Intensive care medicine
-
To review the technology, clinical trials and current status of continuous blood gas monitoring in intensive care. ⋯ Over the past 10 years a number of continuous intra-arterial blood gas monitoring systems have been developed. The performance characteristics of these systems are comparable. Their levels of accuracy as measured in bench tonometry are not consistently achieved in clinical trials. The potential usefulness of these monitors in various clinical situations has been described in case studies. Controlled studies demonstrating an improvement in outcome with the use of these monitors have not been published.
-
Intensive care medicine · Aug 1996
Early and late onset bacteremia have different risk factors in trauma patients.
The aim of this study was to identify risk factors and to describe epidemiological patterns for early-(EOB) and late-onset bacteremias (LOB) after trauma. ⋯ Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.
-
Intensive care medicine · Aug 1996
Clinical TrialThe influence of weight on stroke volume determination by means of impedance cardiography in cardiac surgery patients.
Obesity is thought to be one of the conditions in which the impedance cardiographic method is less reliable for estimating stroke volume (SV). This led to the introduction of a weight correction factor, sigma, into the equation according to Sramek and Bernstein. However, no scientific evidence has been published to support the use of this factor. The objectives of the present study are to evaluate the influence of body weight on the accuracy of impedance cardiography and to validate Bernstein's weight correction factor by comparison with thermodilution in patients after coronary bypass surgery. ⋯ Weight significantly influences Sramek and Bernstein's method of impedance cardiography, whereas Kubicek's method is not biased by this factor.
-
Intensive care medicine · Aug 1996
Clinical TrialWeaning and extubation in the intensive care unit. Clinical or index-driven approach?
To assess the outcome of a clinical judgement-based approach to weaning and extubation and to adduce the predictive accuracy of various mechanical respiratory indices measured in parallel. ⋯ Bedside clinical judgement of weaning and extubation produces satisfactory outcomes. As a routine, mechanical predictive indices have limited utility.
-
Intensive care medicine · Aug 1996
Analysis of P50 and oxygen transport in patients after cardiac surgery.
To determine whether standard P50 after cardiac surgery decreases and whether decreased P50 is related to the transfusion of red blood cells (RBCs), acid-base changes, body temperature, oxygen parameters and/or duration of cardiopulmonary bypass (CPB). ⋯ Cardiac surgery patients receiving more RBC units have lower standard P50 and consume more oxygen. P50 decreased more when the CPB took longer. Because a decrease in P50 implies a low ratio of mixed venous oxygen tension (PvO2) to SvO2, a shift in P50 should be taken into account when using SvO2 as a measure of global oxygen availability. When a direct measurement of SvO2 is not available, PvO2 should be used instead of calculated SvO2.