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IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Source Type: journals

Multicenter Clinical Trials in Sepsis: Understanding the Big Picture and Building a Successful Operation at Your HospitalEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The environment for clinical trials in sepsis has long been identified as challenging and full of road blocks and land mines. Unlike many other diagnoses (ie, cancer, acute myocardial infarction) relevance of animal studies and predictive capability of phase II trials for dose generation is less clear. The members of the investigative team must realize the essentials for success in a multicenter clinical trial. It is also useful and important to understand the big picture of clinical trial development as well as properly functioning interfaces among sponsor, contract research organizations, and investigative sites. Because...
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: R. Phillip Dellinger, Christa Schorr, Stephen Trzeciak Source Type: journals

Performance Improvement in the Management of SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Performance improvement in medicine based on evidence-based guidelines is a persistent challenge for clinicians. Challenges include deficiencies in collaboration, resistance to change, complex algorithms, inadequate resources, and inability to collect data and provide feedback. In severe sepsis this is further compounded by the perceived importance of early intervention and considerable conflicting literature. The bundle concept first adopted for mechanically ventilated patients and then for central line insertion, has now been applied to care for the patient with severe sepsis. The bundle concept in severe sepsis facilita...
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Christa Schorr Source Type: journals

Genetic Polymorphisms in SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article is meant to serve as a summary of scientific advances from the past 5 years with regard to genetic polymorphisms in sepsis. It is also meant to highlight some of the discoveries that may improve our ability to identify vulnerable patients at earlier time points in sepsis, when interventions are more likely to have a positive effect. The article begins with an overview of polymorphism studies and a discussion of candidate gene versus genome-wide association studies. Next, an overview of polymorphisms associated with sepsis is presented. The overview includes detailed descriptions of E-selectin, apolipoprotein E...
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Allen Namath, Andrew J. Patterson Source Type: journals

Steroid Therapy of Septic ShockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the subject of steroid treatment of patients with septic shock and weighs the advantages and disadvantages of steroid treatment. It reviews and contrasts several low- and high-dose steroid studies, and makes recommendations for future practice. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Charles L. Sprung, Serge Goodman, Yoram G. Weiss Source Type: journals

Hemodynamic Monitoring in SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article examines emerging technologies as well as more established techniques used to monitor hemodynamics in sepsis and assesses their potential roles in optimization of sepsis-induced tissue hypoperfusion. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Brian Casserly, Richard Read, Mitchell M. Levy Source Type: journals

Inotrope and Vasopressor Therapy of Septic ShockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
When fluid administration fails to restore an adequate arterial pressure and organ perfusion in patients with septic shock, therapy with vasoactive agents should be initiated. The ultimate goals of such therapy in shock are to restore effective tissue perfusion and to normalize cellular metabolism. The efficacy of hemodynamic therapy in sepsis should be assessed by monitoring a combination of clinical and hemodynamic parameters. Although specific end points for therapy are debatable, and therapies will inevitably evolve as new information becomes available, the idea that clinicians should define specific goals and end poin...
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Steven M. Hollenberg Source Type: journals

Sepsis-Induced Tissue HypoperfusionEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Sepsis affects the cardiovascular system through multiple mechanisms, and often these derangements result in tissue hypoperfusion. Tissue hypoperfusion is often present in the setting of overt shock, but it can also be present in patients without obvious shock physiology. If left untreated, tissue hypoperfusion contributes to the development of multiple organ dysfunction and, ultimately, death. Therefore, it is critical for the clinician to understand the pathophysiology, recognition, and treatment of sepsis-induced hypoperfusion. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Alan E. Jones, Michael A. Puskarich Source Type: journals

Principles of Source Control in the Management of SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses specific approaches to source control in the abdomen, chest, and skin and soft tissues. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: John C. Marshall, Abdullah al Naqbi Source Type: journals

Optimizing Antimicrobial Therapy in Sepsis and Septic ShockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews principles in the rational use of antibiotics in sepsis and septic shock and presents evidence-based recommendations for optimal antibiotic therapy. Every patient with sepsis and septic shock must be evaluated at presentation before the initiation of antibiotic therapy. However, in most situations, an abridged initial assessment focusing on critical diagnostic and management planning elements is sufficient. Intravenous antibiotics should be administered as early as possible, and always within the first hour of recognizing severe sepsis and septic shock. Broad-spectrum antibiotics must be selected with ...
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Anand Kumar Source Type: journals

Microcirculatory Dysfunction in SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses the role of microcirculatory dysfunction in the pathophysiology of sepsis, reviewing the role of the endothelium in modulating microcirculatory flow, discussing the function of nitric oxide in mediating microcirculatory blood flow, and outlining means of evaluating microcirculatory function in septic patients. Finally, potential novel therapies and challenges in treating microcirculatory dysfunction in septic patients are discussed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: David J. Lundy, Stephen Trzeciak Source Type: journals

Animal Models of SepsisEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this review, we start with a general discussion of relevant factors that can determine the validity of a sepsis animal model. We briefly review some of the currently used animal models of sepsis (small animal models and large animal models). We discuss the clinical relevance of animal models in sepsis research today and address potential reasons for the apparent underperformance of animal models in predicting therapeutic success of novel drugs in clinical trials. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Sergio L. Zanotti-Cavazzoni, Roy D. Goldfarb Source Type: journals

The Pathophysiology of Septic ShockEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There is a profound cellular dysfunction in sepsis, that clinically manifests as a continuum from simple, uncomplicated sepsis to severe sepsis, and finally to septic shock. Septic shock remains a significant challenge for clinicians. Recent advances in cellular and molecular biology have significantly improved our understanding of its pathogenetic mechanisms. These improvements will translate to better care and improved outcomes for these patients. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: O. Okorie Nduka, Joseph E. Parrillo Source Type: journals

Evolving Concepts in Sepsis DefinitionsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Standardization of definitions has been considered important in sepsis to facilitate accurate diagnosis and treatment, to clarify patient inclusion criteria for clinical trials, and to enable comparison of results from different studies. However, despite development and publication of consensus conference definitions, diagnosis of sepsis remains difficult in clinical practice and many patients do not receive the early specific therapy that could benefit them. Concepts of sepsis need to evolve such that good global definitions are accompanied by better strategies for individual diagnosis and disease characterization; patien...
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Jean-Louis Vincent, Eva Ocampos Martinez, Eliezer Silva Source Type: journals

The Evolution of the Understanding of Sepsis, Infection, and the Host Response: A Brief HistoryEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article focuses on the evolution of understanding about the fundamental nature of infection and the host response that leads to sepsis. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: Steven M. Opal Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Severe sepsis remains a difficult condition to characterize and is often a difficult disease to treat. Morbidity and mortality remains unacceptably high. Although the history of sepsis goes back to the origins of modern medicine, only in the last 40 years is the septic state beginning to be unraveled. (Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Authors: R. Phillip Dellinger Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - October 1, 2009 Category: Intensive Care Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Source Type: journals

Cognitive Functioning, Mental Health, and Quality of Life in ICU Survivors: An OverviewEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Critical illness can and often does lead to significant cognitive impairment and to the development of psychological disorders. These conditions are persistent and, although they improve with time, often fail to completely abate. Although the functional correlates of cognitive and psychological morbidity (depression, anxiety, and posttraumatic stress disorder) have been studied, they may include poor quality of life, inability to return to work or to work at previously established levels, and inability to function effectively in emotional and interpersonal domains. The potential etiologies of cognitive impairment and psych...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: James C. Jackson, Nathaniel Mitchell, Ramona O. Hopkins Source Type: journals

Delirium: An Emerging Frontier in the Management of Critically Ill ChildrenEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objectives of this article are (1) to introduce pediatric delirium and provide understanding of acute brain dysfunction with its classification and clinical presentations (2) to understand how delirium is diagnosed and discuss current modes of delirium diagnosis in the critically ill adult population and translation to pediatrics (3) to understand the prevalence and prognostic significance of delirium in the adult and pediatric critically ill population (4) to discuss the pathophysiology of delirium as currently understood, and (5) to provide general management guidelines for delirium. (Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Heidi A.B. Smith, D. Catherine Fuchs, Pratik P. Pandharipande, Frederick E. Barr, E. Wesley Ely Source Type: journals

Delirium Prevention and TreatmentEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Delirium occurs in 35% to 80% of critically ill hospitalized patients. Little is known of delirium prevention and treatment in the critical care setting. Trials emphasizing early mobilization suggest that this nonpharmacologic approach is associated with improved outcome as well as “delirium days”. Titration and reduction of opiate analgesics and sedatives may improve subsyndromal delirium rates. All critical care caregivers should rigorously screen for alcohol abuse, apply alcohol withdrawal scales in alcoholic patients, and titrate sedative drugs. No nonpharmacologic approach or drug has been shown to be beneficial o...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Yoanna Skrobik Source Type: journals

Pharmacoeconomics of Sedation in the ICUEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Despite considerable information on the pharmacotherapy of sedation in the ICU, there is little published on the pharmacoeconomics of sedation in patients who are critically ill. The purpose of this article is to discuss the various components that contribute to the cost of treating the agitated ICU patient and to critically review the articles published since 2000 that evaluated costs and cost-effectiveness in ICU patients receiving drugs for agitation and/or pain. Clinicians should look beyond the acquisition cost of a sedative and include the effect of sedatives on the cost of care when selecting the most appropriate se...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Joseph F. Dasta, Sandra Kane-Gill Source Type: journals

Sedation & ImmunomodulationEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The management of critically ill patients necessitates the use of sedatives and analgesics to provide patient comfort and cooperation. These drugs exert profound effects on all organ systems, not only the central nervous system, and this article describes the immunologic effects of the commonly used critical care sedatives: propofol, the benzodiazepines, opioids, and α2-adrenoceptor agonists. Benzodiazepines, opioids, and possibly even propofol worsen outcome in animal models of infection, whereas preliminary evidence suggests that the α2-adrenoceptor agonist, dexmedetomidine, may improve outcomes in the setting of infec...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Robert D. Sanders, Tracy Hussell, Mervyn Maze Source Type: journals

Sedation and Sleep Disturbances in the ICUEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article reviews the relationship between sedation and sleep from physiologic and clinical perspectives. (Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Gerald L. Weinhouse, Paula L. Watson Source Type: journals

Altering Intensive Care Sedation Paradigms to Improve Patient OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Providing sedation and comfort for intensive care patients has evolved in the last few years. New approaches to improving outcomes for intensive care unit (ICU) patients include providing analgesia before adding sedation and recognizing dangerous adverse effects associated with sedative medications, such as prolonged effects of midazolam, propylene glycol toxicity with lorazepam, propofol infusion syndrome, the deliriogenic effects of benzodiazepines and propofol, and bradycardia with dexmedetomidine. There are now reliable and valid ways to monitor pain and delirium in ICU patients. Dexmedetomidine reduces the incidence o...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Richard R. Riker, Gilles L. Fraser Source Type: journals

Sedation and Weaning from Mechanical Ventilation: Linking Spontaneous Awakening Trials and Spontaneous Breathing Trials to Improve Patient OutcomesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Liberation from mechanical ventilation is a vital treatment goal in the management of critically ill patients. The duration of mechanical ventilation is affected by strategies for ventilator weaning and sedation. The authors review literature on weaning from mechanical ventilation and delivery of sedation in critically ill patients, including current guidelines recommending the use of spontaneous breathing trials and spontaneous awakening trials. Implementation of these strategies in a wake-up-and-breathe protocol has demonstrated benefit over the use of spontaneous breathing trials alone. (Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Michael H. Hooper, Timothy D. Girard Source Type: journals

Protocolized and Target-based Sedation and Analgesia in the ICUEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Administering sedative and analgesic medications is a cornerstone of optimizing patient comfort and minimizing distress, yet may lead to unintended consequences including delayed recovery from critical illness and slower liberation from mechanical ventilation. The use of structured approaches to sedation management, including guidelines, protocols, and algorithms can promote evidence-based care, reduce variation in clinical practice, and systematically reduce the likelihood of excessive and/or prolonged sedation. Patient-focused sedation algorithms are multidisciplinary, including physician, nurse, and pharmacist developme...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Curtis N. Sessler, Sammy Pedram Source Type: journals

Current Sedation Practices: Lessons Learned from International SurveysEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The objective of this review is to present the findings of surveys and practice audits, evaluating the management of sedation and analgesia in mechanically ventilated adults in the intensive care unit, and to summarize international critical care sedation practices. (Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Sangeeta Mehta, Iain McCullagh, Lisa Burry Source Type: journals

Pharmacology of Sedative-Analgesic Agents: Dexmedetomidine, Remifentanil, Ketamine, Volatile Anesthetics, and the Role of Peripheral Mu AntagonistsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
In this article, the authors discuss the pharmacology of sedative-analgesic agents like dexmedetomidine, remifentanil, ketamine, and volatile anesthetics. Dexmedetomidine is a highly selective alpha-2 agonist that provides anxiolysis and cooperative sedation without respiratory depression. It has organ protective effects against ischemic and hypoxic injury, including cardioprotection, neuroprotection, and renoprotection. Remifentanil is an ultra–short-acting opioid that acts as a mu-receptor agonist. Ketamine is a nonbarbiturate phencyclidine derivative and provides analgesia and apparent anesthesia with relative hemodyn...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Oliver Panzer, Vivek Moitra, Robert N. Sladen Source Type: journals

Pharmacology of Commonly Used Analgesics and Sedatives in the ICU: Benzodiazepines, Propofol, and OpioidsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Opioids, benzodiazepines, and propofol remain the mainstay by which to optimize patient comfort and facilitate mechanical ventilation in patients who are critically ill. Unfortunately none of these agents share all of the characteristics of the ideal sedative or analgesic agent: rapid onset, rapid recovery, a predictable dose response, a lack of drug accumulation, and no toxicity. To optimize care, critical care clinicians should be familiar with the many pharmacokinetic, pharmacodynamic, and pharmacogenetic variables that can affect the safety and efficacy of these sedatives and analgesics. (Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: John W. Devlin, Russel J. Roberts Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Anyone who has been privileged enough to care for the critically ill over the past 15 years can speak of the rapid evolution of many facets of ICU medicine. Few areas have shifted more than the area of sedation and mechanical ventilation. These inextricably linked components of critical care represent the cornerstones of what we do for patients during their vulnerable course in the ICU. In a nutshell, we have progressed from a culture that embraced nearly universal deep sedation for days on end, with harsh methods of blowing too much air into patients' lungs, to a “kinder and gentler” approach that involves keeping pa...
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Pratik Pandharipande, E. Wesley Ely Source Type: journals

Erratum: Hemoglobin-Based Oxygen Carriers: First, Second or Third Generation? Human or Bovine? Where are We Now?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The above article which appeared in the April 2009 issue “Hemoglobin-based Oxygen Carriers: The Future in Resuscitation?” contained an unfortunate error regarding the figure legend for Fig. 6. The correct legend should read: (Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Authors: Lena M. Napolitano Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - June 30, 2009 Category: Intensive Care Source Type: journals

IndexEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Source Type: journals

The Ideal Blood SubstituteEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
There is an ongoing need for a red cell substitute, an oxygen-carrying solution to use primarily as a bridge until red cells are available. The replacement of oxygen-carrying capacity has driven the field of research, primarily with the development of hemoglobin-based oxygen carriers, but they are less than ideal. The formulation of a complete substitute for blood, if it can be realized, must take into account all the cellular and molecular components of the immune and coagulation systems. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: A. Gerson Greenburg Source Type: journals

Oxygen Therapeutics: Perfluorocarbons and Blood Substitute SafetyEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Current demands over the blood supply in developed and developing nations will compound over time. Red cell substitutes have a promising value proposition for transfusion services, because they hold the promise of increasing the availability of blood products and removing donor and contamination safety risks. In this article, the authors note that existing products suffer from critical shortcomings such as vasoactivity; they also point out that substitutes not based on human blood introduce potentially more complex safety hurdles. The authors discuss the attributes of an ideal blood substitute, and the mechanism and curren...
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Claudia S. Cohn, Melissa M. Cushing Source Type: journals

Stem Cells—A Source of Adult Red Blood Cells for Transfusion Purposes: Present and FutureEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article describes progress and the challenges that remain in the search for in vitro generated red blood cells that can be efficiently manufactured in high volumes and given to any recipient. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Luc Douay, Hélène Lapillonne, Ali G. Turhan Source Type: journals

Nanobiotechnology for Hemoglobin-based Blood SubstitutesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Nanobiotechnology is the assembling of biological molecules into nanodimension complexes. This has been used for the preparation of polyhemoglobin formed by the assembling of hemoglobin molecules into a soluble nanodimension complex. New generations of this approach include the nanobiotechnological assembly of hemoglobin, catalase, and superoxide dismutase into a soluble nanodimension complex. This acts as an oxygen carrier and an antioxidant for those conditions with potential for ischemiareperfusion injuries. Another recent novel approach is the assembling of hemoglobin and fibrinogen into a soluble nanodimension polyhem...
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: T.M.S. Chang Source Type: journals

Design of Recombinant Hemoglobins for Use in Transfusion FluidsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Molecular biology has been applied to the development of hemoglobin-based oxygen carrier (HBOC) proteins that can be expressed in bacteria or yeast. The transformation of the hemoglobin molecule into an HBOC requires a variety of modifications for rendering the acellular molecule of hemoglobin physiologically acceptable when transfused in circulation. Hemoglobins with different oxygen affinities can be obtained by introducing mutations at the heme pocket, the site of oxygen binding, or by introducing surface mutations that stabilize the hemoglobin molecule in the low-oxygen-affinity state. Modification of the size of the h...
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Clara Fronticelli, Raymond C. Koehler Source Type: journals

The USA Multicenter Prehosptial Hemoglobin-based Oxygen Carrier Resuscitation Trial: Scientific Rationale, Study Design, and ResultsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Human polymerized hemoglobin (PolyHeme) is a universally compatible oxygen carrier developed for use when red blood cells are unavailable and oxygen-carrying replacement is needed to treat life-threatening anemia. This multicenter phase III trial assessed survival of patients resuscitated with a hemoglobin-based oxygen carrier starting at the scene of injury. Patients resuscitated with PolyHeme had outcomes comparable to those receiving the standard of care including rapid access to stored red blood cells. Although there were more adverse events in the PolyHeme group compared with control patients receiving blood, the obse...
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Ernest E. Moore, Jeffrey L. Johnson, Frederick A. Moore, Hunter B. Moore Source Type: journals

Potential Uses of Hemoglobin-based Oxygen Carriers in Critical Care MedicineEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Hemoglobin-based oxygen carriers (HBOCs) were initially developed to provide an alternative to blood transfusion. With the realization that hemoglobin solutions not only are red blood cell substitutes but also have a number of additional properties, including hemodynamic effects related to their oncotic and nitric oxide–scavenging effects, the broader concept of “hemoglobin therapeutics” was born. Promising effects on oxygen transport and the microcirculation need to be confirmed, and the results of studies with newer, second-generation HBOCs are eagerly awaited. In the meantime, possible adverse effects need to be c...
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Jacques Creteur, Jean-Louis Vincent Source Type: journals

Comparison of Hemoglobin-based Oxygen Carriers to Stored Human Red Blood CellsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Since the inception of allogeneic blood transfusion, the search for an alternative to the use of stored packed red blood cells has been underway. Over the last 10 years, modified hemoglobin solutions in the form of hemoglobin-based oxygen carriers (HBOCs) have made significant strides toward becoming clinically available and useful. Although HBOCs are not yet ready for regular use in the clinical arena, this may change in the near future as HBOC products continue to improve and as the elucidation of the mechanisms of any adverse effects becomes clearer. In the mean time, we must further the development of alternative strat...
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Alexander L. Eastman, Joseph P. Minei Source Type: journals

Hemoglobin-based Oxygen Carriers: First, Second or Third Generation? Human or Bovine? Where are we Now?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
This article discusses current efforts to develop hemoglobin-based oxygen carriers as blood substitutes in light of the worldwide shortage of safe and viable allogeneic donor blood. There are now viable approaches to modify the intrinsic biologic properties of hemoglobin to produce improved hemoglobin-based oxygen carriers. Polymerized hemoglobin preparations have proved most successful in clinical trials due to their improved side effect profile. The goal is to evaluate blood substitutes with enhanced intravascular retention, reduced osmotic activity, and attenuated hemodynamic derangements such as vasoconstriction. Altho...
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Lena M. Napolitano Source Type: journals

Why an Alternative to Blood Transfusion?Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
Allogeneic blood transfusions have been associated with several risks and complications and with worse outcomes in a substantial number of patient populations and clinical scenarios. Allogeneic blood is costly and difficult to procure, transport, and store. Global and local shortages are imminent. Alternatives to transfusion provide many advantages, and their use is likely to improve outcomes as safer and more effective agents are developed. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Aryeh Shander, Lawrence Tim Goodnough Source Type: journals

PrefaceEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
The need for an alternative to allogeneic red blood cells for transfusion has been recognized for more than a century. The most serious motivation for the development of a blood substitute is the worldwide shortage of safe and viable allogeneic donor blood. (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Lena M. Napolitano Source Type: journals

Forthcoming issuesEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Source Type: journals

ContentsEmail this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
(Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Source Type: journals

The most serious motivation for the development of a blood substitute is the worldwide shortage of safe and viable allogeneic donor blood. Preface.Email this article to a colleague. Save this article to My Clippings. Discuss or comment on this article.
PMID: 19341907 [PubMed - in process] (Source: Critical Care Clinics)
Source: Critical Care Clinics - April 1, 2009 Category: Intensive Care Authors: Napolitano LM Tags: Crit Care Clin Source Type: journals