Critical care in Europe.

Intensive care medicine developed in Europe following the polio epidemic in Denmark in 1952 and is now a specialty in its own right. Across Europe differences exist between countries regarding unit size, policy, staffing, and patient demographics. There is in particular a marked north/south divide, with smaller units dealing with sicker patients in the south than the north.

Determining the trough-to-peak ratio in parallel-group trials. Systolic Hypertension in Europe (SYST-EUR) Trial Investigators.

We explored how in parallel-group trials interindividual variability, correction for placebo effects, and smoothing of blood pressure profiles can be handled in measuring the trough-to-peak ratio in 244 individuals with isolated systolic hypertension (> or = 60 years) enrolled in the placebo-controlled Systolic Hypertension in europe Trial. Net treatment effects were computed by subtracting the mean changes from baseline during placebo (n = 133) from those during active treatment (n = 111). At entry, systolic/diastolic pressures averaged 176/86 mm Hg in the clinic and 149/80 mm Hg on 24-hour ambulatory monitoring.

Salt and blood pressure in community-based intervention trials.

This article reviews community-based salt intervention trials. In the Belgian Salt Intervention Trial, a controlled 5-y intervention in two Belgian towns resulted in a reduction in urinary sodium of 17 mmol/24 h (P < 0.001) in adult (aged > or = 20 y) women in the intervention town, which differed from the concurrent trend (an increase of 8 mmol/24 h) in the control town (P = 0.

Nocturnal blood pressure fall on ambulatory monitoring in a large international database. The "Ad Hoc' Working Group.

A wide range of definitions is used to distinguish subjects in whom blood pressure (BP) falls at night (dippers) from their counterparts (nondippers). In an attempt to standardize the definition of nondipping, we determined the nocturnal BP fall and night-day BP ratio by 24-hour ambulatory monitoring in 4765 normotensive and 2555 hypertensive subjects from 10 to 99 years old. In all subjects combined, the systolic/diastolic nocturnal fall and corresponding ratio averaged (+/- SD) -16.

Prediction of cardiac structure and function by repeated clinic and ambulatory blood pressure.

We performed imaging echocardiography, Doppler velocimetry, and repeated clinic and ambulatory blood pressure measurements in 74 hypertensive individuals to clarify why reports differ on the strength of the relationships of left ventricular characteristics with clinic blood pressure, on the superiority of ambulatory over clinic pressure, and on the importance of day-time and nighttime pressures. Clinic pressure was measured five times with an automated device and five times with the conventional technique on 2 different days. The partial correlation coefficients of left ventricular mass and wall thickness with the first automated systolic and diastolic clinic pressures amounted to .

Outcome of ICU treatment in invasive aspergillosis.

Objective: To assess the outcome of intensive care treatment in invasive aspergillosis.

Design: Retrospective study.

Setting: University Hospital, Medical Intensive Care Unit (ICU).

Gram-negative shock in rats depends on the presence of capsulated bacteria and is modified by laparotomy.

To develop a hyperdynamic sepsis model in rats, four Escherichia coli strains were used, which differed in the presence or absence of a capsule or K antigen (K1 and K-, respectively) and/or in O serogroup (O9 and O18). Of the two clinical isolates, O9K- did not survive in rat serum, whereas O18K1 and two isogenic laboratory strains (O18K1 and O18K-) were able to resist serum bacteriolysis. Pentobarbital-anesthetized rats (n = 21) received an intravenous bolus of 10(9) bacteria.

Laparotomy and renal function during endotoxin shock in rats.

Despite the wide use of laparotomy to study kidney function, the possible influence of this procedure on systemic and renal parameters in septic rats is unknown. We studied this in anesthetized Wistar rats with and without endotoxin shock (1 h Escherichia coli O 127.B8: 8 mg.

Long-term blood pressure control in older Chinese patients with isolated systolic hypertension: a progress report on the Syst-China trial.

This report on the ongoing double-blind placebo-controlled Syst-China trial investigated whether antihypertensive drug treatment based mainly on a calcium entry blocker and a converting enzyme inhibitor, would be suitable for maintaining long-term blood pressure (BP) control in older Chinese patients (average age: 67 years) with isolated systolic hypertension (systolic pressure 160-219 mm Hg and diastolic pressure < 95 mm Hg). Active treatment consisted of nitrendipine (10- 40 mg/day) with the possible addition of captopril (12.5- 50 mg/day) and hydrochlorothiazide (12.

Continuous quality improvement in the ICU and the role of a data management system.

Quality improvement may be defined as the effort to improve the level of performance of key processes in the ICU. Based on knowledge of the current level of performance and on systematic analysis of organizational aspects of the ICU, quality improvement will include the implementation of standards, the formulation and analysis of quality indicators (e.g.

Prevalence and persistency of orthostatic blood pressure fall in older patients with isolated systolic hypertension. Syst-Eur Investigators.

Postural hypotension in older people has been the subject of many studies, but there remains some doubt as to its true prevalence. This study investigated the prevalence and persistency of an exaggerated orthostatic blood pressure (BP) fall in a large group of older patients with isolated systolic hypertension. A total of 2716 patients, 917 men and 1799 women, whose age ranged from 60-100 years, were examined at three separate outpatient visits on a placebo in the single-blind run-in phase of the Syst-Eur Trial.

Life style as a blood pressure determinant.

In Belgium, an affluent Western European country, participation in sports, alcohol intake, and living in a working class area were identified as the life style factors with the closest associations with the blood pressure level. Obesity was another important blood pressure correlate. Sodium intake, determined from the 24 h urinary output, and smoking were not associated with blood pressure.

Advantages and disadvantages of the meta-analysis approach.

Unlabelled: ADVANTAGES OF META-ANALYSIS: Literature reviews have traditionally been largely narrative. Meta-analysis now offers the opportunity to critically evaluate and statistically combine results of comparable studies or trials. Its major purposes are to increase the numbers of observations and the statistical power, and to improve the estimates of the effect size of an intervention or an association.

The 67gallium pulmonary leak index in assessing the severity and course of the adult respiratory distress syndrome.

Objective: To establish the value of the 67Gallium (Ga) pulmonary leak index, a marker of increased permeability edema of the lungs, in assessing the severity and course of the adult respiratory distress syndrome (ARDS).

Design: Prospective observational study.

Setting: Medical intensive care unit of a university hospital.

International sepsis trial (INTERSEPT): role and impact of a clinical evaluation committee.

Objective: Several large clinical trials have recently evaluated a variety of potential therapeutic interventions for sepsis and have yielded negative results based on analyses of intention-to-treat cohorts. The present study was undertaken to evaluate the importance of a Clinical Evaluation Committee.

Design: Prospective, double-blind evaluation of a prospective, controlled, double-blind, randomized, multinational trial.

Ambulatory blood pressure monitoring in clinical trials.

Ambulatory blood pressure monitoring is increasingly used in clinical trials. The preliminary threshold values proposed for diagnosing hypertension and adjusting treatment based on ambulatory monitoring cannot yet be widely recommended because they have not been validated in prospective studies. The trough-to-peak or surface ratios may be useful instruments for assessing the duration of action of antihypertensive drugs.

Associations of orthostatic blood pressure fall in older patients with isolated systolic hypertension. Syst-Eur Investigators.

Objectives: To investigate the associations of the orthostatic blood pressure changes in older patients with isolated systolic hypertension.

Methods: A total of 2716 patients, 917 men and 1799 women, aged > or = 60 years, were examined at three separate outpatient visits whilst receiving placebo during the single-blind run-in phase of the Syst-Eur trial. The orthostatic blood pressure changes were calculated by subtracting the average of two blood pressure readings with the patient in the supine position from the mean of two readings obtained after the patient had stood for 2 min.

Effect of strength training on blood pressure measured in various conditions in sedentary men.

To examine the effect of long term strength training on heart rate and blood pressure, measured in different conditions, and on their variability, thirty healthy, previously sedentary men were randomized into a training and a control group. The strength training program consisted of 48 training sessions on a multigym apparatus at a frequency of 3 sessions each week, involving leg press, bench press, leg curl, shoulder press, leg extension and sit ups. The control group was asked not to change their sedentary lifestyle.

Transcranial Doppler and systemic hemodynamic studies in septic shock.

The present study outlines the relationship between cerebral and systemic hemodynamics in patients with septic shock. Sepsis is an immune mediated systemic disease in which the systemic vascular resistance (SVR) often decreases as a result of a Gram negative sepsis. The result is a hyperdynamic systemic circulation with redistribution phenomena in different organ systems.

Diagnostic value of the gallium-67 pulmonary leak index in pulmonary edema.

Unlabelled: We studied the value of a noninvasive, bedside, dual-radionuclide method (67Ga-circulating transferrin and 99mTc-red blood cells) to measure pulmonary microvascular permeability in efforts to discriminate between pulmonary edema due to adult respiratory distress syndrome (ARDS) and hydrostatic pulmonary edema (HPE).

Methods: Patients had respiratory insufficiency and bilateral alveolar pulmonary edema on chest radiographs. All patients, except one, were mechanically ventilated.