Intensive care medicine
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Intensive care medicine · Jan 1996
Event-related potentials--neurophysiological tools for predicting emergence and early outcome from traumatic coma.
To determine the prognostic value of multimodal evoked potentials (EPs) and event-related (ERPs) potentials in coma (Glasgow Coma Score <8), after severe traumatic brain injury (TBI). ⋯ Highly significant (P <0.001) correlations exist between long-latency ERP components and 3-month outcome. Short-latency EPs, brainstem (wave I-V) and somatosensory conduction times also correlate significantly with the GOS (P <0.01). Of the clinical measurements, pupillary response patterns, APACHE II and Glasgow Coma Scores (GCS) correlate significantly with outcome, as do the retrospective measures of duration of coma and post-traumatic amnesia (PTA) in survivors. Unfortunately, due to variance of long-latency responses, even in controls, absolute values cannot be relied upon as prognosticators. The presence of "mismatch negativity" predicted the return of consciousness (89.7% sensitivity and 100% specificity) and preceded changes in GCS. Its latency was the single best indicator of 90-day outcome from coma (r = -0.641).
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Inhaled nitric oxide is rapidly gaining popularity as a selective pulmonary vasodilator in patients with acute lung injury and pulmonary hypertension. The development of nitric oxide as a drug has bypassed the usual regulatory and commercial processes, and as a result clinicians have devised a wide range of delivery and monitoring systems. This review describes these systems, and discusses their advantages, disadvantages and safety. The monitoring of nitric oxide metabolites is also discussed.
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Intensive care medicine · Jan 1996
Clinical Trial Controlled Clinical TrialSplanchnic oxygen transport after cardiac surgery: evidence for inadequate tissue perfusion after stabilization of hemodynamics.
To evaluate the adequacy of visceral oxygen transport and gastric pHi after open heart surgery in patients with stable hemodynamics. ⋯ We conclude that a mismatch between splanchnic oxygen delivery and demand may be present despite stabilization of systemic hemodynamics after cardiac surgery. This is suggested by the parallel changes in splanchnic oxygen delivery and consumption. Dobutamine is likely to improve splanchnic tissue perfusion at this phase.
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Intensive care medicine · Jan 1996
Randomized Controlled Trial Clinical TrialTransgastric, pulsed Doppler echocardiographic determination of cardiac output.
The aim of this study was to evaluate the accuracy of cardiac output measurement with transesophageal echocardiography (TEE) using a transgastric, pulsed Doppler method in acutely ill patients. ⋯ Transgastric pulsed Doppler measurement across the left ventricular outflow tract with TEE is a very feasible and clinically acceptable method for cardiac output measurement in acutely ill patients.