Intensive care medicine
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Intensive care medicine · Mar 1996
Inspiratory pressure/maximal inspiratory pressure: does it predict successful extubation in critically ill infants and children?
To evaluate the accuracy of the initial negative inspiratory pressure (PI) to maximal negative inspiratory pressure (PImax) ratio in predicting extubation outcome for intubated infants and children. ⋯ The PI/PImax ratio cannot be used to predict extubation outcome in pediatric patients. Indices that predict extubation outcome in adults should not be extrapolated to infants and children before testing and validation.
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Intensive care medicine · Mar 1996
Comparative Study Clinical TrialAccuracy of oscillometric blood pressure measurement in critically ill neonates with reference to the arterial pressure wave shape.
To perform further evaluation of the oscillometric device for neonatal arterial blood pressure (ABP) measurement, using a catheter-manometer system (CMS) for accurate intraarterial measurement. We aimed to describe the influence of the radial artery wave shape on oscillometric ABP determination, as pressure wave-shape influences the relationships between systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) in the wave. These relationships are part of the algorithms contributing to the final ABP determination in the oscillometric device. ⋯ Inaccuracy of the oscillometric device may be partly explained by the incorporation of an inappropriately fixed algorithm for final ABP determination in newborns. Care should be taken when interpreting the oscillometrically derived values in critically ill newborn infants.
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Intensive care medicine · Mar 1996
Clinical TrialEffects of rapid permissive hypercapnia on hemodynamics, gas exchange, and oxygen transport and consumption during mechanical ventilation for the acute respiratory distress syndrome.
To measure the effects of rapid permissive hypercapnia on hemodynamics and gas exchange in patients with acute respiratory distress syndrome (ARDS). ⋯ These data indicate that acute hypercapnia increases DO2 and O2 off-loading capacity in ARDS patients with normal plasma lactate, without increasing O2 extraction. Whether this would be beneficial in patients with elevated lactate levels, indicating tissue hypoxia, remains to be determined. Furthermore, even though hypercapnia was well tolerated, the increase in Qva/Qt, CI, and MPAP should prompt caution in patients with severe hypoxemia, as well as in those with depressed cardiac function and/or severe pulmonary hypertension.
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Intensive care medicine · Mar 1996
Case ReportsPain relief with low-dose intravenous clonidine in a child with severe burns.
The case of an 11-year-old boy who suffered second and third degree burns to 78% of his body is reported. The large doses of morphine used as analgesia resulted in severe side effects: ventilatory dependence, impairment of gastrointestinal function and psychological disturbance. Intravenous lignocaine was added without benefit. The addition of low-dose intravenous clonidine, however, precipitated a dramatic reduction in morphine consumption with an attendant improvement in ventilatory, gastrointestinal and psychological functions.
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Intensive care medicine · Mar 1996
Editorial Comment ReviewPermissive hypercapnia in ARDS: just do it?