PubMed Central (PMC3 - NLM DTD)
(2,081,148 recursos)
Archive of life sciences journal literature at the U.S. National Institutes of Health (NIH), developed and managed by NIH's National Center for Biotechnology Information (NCBI) in the National Library of Medicine (NLM).
22.
Vasopressin combined with epinephrine during cardiac resuscitation: a solution for the future? - Wenzel, Volker; Lindner, Karl H
Epinephrine given during cardiopulmonary resuscitation (CPR) may cause beta-mimetic complications in the postresuscitation phase. Vasopressin may be an alternative vasopressor drug during CPR. A subgroup analysis of a large prospective CPR investigation and of retrospective CPR studies suggests that vasopressin may be especially beneficial when combined with epinephrine. Beneficial effects of adding vasopressin were observed in other catecholamine-refractory shock states as well, such as vasodilatory shock and haemorrhagic shock. In order to maximize effects of any vasopressor during CPR, rapid aggressive chest compressions must be ensured to maximize blood flow and to enable advanced cardiac life support drugs to reach...
24.
Erythromycin for prokinesis: imprudent prescribing? - Dall'Antonia, Martino; Wilks, Mark; Coen, Pietro G; Bragman, Susan; Millar, Michael R
Problems with antibiotic resistant bacteria are increasing in the hospital and particularly in the intensive care unit. Methicillin-resistant Staphylococcus aureus, Acinetobacter baumanii and extended spectrum beta-lactamase producing Gram-negative bacilli constitute a therapeutic and infection control challenge. Early enteral feeding improves survival in patients in the intensive care unit. Prokinetic agents are routinely used in patients with inappropriate gastrointestinal motility. The use of erythromycin at sub-therapeutic doses as a prokinetic agent is a cause of concern for the following reasons: it can increase the emergence and spread of antibiotic resistance and the likelihood of Clostridium difficile disease. The use of an...
27.
Reactive oxygen species: toxic molecules or spark of life? - Magder, Sheldon
Increases in reactive oxygen species (ROS) and tissue evidence of oxidative injury are common in patients with inflammatory processes or tissue injury. This has led to many clinical attempts to scavenge ROS and reduce oxidative injury. However, we live in an oxygen rich environment and ROS and their chemical reactions are part of the basic chemical processes of normal metabolism. Accordingly, organisms have evolved sophisticated mechanisms to control these reactive molecules. Recently, it has become increasingly evident that ROS also play a role in the regulation of many intracellular signaling pathways that are important for normal cell growth and inflammatory...
28.
Advances in protocolising management of high risk surgical patients - Bennett, E David
Despite studies clearly demonstrating significant benefit from increasing oxygen delivery in the peri-operative period in high risk surgical patients, the technique has not been widely accepted. This is due to a variety of reasons, including non-availability of beds, particularly in the pre-operative period, and the requirement of inserting a pulmonary artery catheter. There are now data that suggest that increasing oxygen delivery post-operatively using a nurse-led protocol based on pulse contour analysis leads to a major improvement in outcome with reduction in infection rate and length of hospital stay.
29.
Hurricanes Katrina and Rita: role of individuals and collaborative networks in mobilizing/coordinating societal and professional resources for major disasters - Mattox, Kenneth L
The medical support for the coordinated effort for Harris County Texas (Houston) to rescue evacuees from New Orleans following Hurricane Katrina was part of an integrated collaborative network. Both public health and operational health care was structured to custom meet the needs of the evacuees and to create an exit strategy for the clinic and shelter. Integrating local hospital and physician resources into the Joint Incident Command was essential. Outside assistance, including federal and national resources must be coordinated through the local incident command.
31.
Disaster and emergency communications prior to computers/Internet: a review - Farnham, John W
When communications are needed the most desperately and most urgently, the difficulty of effecting the desired communications increases exponentially. Recent natural disasters in different parts of the world have provided eloquent testament to this. The history of disaster or emergency communications can provide us with a foundation for understanding the problems encountered today, and can offer us insight into how we might improve the systems and processes for communications. The first applications of communication technology that allowed messages to be sent more rapidly than the fastest form of transportation were mainly military in origin. This review takes us from the...
33.
Recently published papers: pulmonary care, pandemics, and eugenics in surviving sepsis? - Bouch, Christopher; Williams, Gareth
Respiratory failure is one of the leading admission diagnoses on the critical care unit, and the journals have reflected this over the past few months. An understanding of the aetiology of pulmonary sepsis is important but your choice of ventilator gas humidification system is not. There are prophecies of more pandemics, but panic is futile because survival is all down to your genes.
35.
Clinical review: Molecular mechanisms underlying the role of antithrombin in sepsis - Wiedermann, Christian J
In disseminated intravascular coagulation (DIC) there is extensive crosstalk between activation of inflammation and coagulation. Endogenous anticoagulatory pathways are downregulated by inflammation, thus decreasing the natural anti-inflammatory mechanisms that these pathways possess. Supportive strategies aimed at inhibiting activation of coagulation and inflammation may theoretically be justified and have been found to be beneficial in experimental and initial clinical studies. This review assembles the available experimental and clinical data on biological mechanisms of antithrombin in inflammatory coagulation activation. Preclinical research has demonstrated partial interference of heparin administered even at low doses with the therapeutic effects of antithrombin, and has...
36.
Key advances in critical care in the out-of-hospital setting: the evolving role of laypersons and technology - Pepe, Paul E; Wigginton, Jane G
During the past decade, critical care in the out-of-hospital setting has transcended the original emphasis on on-scene advanced life support interventions by doctors, paramedics, and nurses. Many of the life-saving efforts and advances in critical care situations have now begun to focus more and more on how, through evolving technology, the average person can save lives and perhaps even spare precious intensive care unit (ICU) resources. A striking example was the recent study conducted at the Chicago airports at which automated external defibrillators (AEDs) were deployed throughout the airline terminals for use by the public at large. Not only did...
38.
Introduction of a rapid response system: why we are glad we MET - Jones, Daryl; Bellomo, Rinaldo
Hospital patients can experience serious adverse events during their stay. To identify, review and treat these patients and to prevent serious adverse events, we introduced a medical emergency team (MET) service into our hospital in September 2000 following a 1-year period of preparation and education. The introduction of the MET into our institution has been associated with profound changes to cultural and medical practice that have affected the way in which the intensive care unit and the hospital view the roles of junior doctors, nurses, intensive care physicians, and senior doctors. These changes have also been associated with a progressive...
39.
Recent evolution of renal replacement therapy in the critically ill patient - Ronco, Claudio
The epidemiology of severe acute renal failure has dramatically changed in the past decade. Its leading cause is sepsis and the syndrome develops mostly in the intensive care unit as part of multiple organ dysfunction syndrome. After the significant improvements obtained from the mid 1970s to the mid 1990s, the past decade has seen a dramatic evolution in technology leading to new machines and new techniques for renal and multiple organ support. Extracorporeal therapies are now performed using adequate treatment doses, which have resulted in improved survival in the general population. At the same time, patients with sepsis seem to...
40.
Bench-to-bedside review: Weaning failure should we rest the respiratory muscles with controlled mechanical ventilation? - Vassilakopoulos, Theodoros; Zakynthinos, Spyros; Roussos, Charis
The use of controlled mechanical ventilation (CMV) in patients who experience weaning failure after a spontaneous breathing trial or after extubation is a strategy based on the premise that respiratory muscle fatigue (requiring rest to recover) is the cause of weaning failure. Recent evidence, however, does not support the existence of low frequency fatigue (the type of fatigue that is long-lasting) in patients who fail to wean despite the excessive respiratory muscle load. This is because physicians have adopted criteria for the definition of spontaneous breathing trial failure and thus termination of unassisted breathing, which lead them to put patients...
21.
