Search PubMed⌕ Search

Biomedical subjects

R C Bone

Publications and source records attributed to R C Bone.

At least 55 records · Page 3Linked to original sources
PubMed1995

Recognition, assessment, and treatment of anxiety in the critical care patient.

A multidisciplinary group of experts involved in the treatment of critically ill patients participated in a workshop conference designed to develop practice recommendations for the recognition, assessment, and treatment of anxiety in the critical care environment. Anxiety was identified as a ubiquitous problem in critical care that may interfere with healing and recovery. The faculty agreed that clinicians should be familiar with the signs and symptoms of anxiety and should be able to determine when interventions are necessary. Whenever possible, nonpharmacologic methods for anxiolysis should be incorporated into intensive care protocols. Intensive care personnel should be trained in those interventions that require specialized expertise, and they should become familiar with the drugs available for the treatment of anxiety. Protocols for determining the best agents to be used in a given setting and their most appropriate method of administration should be established. Pharmacologic and nonpharmacologic treatments are not mutually exclusive but should be complementary. Finally, procedures for obtaining psychiatric consultation, when necessary, should be in place.

Adaptation, Psychological↗
PubMed1994

Gram-positive organisms and sepsis.

In recent years, the importance of gram-negative organisms in the genesis of sepsis has been emphasized. However, this emphasis may no longer be correct; recent studies show an increasing incidence of gram-positive sources of sepsis, and its is possible that these cases may predominate in the coming years. This increase results from more than just a greater prevalence of infection--it appears that gram-positive organisms may also be more virulent in fomenting the disease, as can be evidenced by the emergence of streptococcal toxic shock syndrome and the resurgence of acute rheumatic fever. This may result from the ability of gram-positive organisms to produce more inflammation-causing cell wall constituents, as well as unbound exotoxins. Despite the recent emphasis on gram-negative causes, sepsis resulting from gram-positive sources is increasingly common. Research on these causes of sepsis should be encouraged.

Animals↗
PubMed1994

Initial evaluation of human recombinant interleukin-1 receptor antagonist in the treatment of sepsis syndrome: a randomized, open-label, placebo-controlled multicenter trial.

OBJECTIVES: To evaluate the safety, pharmacokinetics, and efficacy of human recombinant interleukin-1 receptor antagonist (IL-1ra) in the treatment of patients with sepsis syndrome. DESIGN: Prospective, open-label, placebo-controlled, phase II, multicenter clinical trial using three different doses of human recombinant IL-1ra. SETTING: Twelve academic medical center intensive care units in the United States. PATIENTS: Ninety-nine patients with sepsis syndrome or septic shock who received standard supportive care and antimicrobial therapy, in addition to infusion with escalating doses of IL-1ra or placebo. INTERVENTIONS: Patients received an intravenous loading dose of either human recombinant IL-1ra (100 mg) or placebo, followed by a 72-hr intravenous infusion of either one of three doses of IL-1ra (17, 67, or 133 mg/hr) or placebo. All patients were evaluated for 28-day, all-cause mortality. MEASUREMENTS AND MAIN RESULTS: A dose-dependent, 28-day survival benefit was associated with IL-1ra treatment (p = .015), as indicated by the following mortality rates: 11 (44%) deaths among 25 placebo patients; eight (32%) deaths among 25 patients receiving IL-1ra 17 mg/hr; six (25%) deaths among 24 patients receiving IL-1ra 67 mg/hr; and four (16%) deaths among 25 patients receiving IL-1ra 133 mg/hr. A dose-related survival benefit was observed with infusion of IL-1ra in patients with septic shock at study entry (n = 65; p = .002) and in patients with Gram-negative infection (n = 45; p = .04). Patients with an increased circulating interleukin-6 (IL-6) concentration of > 100 pg/mL at study entry demonstrated a dose-related survival benefit with IL-1ra treatment (p = .009). In patients with an increased IL-6 concentration at study entry, the magnitude of the decrease in IL-6 concentration 24 hrs after the initiation of therapy was correlated with increasing the IL-1ra treatment dose (p = .052). A significant dose-related reduction in the Acute Physiology and Chronic Health Evaluation (APACHE II) score was achieved by the end of infusion (p = .038). A renal elimination mechanism for IL-1ra was suggested by the positive correlation between IL-1ra plasma clearance and estimated creatinine clearance (p = .001; r2 = .51). Human recombinant IL-1ra was well tolerated. CONCLUSIONS: This initial evaluation suggests that human recombinant IL-1ra is safe and may provide a dose-related survival advantage to patients with sepsis syndrome. A larger, definitive clinical trial is needed to confirm these findings.

Adult↗
PubMed1994

Sepsis and SIRS.

Explore the source record for details and available documents.

Animals↗
PubMed1994

Sepsis and its complications: the clinical problem.

OBJECTIVES: To review the difficulties associated with defining sepsis and its complications and to characterize the role of the proinflammatory cytokines in the development of human septic shock, adult respiratory distress syndrome, and the systemic inflammatory response syndrome. DATA SOURCES: Information presented at the 22nd Educational and Scientific Symposium of the Society of Critical Care Medicine on June 9-13, 1993 in New York City was reviewed, along with supportive documentation from the English language literature. STUDY SELECTION: Human studies that provide evidence for the definitions of sepsis and related entities. DATA EXTRACTION: This review focused on those data that described the role of selected cytokines in septic shock. DATA SYNTHESIS: Information concerning the evolution of the definition of sepsis and its sequelae was integrated with considerations used for patient identification for clinical trials involving novel septic shock therapies. CONCLUSIONS: Sepsis and its complications constitute a complex biological cascade that may be defined by specific clinical characteristics. The clinical variability in these events suggests that definitions based on clinical end points be used in combination with assessments of severity of illness to best define patient status, predict clinical course, and guide treatment decision-making.

Cytokines↗
PubMed1993

Plasma cytokine and endotoxin levels correlate with survival in patients with the sepsis syndrome.

OBJECTIVE: To determine whether plasma tumor necrosis factor-alpha (TNF-alpha), interleukin-1 beta (IL-1 beta), interleukin-6 (IL-6), and lipopolysaccharide are detectable in patients when they first present with the sepsis syndrome and to determine whether levels correlate with patient survival. DESIGN: Prospective study comparing patients with the sepsis syndrome, critically ill patients without sepsis, and normal healthy volunteers. SETTING: Tertiary care hospital affiliated with a medical school. PATIENTS: The study included 97 consecutive patients on a medical service who met the criteria for the sepsis syndrome; 20 critically ill patients without sepsis who were in the medical intensive care unit; and 20 healthy volunteers who served as comparison groups. MEASUREMENTS: Plasma tumor necrosis factor-alpha, IL-1 beta, interleukin-6, and endotoxin (lipopolysaccharide) levels were measured when a patient was first identified as having the sepsis syndrome. Survival was defined as being alive 30 days after the sepsis syndrome was diagnosed. RESULTS: Fifty-four percent of patients with the sepsis syndrome had detectable levels of TNF-alpha (median, 26 pg/mL; range, nondetectable to 1000 pg/mL); 37% had detectable levels of IL-1 (median, 20 pg/mL; range, nondetectable to 2850 pg/mL); 80% had detectable levels of IL-6 (median, 415 pg/mL; range, nondetectable to 2380 pg/mL); and 89% had detectable levels of lipopolysaccharide (median, 2.6; range, nondetectable to 12.5 endotoxin units [EU]/mL). In all cases levels were higher than those in critically ill patients without sepsis and normal healthy controls (P < 0.001 for all comparisons). Plasma levels of TNF-alpha, IL-1 beta, IL-6, and lipopolysaccharide were detectable in patients regardless of culture status. The IL-6 level was 69% (95% CI, 30% to 108%) higher in patients who died compared with those who survived. The scores for the individual levels of TNF-alpha, IL-1 beta, IL-6, and lipopolysaccharide were summed to arrive at a total lipopolysaccharide-cytokine score, and mortality increased with lipopolysaccharide-cytokine score (P < 0.001). CONCLUSIONS: Patients with the sepsis syndrome have detectable levels of circulating TNF-alpha, IL-1, IL-6, and lipopolysaccharide independent of culture-documented infection. Lipopolysaccharide and cytokines may play a pathogenic role in sepsis, and the combination of several elevated factors may be important in determining patient survival.

Adolescent↗
PubMed1993

Bronchial asthma: diagnostic and treatment issues.

The increasing morbidity and mortality associated with asthma may, in part, be due to inadequate treatment. Step-care management aims to improve control by addressing both the bronchospastic and inflammatory components of the disease. beta-Adrenergic agonists are central to alleviating symptoms, whereas corticosteroids may reduce inflammation and associated airway hyperresponsiveness.

Administration, Inhalation↗
PubMed1993

Detrimental effects of high-dose methylprednisolone sodium succinate on serum concentrations of hepatic and renal function indicators in severe sepsis and septic shock. The Methylprednisolone Severe Sepsis Study Group.

OBJECTIVE: To evaluate the effects of high-dose methylprednisolone sodium succinate on biochemical markers of hepatic and renal function in patients with severe sepsis and septic shock. DESIGN: Retrospective analysis of serial serum chemistries in 382 patients who were entered prospectively into a randomized, placebo-controlled, double-blind clinical trial of high-dose methylprednisolone or placebo in the sepsis syndrome. SETTING: The original study was conducted at 19 academic centers. PATIENTS: Adult patients in severe sepsis or septic shock who met the study entry criteria, which included a clinically defined source of infection and signs of systemic sepsis, were enrolled into the study. Three hundred eighty-two patients were evaluated. INTERVENTIONS: Patients received either methylprednisolone (30 mg/kg) or placebo by iv infusion every 6 hrs for four doses. Hemodynamic variables and serum concentrations of creatinine, urea nitrogen, bilirubin, and aspartate aminotransferase (AST) were recorded on entering the study, at 12 and 24 hrs, and at 3, 7, and 14 days after the first infusion of methylprednisolone or placebo. These data were analyzed retrospectively. MAIN OUTCOME MEASUREMENTS: Hemodynamic and biochemical data were analyzed to determine whether or not hepatic and renal function in the sepsis syndrome had been influenced by methylprednisolone treatment. RESULTS: Differences between methylprednisolone and placebo in hemodynamic variables, the occurrence rate of shock and recovery from shock, mortality rates and serum concentrations of creatinine and AST were not statistically significant. At 12 and 24 hrs, and at 3 and 7 days after the first drug infusion (of methylprednisolone or placebo), blood urea nitrogen was increased from baseline values in a significantly (p < .01) greater proportion of the methylprednisolone-treated patients compared with placebo-treated patients. The frequency of increased serum bilirubin concentrations was significantly (p < .01) greater among methylprednisolone patients vs. the placebo group at 12 and 24 hrs. CONCLUSIONS: The frequency of acutely increased blood urea nitrogen and bilirubin concentrations in severe sepsis was increased significantly with high-dose methylprednisolone therapy. Similar frequencies of circulatory shock in the study groups excluded differences in global perfusion as a cause of this phenomenon. Possible adverse effects of pharmacologic concentrations of methylprednisolone in critically ill patients should be considered in planning treatment.

Aspartate Aminotransferases↗