Journal of critical care
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Journal of critical care · Jun 1993
Allocation of critical care resources: entitlements, responsibilities, and benefits.
Determination of allocation of limited critical care resources appears to be an inevitable development. Criteria proposed to assign such limited resources among patients are not defined. It has been argued that allocation of critical care resources could be based on the principals of patient entitlements to health care, responsibilities of the physician to the critically ill patient, and beneficence. However, based on an analysis of the philosophical tenants of the Hippocratic Oath, there is little to support the concept of "sin" taxes or patient triage on the basis of judgment on the moral merit of the patient.
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Journal of critical care · Jun 1993
Cardiopulmonary responses to continuous positive airway pressure in acute asthma.
The effects of nasal continuous positive airway pressure (CPAP) on expiratory flow, arterial blood gas tensions, cardiovascular status, and dyspnea were studied in 21 patients with acute asthma. Therapy consisted of the following CPAP sequence: 30 minutes at 5 cm H2O, 20 minutes at 0 cm H2O, 30 minutes at 7.5 cm H2O, and 20 minutes at 0 cm H2O. Six control patients were fitted with a CPAP mask but given no positive-pressure therapy. ⋯ These levels of CPAP were tolerated without deleterious side effects. In comparison, the control group showed no change in heart rate, respiratory rate, or breathlessness score during the study period. These data show that application of CPAP in acute asthma reduces respiratory rate and dyspnea with no untoward effects on gas exchange, expiratory airflow, or hemodynamics.
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Journal of critical care · Jun 1993
Systemic oxygen extraction can be improved during repeated episodes of cardiac tamponade.
We used a tamponade model to study the relationship between oxygen uptake (VO2) and oxygen delivery (DO2) during successive, reversible decreases in blood flow. In 7 pentobarbital-anesthetized and mechanically ventilated dogs, a catheter was introduced via a left thoracotomy into the pericardium to inject and to withdraw saline. Each experiment consisted of three steps. ⋯ There was no significant difference in VO2 at DO2crit for the three steps. Hence, critical oxygen extraction ratio (ERO2crit) increased from 60% +/- 12% in step 1 to 64% +/- 11% in step 2 (not significant) and to 73% +/- 12% in step 3 (P < .01). The VO2/DO2 dependency slope was also steeper in step 3 than in step 1 (0.77 +/- 0.31 v 0.54 +/- 0.20, P < .05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Journal of critical care · Jun 1993
Stressing the critically ill patient: the cardiopulmonary and metabolic responses to an acute increase in oxygen consumption.
Critically ill patients frequently have compromised respiratory and hemodynamic function. Chest physical therapy has been previously shown to increase oxygen demand and therefore was used to examine how postoperative mechanically ventilated patients responded to an increased oxygen demand. We found that during chest physical therapy, oxygen consumption increased 52% +/- 37% (SD) over baseline values. ⋯ There was no significant change in systemic vascular resistance. The increase in oxygen demand caused by chest physical therapy triggered an integrated physiological response that resulted in increased respiratory and cardiac performance. This in some ways, such as the lack of increase in systemic vascular resistance, resembles the response to exercise.
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Journal of critical care · Jun 1993
Comparative StudyOrgan blood flow and distribution of cardiac output in dopexamine- or dobutamine-treated endotoxemic rats.
Endotoxemia causes a decrease of blood flow to most organs. If this could be prevented, chances of survival might improve. In endotoxemic rats, we studied the effect of a therapeutic infusion of dopexamine (dopaminergic, beta 2-adrenergic) on blood flow and percentage of the cardiac output distributed to heart, brain, hepatic artery, stomach, intestines, spleen, pancreas, kidneys, adrenals, diaphragm, skeletal muscle, and skin. ⋯ Dopexamine and dobutamine similarly improved cardiac output in endotoxemic rats. All organs benefitted to the same extent from the increased cardiac output. Therapeutic infusion of dopexamine during endotoxemia did not favor flow to any particular organ; redistribution of cardiac output changed little after administration of dopexamine, and its effects were not significantly different from those of dobutamine.