Journal of critical care
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Journal of critical care · Dec 1993
Comparative StudyThe relationship between the arteriovenous carbon dioxide gradient and cardiac index.
It has been reported that under normal conditions, mixed venous blood gases have approximated arterial samples; however, during cardiac arrest or severe cardiogenic shock, marked differences between arterial and venous blood gases have been noted. To further assess the relationships between arterial and mixed venous blood gases and cardiac index, a study population was chosen consisting of patients with less severe states of cardiac impairment. The differences between arterial and mixed venous PCO2s and pHs were compared with cardiac indexes (CI) of 44 patients in an intensive care unit with arterial lines and Swan-Ganz catheters in place. ⋯ When the CIs of all patients were plotted against the delta PCO2s, there was an inverse linear relationship wherein delta PCO2 increased as CI decreased (r = -.47, P = .0011). There is an inverse relationship between delta PCO2 and CI that has not been previously described. An elevated delta PCO2 may be a marker of a low cardiac index.
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Journal of critical care · Dec 1993
Randomized Controlled Trial Clinical TrialSafety and efficacy of intravenous immunoglobulin prophylaxis in pediatric head trauma patients: a double-blind controlled trial.
Infection is one of the major complications of severe head trauma in children. To assess whether intravenous immunoglobulin (IVIg) decreases the incidence of secondary infection after head injury in children, a randomized, double-blind trial was performed. Thirty-three children (mean age, 6.67 years; mean injury severity score, 32.8; mean Glasgow coma score, 6.1) with severe head injuries were enrolled; 1 child was excluded, 18 received IVIg, and 14 received the placebo preparation. ⋯ There was no difference in the number of days on mechanical ventilation or in number of hospital days. There were no side effects. It is concluded that prophylactic administration of commercial IVIg at a dose of 400 mg/kg, although safe, had no effect on the incidence of secondary infections in children with severe head injuries.
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Journal of critical care · Dec 1993
What good are we doing? The role of clinical research in enhancing critical care medicine.
The amount of financial and other resources used by physicians in the treatment of critically ill patients makes it incumbent upon physicians to ensure that sufficient benefit is obtained from these resources and that physicians are in fact doing good for their patients. Knowing that one is in fact doing good requires an understanding of what counts as benefit. Current medical practice suggests that patient benefit is typically understood in terms of physiological changes and responses, highlighting the role of medical subspecialties in patient care. ⋯ This broader understanding calls for an ambitious research agenda so that physicians will be able to learn how they can genuinely help critically ill patients and their families during times of illness. Carrying out such an agenda requires overcoming the ethical challenges of performing research on patients as vulnerable as critically ill patients. It also requires physicians to establish collaborative ties with other professionals so that truly interdisciplinary research can be performed on a routine basis.
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Journal of critical care · Dec 1993
Comparative StudyEffect of pretreatment with anticonvulsants on theophylline-induced seizures in the rat.
Seizures, often with fatal outcome, are a manifestation of pronounced theophylline toxicity. Prodromal symptoms are not always apparent, and the seizures are reported to be, in certain cases, refractory to treatment with anticonvulsant drugs. The purpose of this investigation was to examine, by an established animal model, which of the commonly used anticonvulsants can reduce the central nervous system sensitivity to theophylline neurotoxicity and what should be the preferred treatment in cases in which theophylline toxicity is anticipated. ⋯ Theophylline concentrations in the cerebrospinal fluid, brain, and serum were assayed by a high-performance liquid chromatography method. It was found that pretreatment with either clonazepam, diazepam, phenobarbital, or valproic acid increased the central nervous system thresholds to the theophylline-induced seizures, whereas phenytoin and magnesium sulphate did not attenuate the sensitivity of the brain to the stimulatory action of this widely used bronchodilator. Therefore, whenever theophylline toxicity is suspected, treatment with either diazepam, clonazepam, phenobarbital, or valproic acid can reduce the hazard associated with theophylline-induced seizures.
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Journal of critical care · Sep 1993
Deciding to terminate treatment: a practical guide for physicians.
Providing house officers and practicing physicians with annotated, concise, practical guidelines for decisions to terminate treatment is the objective of this report. The study selection and data extraction focused on statutes, regulations, court decisions, medicolegal analyses, clinical studies, and position papers addressing termination-of-treatment issues. To foster a systematic approach, we developed a laminated, pocket-sized card containing a series of questions to be asked by any physician confronted with termination-of-treatment decisions. Systematic identification and deliberate assessment of (1) brain death; (2) the nature, extent, cause, prognosis, and reversibility of impairment; (3) the type of treatment to be withheld or withdrawn; (4) the futility of any proposed intervention; (5) the capacity of the patient for health care decision-making; (6) the evidence of patient's wishes; (7) the proper roles of family members, surrogate decision makers, and other health professionals (eg, ethics committees); and (8) applicable policies, ethics, laws, and potential conflicts of interest will enhance efficiency and add value to the decision-making process at the end of life.