Intensive care medicine
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Intensive care medicine · Jan 1988
Central mixed and splanchnic venous oxygen saturation monitoring.
Central mixed venous oxygen saturation (SvO2) monitoring in critically ill patients to estimate adequacy of peripheral perfusion is gaining increasing popularity. However, a number of unexpected responses, one of which is marked depression of regional (splanchnic) venous oxygen saturation which may coexist with normal or high SvO2, makes interpretation of this parameter difficult. The SvO2 and hepatic venous oxygen saturation levels in seven injured (postoperative) and 15 septic patients were measured. ⋯ This reduced oxygen saturation was noted to arise from an increased regional metabolic rate rather than reduced perfusion. Nevertheless, we conclude that a flow limited regional oxygen consumption may potentially exist despite the presence of a normal SvO2 in certain patient subgroups such as septic subjects. Therefore, a normal SvO2 should not be considered as sole criteria to insure optimal oxygen delivery in critically ill patients.
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Intensive care medicine · Jan 1988
Case ReportsInadvertent intrathecal administration of amidetrizoate.
Two cases are presented in which amidetrizoate (Urografin) was accidentally introduced into the intrathecal cavity. Intrathecal lavage and continuous administration of thiopentone were very successful in preventing further systemic deterioration.
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A continuous high flow CPAP system incorporating a turbine blower is described. The system achieves inspiratory flow rates of 150 l/min or more by means of reticulated gas flow and inspired oxygen fractions of 0.21-0.95. ⋯ The mobility of the system also enables its use as an intermittent physiotherapy aid. Work of breathing of the system, as assessed by total pressure fluctuations is at a minimum.
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Intensive care medicine · Jan 1988
Peripheral, visceral and body nitrogen balance of catabolic patients, without and with parenteral nutrition.
The effect of major trauma and sepsis on skeletal muscle, central tissue and whole body nitrogen (N) metabolism was investigated in 5 patients before and during TPN (30 kcal, 0.30 g N kg-1 day-1). Fasting 3-methylhistidine (MEH) urinary excretion was elevated (407.9 +/- 67.6 mumol m-2 day-1), muscle and body N balances (NB) were markedly negative (-28.2 +/- 4.6 g m-2 day-1 and -15.7 +/- 3.1 g m-2 day-1), while central tissue NB was positive (13.0 +/- 2.4 g m-2 day-1). ⋯ Gathering fasting and TPN data MEH excretion was significantly related to both body (r = 0.89) and muscle (r = 0.73) NB, that were highly related to each other (r = 0.93), being muscle always worse than body NB. In conclusion, the anticatabolic activity of TPN is confirmed, although our setting did not achieve muscle NB, it was consistently improved and seems to be the major determinant of body NB, in contrast central NB and central N utilization (46.4% +/- 5.4 vs 15.8% +/- 8.4 - p less than 0.05) worsened.
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Intensive care medicine · Jan 1988
Comparative StudyToe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure.
Measurements of toe temperature and transcutaneous PO2 (PtcO2) have been both suggested for non-invasive assessment of peripheral blood flow in acute circulatory failure. The underlying principle of the two methods is that cutaneous vasoconstriction occurs early when tissue perfusion is altered. In 15 patients, we compared the two measurements during cardiogenic shock (27 measurements) or septic shock (29 measurements). ⋯ Since measurement of PtcO2 is technically more complicated, correlates less well with standard hemodynamic parameters and later reflects cardiovascular improvement, it has no advantage over measurement of toe temperature in circulatory shock. In cardiogenic shock, measurements of toe temperature can reliably track cardiac output changes. In septic states, however, non-invasive assessment of skin perfusion is of limited interest.