Critical care medicine
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It is suspected, but still unproven, that the increased capillary permeability which accompanies sepsis and contributes to the development of pulmonary edema (PE) involves systemic as well as pulmonary capillaries. We investigated the relationship between the colloid osmotic pressure of serum (COPS) and edema fluid (COPE) in 16 septic and 19 nonseptic patients with severe generalized edema. COPS values of septic and nonseptic patients were not significantly different (14.6 +/- 2.1 and 15.8 +/- 3.4 torr, respectively). ⋯ Thus, 16/17 determinations in septic patients had a ratio greater than .1, while 17/22 determinations in nonseptic patients showed a ratio less than .1. PE was present in 8/16 septic patients but in only 2/19 nonseptic patients. These data suggest that the increase in capillary permeability during sepsis is generalized.
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The ability to recognize symptoms, to make priority decisions, to dispatch suitable ambulance transport and inform the crews, and finally, to initiate first aid via the caller is essential for optimum care of severely injured or ill patients outside the hospital. In Sweden, a special job-related course trains dispatch-center personnel to think in terms of symptoms and evolution of the victim's status, and to assess the level of seriousness.
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Critical care medicine · Aug 1984
Adult respiratory distress syndrome: hospital charges and outcome according to underlying disease.
We reviewed the hospital charges, underlying diagnoses, and hospital outcomes in 39 patients with adult respiratory distress syndrome (ARDS) admitted to the respiratory ICU of a university hospital between July 1979 and June 1981. Charges per patient ranged from $9263 to $187,893 with a median of $52,894. Median ICU charges were $2430/day. ⋯ Only 1 of 27 patients with underlying hematologic/oncologic diseases survived, compared to 6 of 12 patients with other underlying diseases. Charges and outcomes in this study reflect the underlying patient population and philosophy of care at the study institution. Considering the high costs and poor outcomes in ARDS patients with underlying hematologic/oncologic problems, we recommend that the appropriateness of aggressive treatment be reconsidered.
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Critical care medicine · Aug 1984
Renal hypoxia and lactate metabolism in hemorrhagic shock in dogs.
Central and renal hemodynamics, renal cortical and medullary oxygen tension, and renal lactate metabolism were investigated in hemorrhagic shock in dogs. During graded hemorrhage, renal tissue PO2 decreased in parallel with renal blood flow, whereas renal lactate uptake remained virtually unchanged. ⋯ Reinfusion of shed blood increased renal tissue PO2 above its preshock value but did not restore baseline renal oxygen consumption and lactate uptake levels. These results suggest that renal lactate utilization is not limited by oxygen delivery under moderate hemorrhagic hypotension but decreases linearly with renal tissue PO2 during shock.