Intensive care medicine
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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.
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Intensive care medicine · Aug 1996
Clinical TrialRight ventricular myocardial function in ARF patients. PEEP as a challenge for the right heart.
To examine the hemodynamic effects of external positive end-expiratory pressure (PEEP) on right ventricular (RV) function in acute respiratory failure (ARF) patients. ⋯ PEEP affects RV function in ARF patients. The decrease in cardiac output is more often associated with a preload decrease and no change in RV contractility. On the other hand, the finding of increased RV volumes with PEEP may be associated with a reduction in RV myocardial performance. Thus, these results suggest that assessment of RV function by PEEP and preload recruitable stroke work may disclose otherwise unpredictable alterations in RV function.
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Intensive care medicine · Aug 1996
Intermittent hemodialysis in critically ill patients with multiple organ dysfunction syndrome is associated with intestinal intramucosal acidosis.
Conventional intermittent hemodialysis in the critically ill patient can be associated with hemodynamic and respiratory instability. Intermittent hemodialysis induced arterial hypotension might be detrimental. We therefore studied the influence of intermittent hemodialysis on systemic and regional oxygen transport in critically ill patients. ⋯ In critically ill patients with multiple organ dysfunction syndrome intermittent hemodialysis induces an increase in oxygen consumption. Despite higher inotropic support to maintain systemic calculated oxygen delivery intestinal intramucosal acidosis occurs during intermittent hemodialysis and may even persist after the procedure is terminated.
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Intensive care medicine · Aug 1996
Hypocholesterolemia and risk of death in the critically ill surgical patient.
To evaluate the additional information provided by the determination of cholesterolemia to the Acute Physiology and Chronic Health Evaluation (APACHE) II score. ⋯ Both hyper- and hypocholesterolemia have a highly significant relationship to mortality. Cholesterolemia improves the prognostic power of the APACHE II score. This result could be used to create a more powerful prognostic index.