Journal of critical care
-
Journal of critical care · Sep 1999
Myocardial oxygen consumption during dobutamine infusion in endotoxemic pigs.
Dobutamine infusion is used to increase whole-body oxygen delivery in septic patients to satisfy unmet oxygen demand of hypoxic tissues. However, dobutamine infusion also increases myocardial work and myocardial oxygen consumption. Our goal was to determine the importance of this effect as a fraction of the increase in whole-body oxygen consumption, in a porcine model of septic shock. ⋯ In this porcine model of sepsis, dobutamine infusion significantly increases myocardial oxygen consumption. Because whole-body oxygen consumption does not change, dobutamine infusion may fail to increase and may decrease oxygen consumption by other organs.
-
Journal of critical care · Sep 1999
Multicenter StudyEfficiency of inhaled nitric oxide as rescue therapy during severe ARDS: survival and factors associated with the first response.
The purpose of this study was to determine if the response to inhaled nitric oxide (NO) as salvage therapy is an independent factor for survival in adult respiratory distress syndrome (ARDS) patients and to identify the factors that predict the response to inhaled NO during ARDS. ⋯ We conclude that (1) efficacy of inhaled NO in improving oxygenation was moderate and difficult to predict, (2) response to first NO inhalation was not associated with prognosis, and (3) treatment of the most severe ARDS patients with inhaled NO did not influenced their intensive care unit survival.
-
Journal of critical care · Sep 1999
Adapting prognostic respiratory variables of ARDS in children to small-scale community needs.
The clinical literature on the incidence and subsequent mortality of adult respiratory distress syndrome (ARDS) has come primarily from the experiences of large tertiary referral centers, particularly in Western Europe and North America. Consequently, very little has been published on the incidence, management, and outcome of ARDS in smaller community-based intensive care units. We aimed to delineate early clinical respiratory predictors of death in children with ARDS on the modest scale of a community hospital. ⋯ A small-scale mortality outcome for ARDS is comparable to large tertiary referral institutions. The PIP, PEEP, and ventilation index are valuable for predicting outcome in ARDS by the third day of conventional therapy. The development of a local risk profile may assist in decision-making of early application of supportive therapies in this population.
-
Journal of critical care · Sep 1999
Nitric oxide and nitrogen dioxide concentrations during in vitro high-frequency oscillatory ventilation.
The purpose of this study was to measure nitric oxide (NO) and nitrogen dioxide (NO2) concentrations, at various ventilatory settings and sampling sites, during in vitro inhaled NO and high-frequency oscillatory ventilation therapy [iNO-HFOV]. ⋯ During HFOV, the concentrations of NO and NO2 vary between sampling sites and also are influenced by the frequency, amplitude, and inspired oxygen concentration. NO2 concentrations in the lung were significantly increased above commonly accepted toxic concentrations during ventilation with high concentrations of NO (80 ppm) and high fractional concentrations of oxygen. The excessive increase in NO2 concentration at the "alveolar" level in our test lung model warrants confirmation in an in vivo model.
-
Journal of critical care · Sep 1999
Nosocomial pneumonia with isolation of anaerobic bacteria in ICU patients: therapeutic considerations and outcome.
Evaluate the influence of the anti-anaerobic antimicrobial therapy in the outcome of patients with nosocomial pneumonia. ⋯ This study suggests that specific antianaerobic therapy may be considered in the choice of empirical antibiotherapy in patients with nosocomial pneumonia.