Critical care clinics
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Critical care clinics · Oct 1996
ReviewOxygen transport and oxygen metabolism in shock and critical illness. Invasive and noninvasive monitoring of circulatory dysfunction and shock.
The common underlying physiologic problem in shock is low flow from hypovolemia or maldistributed microcirculatory flow from uneven vasoconstriction, leading to inadequate tissue perfusion (hypoxia), often in the face of increased metabolic demands. Noninvasive monitoring which was found to provide similar information to that of invasive monitoring, was used in the earliest period of time shortly after admission to the emergency department to provide objective physiologic criteria as therapeutic goals for each of the three major circulatory components: cardiac, pulmonary, and tissue perfusion functions. A clinical algorithm or branch-chain decision tree for high-risk surgical patients was developed from decision rules based on survivor and nonsurvivor patterns, outcome predictors, prospective controlled clinical trials of the oxygen delivery/oxygen consumption (DO2/VO2) concept, and the DO2/VO2 responses of a wide variety of therapeutic agents.
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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.