Critical care medicine
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Critical care medicine · Dec 1991
Resuscitation fluids for the treatment of hemorrhagic shock in dogs: effects on myocardial blood flow and oxygen transport.
The efficacy of using colloids vs. crystalloids in the treatment of hemorrhagic shock remains controversial. An important aspect in the treatment of hemorrhagic shock is the reestablishment of normal myocardial blood flow after fluid resuscitation. This study, therefore, was designed to investigate the effect of resuscitation with different plasma substitutes on myocardial blood flow and oxygen transport after acute hemorrhage in dogs. Forty-three dogs were anesthetized and bled into a heparinized Wiggers' reservoir to a mean arterial pressure of 35 mm Hg. The animals were maintained at this level of hypotension for 90 mins, whereupon the animals were infused with one of five randomly selected fluids: a) succinylated gelatin (Gelofusine); b) urea-linked gelatin (Haemaccel); c) 6% hetastarch (Hespan); d) lactated Ringer's solution; or e) shed blood. Myocardial blood flow was measured using the radiolabeled microsphere technique. ⋯ These results suggest that in lieu of blood, the artificial colloids are more effective than crystalloids in restoring myocardial blood flow and oxygen transport after acute experimental hemorrhage in dogs.
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Critical care medicine · Dec 1991
Multicenter Study Clinical Trial Controlled Clinical TrialAcute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest.
a) To examine the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) and the Glasgow Coma Scores as predictors of the outcome of patients following resuscitation from cardiac arrest; b) to study the impact of the components of APACHE II on the prediction. ⋯ The APACHE II scoring system cannot be recommended as a prognostic tool to support clinical judgement in cardiac arrest patients, but by modifying it, a more accurate prediction of poor outcome could be achieved. The Glasgow Coma Score explained to a great extent the predictive power of the APACHE II.
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Critical care medicine · Dec 1991
Severity of illness correlates with alterations in energy metabolism in the pediatric intensive care unit.
To evaluate the correlations between severity of illness scoring systems and biochemical markers of physiologic stress. ⋯ The correlations were independent of diagnostic category, suggesting that the alterations in biochemical variables were most directly related to the overall severity of illness as measured by the scoring system.
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Critical care medicine · Dec 1991
Safety of bronchoalveolar lavage in the critically ill, mechanically ventilated patient.
To assess complications of bronchoalveolar lavage in the intubated, mechanically ventilated patient. ⋯ We conclude that bronchoalveolar lavage is a well-tolerated procedure in critically ill, mechanically ventilated patients, provided that risk factors for complications are corrected before the procedure and one adheres to procedural guidelines focused on patient safety. Clinically important complications are uncommon. Some patients exhibit deterioration in oxygen after bronchoalveolar lavage; this occurrence cannot be predicted before the procedure.
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Critical care medicine · Dec 1991
Systemic and regional oxygen uptake and delivery and lactate flux in endotoxic dogs infused with dopexamine.
To test whether dopexamine, a dopaminergic and beta 2-adrenergic receptor agonist, would: a) direct a greater share of cardiac output to gut than to muscle when used to increase systemic oxygen delivery (DO2) in endotoxic dogs; and b) enhance the ability of peripheral tissues to extract oxygen. ⋯ Dopexamine temporarily increased systemic DO2 and VO2 in volume-expanded endotoxic dogs during normoxia and may have caused gut mucosa to be preferentially perfused and thus to be kept better oxygenated.