Intensive care medicine
-
Intensive care medicine · Jan 1991
Blood lactate and mixed venous-arterial PCO2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgery.
Conventional indices of tissue perfusion after surgery involving cardiopulmonary bypass (CPB) may not accurately reflect disordered cell metabolism. Venous hypercarbia leading to an increased veno-arterial difference in CO2 tensions (V-aCO2 gradient) has been shown to reflect critical reductions in systemic and pulmonary blood flow that occur during cardiorespiratory arrest and septic shock. We therefore measured plasma lactate levels and V-aCO2 gradients in 10 patients (mean age 57.2 years) following CPB and compared them with conventional indices of tissue perfusion. ⋯ We conclude that blood lactate, CI and VO2 increase progressively following CPB. An increase in lactate was associated with a decrease in V-aCO2. An increase in V-aCO2 was not therefore associated with evidence of inadequate tissue perfusion as indicated by an increased blood lactate concentration.
-
Intensive care medicine · Jan 1991
Case ReportsTotal extracorporeal lung assist--a new clinical approach.
Total extracorporeal lung assist (ECLA) requires a bypass flow approaching cardiac output. Recirculation of venous blood through the oxygenator is minimized with a veno-right ventricular cannulation technique which separates venous drainage from returned oxygenated blood. A case of posttraumatic ARDS was treated with surface-heparinized veno-right ventricular ECLA for 35 days. ⋯ Low platelet counts and a marked bleeding tendency complicated treatment, even though no heparin was used during the last 24 days of ECLA. Weaning from the ventilator was accomplished 2 months after ECLA. Lung function tests show constant improvement.
-
Intensive care medicine · Jan 1991
Two-stage resuscitation of the cat brain after prolonged cardiac arrest.
Following prolonged cardiac arrest, reperfusion of the brain is endangered by the low blood perfusion pressure during the early resuscitation phase. In order to avoid low perfusion brain injury, a two-stage resuscitation protocol was applied to cats submitted to 30 min potassium chloride induced cardiac arrest: first, the heart was resuscitated, followed--after stabilisation of blood pressure--by recirculation of the brain. During cardiac resuscitation the brain was disconnected from the general circulation by inflating a pneumatic cuff around the neck. ⋯ Cardiac resuscitation was successful in 5 out of 8 animals with 15 min and in 6 out of 13 animals with 30 min cardiac arrest. In successfully resuscitated animals of both groups, brain energy metabolism recovered to normal within 3 h although two-stage resuscitation increased brain ischemia time to 37-61 min. Two-stage resuscitation, in consequence, is a promising approach for revival of the brain after prolonged cardiac arrest.
-
Intensive care medicine · Jan 1991
Case ReportsBreast abscess following central venous catheterization.
We describe a case of late perforation of the right internal mammary vein by a central venous catheter inserted via the left subclavian vein. This resulted in extravasation of parenteral nutritional fluid and breast abscess formation. ⋯ Confirmation of correct placement of the central venous catheter must be sought in any patient who develops these symptoms or signs so that the delay in diagnosis we experienced can be avoided. This may be obtained by a lateral or oblique chest radiograph or by contrast studies if preferable.
-
Intensive care medicine · Jan 1991
Case ReportsAcute pulmonary emboli associated with guidewire change of a central venous catheter.
The potential complications of percutaneous venous catheterizations are many and include pneumothorax, subclavian and carotid artery puncture, hematoma, air embolism, catheter malposition, catheter fragment embolization, venous thrombosis and infection. This case report describes a patient who developed angiographically documented pulmonary emboli associated with the changing of a central venous catheter over a guidewire using Seldinger technique. This episode adds the possibility of acute pulmonary emboli to the list of potential complications from central venous catheterizations.