Critical care clinics
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Oxygen consumption is physiologically dependent on DO2 below the critical DO2. Thus, patients in overt shock have physiologic dependence of VO2 on DO2. The first priority of prevention and reversal of tissue hypoxia is to balance oxygen demand and oxygen supply. ⋯ Finally, we suggest that intensivists continue to assess DO2 and VO2 carefully. Global assessment of VO2 and DO2 appears inadequate to detect occult tissue hypoxia in most critically ill patients. However, research focused on regional assessment such as gastric tonometer measurement of gastric mucosal PCO2 and pH provides opportunity for safe, convenient detection of occult tissue hypoxia in critically ill patients.
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Critical care clinics · Oct 1996
ReviewThe new pulmonary arterial catheters. Right ventricular ejection fraction and continuous cardiac output.
The flow-directed pulmonary artery catheter is the mainstay of hemodynamic monitoring in critically ill and injured patients. During its 25-year history, the catheter has been modified to measure mixed venous oxygen saturation, right ventricular ejection fraction, and recently, continual thermodilution cardiac output. The clinical application of the new generations of pulmonary artery catheters is reviewed in this article.
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Pulmonary capillary pressure (Pcap) is the true edema-forming pressure within the pulmonary vascular bed. Pulmonary artery occlusion pressure has long been used to approximate Pcap. These two pressures may not always be well correlated, which has significant implications for fluid resuscitation and the evolution of pulmonary edema. This article reviews the technique for bedside measurement of Pcap.
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Critical care clinics · Oct 1996
Historical ArticleThe Swan-Ganz catheter. Twenty-five years of monitoring.
The years that have passed since the introduction of the pulmonary artery catheter have been marked by radical changes in the practice of general and critical care medicine. There has been an increase in the application of physiologic principles to the management of shock states, myocardial infarction, and respiratory failure. These developments have caused an increase in the expectations of patients and physicians alike and in the general preparedness to offer critical care to extremely aged or infirmed patients.