The administration of AT III was safe and well-tolerated. It was followed by a 39 % reduction in 30-day all-cause mortality (NS). The reduction in mortality was accompanied by a considerably shorter stay in the ICU. Patients treated with AT III exhibited a better performance in overall severity of illness and organ failure scores (Acute Physiology and Chronic Health Evaluation II, multiple organ failure, organ system failure), which was noticeable soon after initiation of treatment. Patients treated with AT III demonstrated a better resolution of pre-existing organ failures and a lower incidence of new organ failures during the observation period. A meta-analysis comprising this and two other double-blind, placebo-controlled trials with AT III with a total of 122 patients suffering from severe sepsis confirms the positive trend. The results of the meta-analysis demonstrate a 22.9 % reduction in 30-day all-cause mortality in patients treated with AT III. Although still too small to be confirmative, the meta-analysis clearly points to the fact that a sufficiently powered phase III trial is warranted to prove whether AT III has a beneficial role in the treatment of severe sepsis.
Fenoldopam, a newly developed intravenous dopaminergic DA1 receptor agonist, was used in an open, prospective study for blood pressure control in 12 patients presenting with hypertensive crisis. At a dose of 0.2-0.5 microgram kg-1 min-1 fenoldopam decreased systolic blood pressure from 209 +/- 13 to 151 +/- 17 mmHg and diastolic blood pressure from 114 +/- 10 to 78 +/- 10 mmHg. Blood pressure was controlled in all 12 patients within 5-50 min. In none of the patients did rebound hypertension occur upon termination of the study medication, nor was any adverse event reported. Major hemodynamic changes induced by fenoldopam were a decrease in total peripheral resistance from 1853 +/- 611 to 1193 +/- 368 and in pulmonary vascular resistance from 252 +/- 170 to 180 +/- 74 dyne s-1 cm-5. In patients with high left ventricular filling pressure at study pulmonary capillary wedge pressure decreased while the stroke volume index and mixed venous oxygen saturation increased under fenoldopam. Thus, fenoldopam appears to be a rapid-acting, well-tolerated, and highly effective intravenous substance for the treatment of severe hypertension.
Creatine kinase MB isoenzyme was measured (using antibody inhibition) in serum of patients with exogenous intoxication, acute pancreatitis, cerebrovascular accidents, meningitis, encephalitis, skeletal muscle disease, shock, postoperative states and after coronary arteriography, cardiac catherisation of cardioversion. CK-MB activity was revealed only in sera of patients with exogenous intoxication (severity III and IV), polymyositis, scleroderma, after operation or after coronary arteriography, cardiac catherisation or cardioversion. As it is not possible to differentiate between CK-MB and CK-BB using inhibiting antibodies against CK-M subunit, CK-isoenzyme activity was determined in parallel, using precipitating antibodies. No CK-BB was found in any case. The determination of CK-MB isoenzyme after blocking of the CK-MB subunit by means of inhibiting antibodies is suitable for clinical diagnosis. The method significantly increases the value of creatine kinase measurement.
The remaining quality of life is tolerable. This is in accordance with the positive overall judgement of intensive care by patients themselves. The chief problem of intensive care remain diseases with continuing high mortality.
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