Critical care medicine
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Critical care medicine · May 1990
Whole blood activated clotting time in infants during extracorporeal membrane oxygenation.
Bleeding complications are the principal cause of morbidity and mortality in infants treated with extracorporeal membrane oxygenation (ECMO). The whole blood activated clotting time (ACT) test is used universally to monitor heparin therapy during this procedure. To enhance our understanding of this test and improve our management of anticoagulation, we studied the relationship between the ACT and blood heparin concentration in nine infants during ECMO. ⋯ The ACT is a low cost, bedside test whose accuracy and precision allow the achievement of target heparin concentrations required in infants during ECMO. Multiple determinations, either in duplicate or serially, are needed to achieve satisfactory precision. These data will be useful in designing future studies to determine the optimal serum heparin concentration to provide adequate anticoagulation, but avoid bleeding complications.
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Critical care medicine · May 1990
Case ReportsThird-degree burns from the use of an external cardiac pacing device.
Noninvasive external cardiac pacing has been used safely in various cardiac emergencies for over 30 yr. Its use in neonates, however, has been associated recently with burns. We report the case of a 7-wk-old infant who sustained a full-thickness burn after prolonged use of an external pacing device.
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Critical care medicine · May 1990
Comparative StudyDetermination of cardiac output during positive end-expiratory pressure--noninvasive electrical bioimpedance compared with standard thermodilution.
Many investigators have demonstrated the accuracy and reliability of thoracic electrical bioimpedance (TEB) in spontaneously breathing patients and under mechanical intermittent positive-pressure ventilation. Most of these studies showed a good correlation between TEB and invasive methods, such as thermodilution (TD) or the Fick method. But during PEEP, contrary results occur when comparing TEB and TD. ⋯ The data revealed a good correlation during ZEEP (r = .93) and during PEEP (r = .91). There was no significant statistical difference when measuring cardiac output by TEB during ventilation with PEEP. During normal or decreased cardiac output, TEB overestimated cardiac output compared with TD, whereas TEB underestimated cardiac output compared with TD during increased cardiac output, especially during PEEP.
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Critical care medicine · May 1990
Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit.
We retrospectively studied relations between age, pre-existing chronic disease, sepsis, organ system failure, and mortality in 487 patients from a medical ICU. Single organ system failure (SOSF) occurred in 136 (28%) and multiple (greater than or equal to 2) organ system failure (MOSF) in 187 (38%) patients. Cardiovascular and pulmonary failure predominated. ⋯ Advancing age and prior chronic disease may diminish physiologic reserve and predispose to sepsis and MOSF. Although sepsis is a major risk factor for MOSF, a nonspecific host response to critical illness may contribute to the syndrome in 35% of patients. Advancing age, chronic disease, and the number of failing organs, particularly failure of cardiovascular, pulmonary, renal, and neurologic systems, are major determinants of overall mortality, but sepsis is not an independent contributor.
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Critical care medicine · May 1990
Influence of parenteral nutrition on rates of net substrate oxidation in severe trauma patients.
Optimal nutritional support should use a patient's energy expenditure as a guide for administering sufficient but not excessive caloric intake. Eight patients requiring parenteral nutrition were evaluated, using indirect calorimetry measurements, to determine the nutritional influence on the rates of substrate utilization in the critical period of catabolic illness due to accidental trauma. ⋯ The results suggest that positive energy balance could be achieved in trauma patients by providing total energy intake matching their basal measured energy expenditure plus 7% to 10% for activity energy expenditure. To prevent further loss of lean body mass, an N intake of 350 mg/kg.day was needed in these catabolic ICU patients.