Critical care medicine
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Critical care medicine · Jul 1988
Randomized Controlled Trial Clinical TrialEfficacy of pulse oximetry and capnometry in postoperative ventilatory weaning.
We examined the ability of capnometry and pulse oximetry to identify potential respiratory problems by comparing oxyhemoglobin saturation (O2Sat) as measured by pulse oximetry and end-tidal CO2 (PetCO2) with arterial blood gas (ABG) determinations in 40 mechanically ventilated ICU patients. Hemoglobin saturation as measured by pulse oximetry correlated significantly with PaO2 (r = .65, p less than .0001); more importantly, an oximeter O2 Sat less than 95% showed 100% sensitivity in identifying hypoxemia (i.e., PaO2 less than 70 torr). PetCO2 tended to correlate strongly with PaCO2 for individual patients, but not when evaluated as a screening tool for identifying ventilatory abnormalities in the overall group (r = .52, p less than .0001). ⋯ The efficacy of pulse oximetry and capnometry in monitoring respiratory status during postoperative ventilatory weaning was examined in a subset of 24 patients who had undergone elective cardiac surgery. All patients were weaned by intermittent mandatory ventilation, but each was assigned randomly to either a control group monitored with periodic ABG sampling or to an experimental group, monitored by following PetCO2 and O2 Sat via pulse oximetry. In the experimental group, ABG values were obtained on ICU admission, but thereafter only if a) O2 Sat less than 95%, b) PetCO2 less than 26 or greater than 40 torr, or c) felt to be clinically indicated by ICU staff.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical care medicine · Jul 1988
Comparative StudyOptimal composition of burn resuscitation fluids.
The hemodynamic, renal, and hematologic responses to fluid resuscitation with four different hydrating solutions (lactated Ringer's and hypertonic salt solutions, with and without albumin) administered in equal quantities were compared in an ovine burn model. Forty-five animals, including a sham group, were studied. ⋯ While all animals survived the burn and disclosed reasonable hemodynamic stability throughout the experiment, those that received lactated Ringer's with albumin (LRA) restored their cardiac output to preburn values, by 24 h postinjury demonstrated higher serum albumin and colloid osmotic pressure levels, experienced no electrolyte or acid-base imbalances, and maintained serum osmolality within normal limits. In contrast to the other solutions, LRA did not induce edema in unburned tissues, and seemed optimal for burn resuscitation.
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Ten patients with severe septic shock were studied. After plasma volume expansion to an optimal pulmonary artery wedge pressure, above which there were no further increases in cardiac index, all patients remained hypotensive and oliguric. ⋯ There were only minor increases in heart rate. Oxygen transport indices measured in six patients demonstrated variable alterations in oxygen delivery and consumption.
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Critical care medicine · Jul 1988
Case ReportsAutopsy as quality assurance in the intensive care unit.
A prospective study of 100 autopsies was carried out. The clinical and pathologic diagnoses were made independently by intensivists and pathologists; at the end of the study, the differences were determined. There were seven Class I errors (which if detected before death, would probably have led to a change in management that might have resulted in cure or prolonged survival), six of these relating to the basic disease and one to the cause of death. ⋯ In 61% of the patients, the major and minor diagnoses coincided. In 77% of the patients, the major diagnoses coincided. No relationship was found between the incidence of Class I and Class II errors and the length of the patients' stay in the ICU.