Critical care clinics
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This article discusses the advantages of pulmonary artery catheters, with emphasis on the Swan-Ganz catheter. Various studies and published reports confirming the efficacy of pulmonary artery catheter use are reviewed. In the author's opinion, it is evident that the Swan-Ganz catheter has withstood the test of time and scrutiny.
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Critical care clinics · Jul 1996
ReviewHigh-inflation pressure and positive end-expiratory pressure. Injurious to the lung? Yes.
There is a growing body of evidence suggesting that high levels of inflation pressure and high levels of PEEP may be injurious to lung tissue and other organ systems. Limiting peak alveolar pressures below 35 cm H2O may help in avoiding these injuries. The findings have led to the development of a lung-protective strategy that is based on physiologic parameters. ⋯ Usually a PEEP of 8 to 12 cm H2O is sufficient. Although we usually initiate mechanical ventilation with a volume-cycled mode, we are not hesitant to switch rapidly to a pressure-limited mode if results are unsatisfactory. We believe that more attention to the potential harmful effects of pressure and volume on lung architecture may result in further improvement of survival in patients with acute respiratory failure.
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The PAC has allowed physicians to obtain information that was unavailable prior to its introduction into clinical medicine. There are numerous pitfalls, however, in obtaining and interpreting this information. ⋯ Can PA catheterization lead to an improved outcome in an individual patient? If the patient is chosen carefully, the catheter inserted successfully and safely, the data obtained meticulously and interpreted correctly, and this interpretation leads to a change in therapy to which the patient responds appropriately, then the patient will experience an improved outcome based on PAC use. Does this happen often enough in the millions of catheterizations that are performed each year to improve the outcome of the group significantly as a whole? Almost certainly not.
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In conclusion, dopamine has the unique ability, compared with other catecholamines, to improve renal blood flow, glomerular filtration rate, sodium excretion, and creatinine clearance, independent of its cardiac effects. In addition, low-dose dopamine can decrease renal and systemic vascular resistance, suppress aldosterone secretion, and interact with atrial natriuretic factor. Because of these clinically significant properties, dopamine has been used successfully to improve and treat acute oliguric renal failure in a variety of clinical situations as just described. ⋯ For those who are skeptical, we offer the following suggestion: "The obscure we see eventually, the obvious takes a little longer"--E. R. Murrow.
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This article argues that dopamine infused in low doses has not been shown to avert the onset of or ameliorate the course of acute renal failure in critically ill patients. The inotropic and diuretic effects of dopamine are discussed, and its adverse effects are described. An attempt is made to offer an evidence-based role for low-dose dopamine, namely as a diuretic in ventilated, euvolemic patients, resistant to conventional diuretic therapy.