Intensive care medicine
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Intensive care medicine · Jul 1994
ReviewTonometry to assess the adequacy of splanchnic oxygenation in the critically ill patient.
Tonometry, a relatively non-invasive technique for indirectly measuring the intramucosal pH (pHi) of the gastrointestinal tract, has recently been developed for use in critically ill patients. Reports in the literature suggest that the technique is of greatest benefit to patients at risk of developing reductions in splanchnic oxygenation (decreased O2 delivery) in whom early detection of the ischemic episode could possibly guide treatment. Tonometry, although still at a relatively early stage in its clinical development, could be of value for selected patient groups although further evaluation of the technique is necessary.
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Intensive care medicine · Jul 1994
Clinical TrialTracheal gas insufflation reduces the tidal volume while PaCO2 is maintained constant.
The aims of the present study were two-fold: first, to confirm the effect of tracheal gas insufflation (TGI) throughout the respiratory cycle on alveolar ventilation at various catheter flows and constant total inspired VT as an adjunct to conventional volume cycled mechanical ventilation in patients with acute lung injury; second, to test the efficacy of TGI in the reduction of toal VT, peak and mean airway pressure while maintaining PaCO2 in its baseline value. The hemodynamic effect and the consequences on oxygenation as result of the reduction of VT, were also estimated. ⋯ The results of this study suggest that TGI may be an useful adjunct mode of mechanical ventilation that limits alveolar pressure and minute ventilation requirements.
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Intensive care medicine · Jul 1994
Case Reports Comparative StudyUsefulness of central venous oxygen saturation monitoring during cardiopulmonary resuscitation. A comparative case study with end-tidal carbon dioxide monitoring.
The usefulness of continuous monitoring of central venous oxygen saturation (ScvO2) in comparison with the capnogram during cardiopulmonary resuscitation (CPR) was demonstrated in a cardiac arrest patient. ScvO2 and end-tidal carbon dioxide (ETCO2) decreased following cessation of chest compression or increased during recovery of systemic circulation. During the complete stasis of systemic circulation, when defibrillation was done, ScvO2 did not change, while ETCO2 gradually decreased. ⋯ And also the ScvO2 monitoring had great advantage to detecting peripheral tissue oxygenation. ScvO2 seems to be no less accurate and reliable monitoring than the capnogram during CPR procedures. Since the capnogram is non-invasively and easily used in cardiac arrest patients, ScvO2 monitoring combined with the capnogram is a more preferable method for assessing the efficacy of ongoing CPR.
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Intensive care medicine · Jul 1994
Comparative Study Clinical TrialEvaluation of respiratory system resistance in mechanically ventilated patients: the role of the endotracheal tube.
To investigate the role played by the endotracheal tube (ETT) in the correct evaluation of respiratory system mechanics with the end inflation occlusion method during constant flow controlled mechanical ventilation. ⋯ When precise measurements of ohmic resistances are required in mechanically ventilated patients, the measurements must be obtained from airways pressure data obtained at tracheal level. The "in vivo" positioning of ETT significantly increases the airflow resistance of the ETT.
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Intensive care medicine · Jul 1994
Can bacteremia be predicted in surgical intensive care unit patients?
To determine which clinical features are associated with bacteremia in a SICU. To determine if infections are identified prior to bacteremia via culturing of other body fluids. To determine if antibiotic regimens are changed after the results of the blood culture were obtained. ⋯ A better screen for obtaining blood cultures in this SICU was not identified. If antibiotics are begun empirically before the results of blood cultures are known, the results of other body fluid cultures can be used to guide therapy initially. However, the data obtained from positive blood cultures was often helpful in changing empirical therapy. Therefore, blood cultures remain important diagnostic tools.