Intensive care medicine
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Intensive care medicine · Jan 1991
Comparative StudyBioimpedance versus thermodilution cardiac output measurement: the Bomed NCCOM3 after coronary bypass surgery.
Values obtained for cardiac output (CO) were compared using thermodilution (TD) with those obtained using bioimpedance (Bi) as measured using the Bomed NCCOM3 (Revision 6) in 28 consecutive patients in the first 24 h after coronary artery bypass surgery (CABS). In 46 paired measurements made in the first 12 h after CABS Bi values for CO were significantly lower than TD values, the limits of agreement between the two methods were also unacceptably large (mean Bi 4.38 (SD 1.40) l/min, mean TD 5.46 (SD 1.19) l/min, limits of agreement -3.05 to +0.89). In 55 paired measurements made after 12 h (all in spontaneously breathing patients) there was no significant difference between the two methods and acceptable limits of agreement, mean Bi 5.69 (SD 1.2) l/min mean TD 5.6 (SD 1.2) l/min, limits of agreement -0.99 to +1.17). The significantly lower BiCO values obtained in the first 12 h after CABS show that BiCO measurement is not consistently reliable in the intensive care setting.
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Intensive care medicine · Jan 1991
Case ReportsContinuous multivariable monitoring in neurological intensive care patients--preliminary reports on four cases.
Evoked potential monitoring is a standard examination method in neurological intensive therapy units. Previously, multimodality observation was only possible in follow-up examinations. First experience with a new bed-side system continuously monitoring 12 neurophysiological and clinical parameters is reported. ⋯ This paper reports on 4 exemplary cases of the 33 patients we have monitored to date, illustrating the principles and main advantages of the system. The system was developed to support the observation of ICU patients as well as to aid therapeutic decisions. It supports the clinical determination of brain death by specifying the deterioration of various neurological systems.
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Intensive care medicine · Jan 1991
Comparative StudyContinuous positive pressure breathing without and with inspiratory pressure support in acute respiratory failure when mean airway pressure is constant.
Mean airway pressure (Pawm) may be a major factor for PaO2, functional residual capacity, and cardiac output in acute respiratory failure (ARF). To clarify effects of inspiratory pressure support (IPS) as a ventilatory mode in ARF, we studied patients in ARF either using IPS or continuous positive pressure breathing (CPAP) at the same level of Pawm, measuring respiratory and circulatory parameters. ⋯ For IPS, tidal volume (VT) increased by +31% and respiratory frequency (RF) decreased by -19% (VT IPS 608 +/- 179 vs. VT CPAP 465 +/- 141 ml, p = 0.01; RF IPS 21.6 +/- 7.6 vs. RF CPAP 26.7 +/- 8.3 breaths per minute, p = 0.02). Also, PaCO2 showed a tendency to be lower for IPS, not reaching significance (PaCO2 IPS 44.3 +/- 5 vs. PaCO2 CPAP 47.4 +/- 4.9 mmHg, p = 0.1). All other parameters were unchanged (expiratory minute volume, PaO2, pH, intravascular pressures, cardiac index, stroke volume index (n = 6), systemic and pulmonary vascular resistances, venous admixture, deadspace (n = 3), oxygen consumption and oxygen delivery). WE CONCLUDE: When Pawm remained constant, IPS added to CPAP improved VT and RF without improving oxygenation or deteriorating circulation in patients with ARF of moderate severity. IPS mainly supports the ability to breathe spontaneously in ARF.
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Intensive care medicine · Jan 1991
Comparative Study Clinical Trial Controlled Clinical TrialLow molecular weight hydroxyethyl starch 6% compared to albumin 4% during intentional hemodilution.
Intentional normovolemic hemodilution was chosen as the model to compare a 6% low molecular weight hydroxyethyl starch (LMW HES) to 4% albumin. The study ran over the plasma exchange period for 24 h. Nine patients, scheduled for abdominal aortic surgery, were included in each group. ⋯ After hemodilution, despite a significant decrease in arterial oxygen O2 content, systemic oxygen transport did not significantly vary until 24 h in relation to the increased cardiac index. An increase in O2 extraction was observed after the exchange but no further increase was observed until the 24 h. No significant changes either in global O2 consumption or in lactate concentration were detected.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1991
Subclavian vein catheterization in critically ill children: analysis of 322 cannulations.
Complications in 322 percutaneous subclavian vein catheters placed in 272 children by the infraclavicular approach were investigated prospectively. Ages ranged from 4 days to 15 years. Incidents during catheter introduction occurred in 13 cases, and were more common when insertion was on the right side (p less than 0.01). ⋯ Staph. epidermidis isolation and duration of cannula use were statistically related (p less than 0.01). No catheter-related deaths occurred. We conclude that subclavian vein catheterization is a simple and useful procedure that entails relatively few serious complications when performed by experienced pediatricians.