The results of this meta-analysis confirms that low-dose dopamine has no reno-protective effect. Considering the potential side-effects of dopamine this agent should not be used for this indication.

The volume oj distribution oj amikacin and the APACHE II score were determined in 42 critically ill patients being treated jor a gram-negative injection. The mean volume oj distribution (Vd!) was 0041 ± 0.12 IIkg with a wide range (normal oj 0.25 IIkg). There was a good relationship between the Vdt and illness severity as measured by the APACHE II score (r=0.70; P< 0.001). Critically ill patients should receive larger loading doses oj aminoglycosides in order to achieve therapeutic blood levels. The aminoglycoside Vdt may be usejul in determining the degree oj capillary leak and tissue oedema that accompanies sepsis.

Hypothermic patients with septic shock have a significantly higher mortality with a higher incidence of organ dysfunction than febrile septic shock patients. The hypothermia in these patients cannot be explained by lower levels of circulating proinflammatory cytokines.

OBJECTIVE: To document the impact of routine daily chest radiographs on treatment decisions in a medical ICU. METHODS: The study sample consisted of 200 consecutive patients in an 11-bed medical ICU of a university-affiliated teaching hospital. During the study period, each patient's current and previous chest radiographs were reviewed in the ICU during morning rounds. A computerized digital video display system was used. Changes in therapy made as a consequence of this review were recorded. RESULTS: A total of 471 chest radiographs were reviewed. The patients' mean score on the Acute Physiology and Chronic Health Evaluation II (APACHE II) was 14.6 +/- 2.5, and the mean length of stay in the ICU was 3.6 days +/- 2.1 days (range, 11-24 days). A change in therapy was made on the basis of information obtained from review of the chest radiograph in 174 instances (37% of radiographs). The most frequent therapeutic interventions were use of a loop diuretic to treat pulmonary edema (26%), repositioning of an endotracheal tube (24%), and diagnostic studies to determine the cause of a new pulmonary infiltrate (16%). At least one change in therapy was made for 91 (66%) of the 138 intubated patients but for only 14 (23%) of the 62 nonintubated patients; this difference was significant. Differences among diagnostic groups were largely a reflection of the number of patients who were intubated. CONCLUSION: Routine daily chest radiographs may be justified in critically ill patients in a medical ICU because for a large proportion of these patients management decisions are made on the basis of information obtained from the chest radiograph. This observation may be applicable only to ICUs that have a high turnover of patients who are in the unit for a short time.