更新日期:1996-07-01 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::Hemodynamic, respiratory, and cerebral variables during 2 h of standard external CPR were studied in 5 dogs. In an additional 12 dogs, possible augmentation of these variables by Military Anti-Shock Trousers (MAST) was evaluated. In 9 dogs, external and internal cardiac massage were compared. During ventricular fibril...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198003000-00012
更新日期:1980-03-01 00:00:00
abstract:OBJECTIVE:Although hepatic cytochrome P-450 protein concentrations are altered following endotoxin shock, changes in P-450 isoforms in sepsis have not been fully investigated. The aim of this study was to determine whether the major P-450 isoform in rat liver (i.e., CYP1A2) is down-regulated during the progression of s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000109453.57709.E2
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:To prospectively evaluate the oxygenation effect of inhaled nitric oxide (INO) delivered during high-frequency oscillatory ventilation in adult patients with the acute respiratory distress syndrome and oxygenation failure. DESIGN Prospective, clinical study. SETTING:Intensive care unit of a university teachi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000049953.86613.02
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVES:With decreasing mortality in PICUs, a growing number of survivors experience long-lasting physical impairments. Early physical rehabilitation and mobilization during critical illness are safe and feasible, but little is known about the prevalence in PICUs. We aimed to evaluate the prevalence of rehabilitatio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004291
更新日期:2020-05-01 00:00:00
abstract:OBJECTIVE:To elucidate sources of variability in the estimate of treatment effects in a successful phase 3 trial in severe sepsis and to assess their implications on the design of future clinical trials. DESIGN:Retrospective evaluation of prospectively defined subgroups from a large phase 3, placebo-controlled clinica...
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:10.1097/01.ccm.0000147440.71142.ac
更新日期:2004-12-01 00:00:00
abstract::Bacterial translocation and ileal and cecal injury have been shown to occur 24 h after limited periods of hemorrhagic shock. The present studies were performed to determine the temporal sequence of mucosal injury, permeability, and bacterial translocation after hemorrhagic shock. The results indicated that bacterial t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199005000-00014
更新日期:1990-05-01 00:00:00
abstract:OBJECTIVE:Toxic free radicals cause dysfunction of respiratory muscles, probably leading to respiratory distress. Exposure to high concentrations of oxygen generates plenty of free radicals. Lidocaine scavenges the reactive molecules. The purposes of the current study were first to examine whether hyperoxia impairs dia...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200006000-00048
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:To determine the significance of moderate elevations of serum troponin I in a surgical intensive care unit patient population in terms of its impact on indexes of outcome including mortality, morbidity, and hospital and intensive care unit length of stay. DESIGN:Retrospective chart review and analysis of cli...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000089931.09635.D2
更新日期:2003-11-01 00:00:00
abstract:OBJECTIVE:Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB). DESIGN:Prospective, randomized, experimental, controlled,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00021
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVES:Given the efficacy and safety of recombinant human activated protein C (rhAPC) in the systemic inflammatory response syndrome, this study was designed to review the evidence for a role for APC in the pathogenesis of preeclampsia. Preeclampsia is a proinflammatory and procoagulant state, and it is a pregnancy...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验,评审
doi:10.1097/00003246-200208000-00035
更新日期:2002-08-01 00:00:00
abstract:OBJECTIVE:To assess the agreement between computed tomography and transcranial sonography in patients after decompressive craniectomy. DESIGN:Prospective study. SETTING:The medical intensive care unit of a university-affiliated teaching hospital. PATIENTS:Thirty head-injured patients consecutively admitted to the in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318246b6ea
更新日期:2012-06-01 00:00:00
abstract:OBJECTIVES:This study was designed to assess the effects on macrocirculation and microcirculation of adding an intra-aortic balloon pump to peripheral venoarterial extracorporeal membrane oxygenation in patients with severe cardiogenic shock and little/no residual left ventricular ejection. DESIGN:A prospective, singl...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000410
更新日期:2014-09-01 00:00:00