Journal of critical care
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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.
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Cytokines released in response to stress may have a profound impact on circulatory stability. There is no information on the effect of general anesthesia alone on plasma cytokine levels and little information on cytokine release following surgery. Plasma cytokine levels and hemodynamic parameters were measured during anesthesia and abdominal surgery under sterile and nonpyrogenic conditions in seven pigs anesthetized with ketamine and pentobarbital. ⋯ Heart rate was unchanged during the experiment, and central venous pressure decreased after endotoxin (P < .05). There were no increases in TNF or IL-6 (using a low sensitivity assay) with anesthesia alone or following IM with shock, but both increased after endotoxin administration (P < .05); using a high sensitivity assay, IL-6 did not change during anesthesia alone but did increase fivefold following IM with shock (P < .05) and 50-fold following endotoxin administration (P < .05). We conclude that in a porcine model under sterile and nonpyrogenic conditions, prolonged anesthesia does not increase plasma cytokine levels.(ABSTRACT TRUNCATED AT 250 WORDS)
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Journal of critical care · Jun 1993
Comparative StudyPositive end-expiratory pressure increases capillary pressure relative to wedge pressure in the closed and open chest.
The pulmonary arterial wedge pressure is used as a measure of left atrial pressure and frequently as an estimate of pulmonary capillary pressure. The arterial occlusion concept has recently been used to derive a pressure that is thought to be more representative of capillary pressure (Pcap) than wedge pressure (Pw). The object of this study was to measure the arterial occlusion Pcap at different positive end-expiratory pressure (PEEP) levels and to compare it with Pw. ⋯ Increasing PEEP between 0 to 15 mm Hg caused a gradual decline in cardiac output in the closed and open chest conditions. Despite this decline, all three pressures (Pa, Pcap, and Pw) rose gradually in the closed chest. However, in the open chest, increasing PEEP from 0 to 4.7 mm Hg had no effect on the pressures, but between 4.7 and 13.4 mm Hg of PEEP, Pa and Pcap increased markedly with minimal change in Pw.(ABSTRACT TRUNCATED AT 250 WORDS)
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Journal of critical care · Mar 1993
ReviewThe influence of gender on conflicts of interest in the allocation of limited critical care resources: justice versus care.
After noting that the principle of autonomy has been inadequate for the resolution of many of the complex and difficult moral dilemmas involving conflicts of interest in the allocation of limited critical care resources, this paper analyzes the concepts of justice and care as alternative solutions to moral problems and applies them to the issue of repeat organ transplants to a single recipient. These concepts are found to be the basis of the notions of moral reasoning and moral orientation, respectively, which serve in moral development theory as two fundamentally different ways to approach moral problem solving. Following an elaboration of moral reasoning as found in Kohlberg's cognitive moral development theory, the influence of gender on moral reasoning is investigated. ⋯ Following an elaboration of moral orientation as found in Gilligan's moral theory of the ethics of care, the influence of gender on moral orientation is investigated. The empirical data show that women use the concept of care significantly more often (P < or = .0139) than their male colleagues in resolving moral dilemmas. From these data it is concluded that men are more likely than women to use justice in the resolution of moral dilemmas, such as the conflicts of interest in the allocation of limited critical care resources, but that if women do use, or are required by the social system to use, justice in the resolution of moral dilemmas, they do a better job of it than men.