Critical care medicine
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Critical care medicine · Feb 1991
Prolonged hemorrhagic shock does not impair regeneration of plasma coagulant masses in the rabbit.
Twelve adult male albino rabbits were assigned alternately to normotensive and hypotensive groups to assess the effect of hypovolemic shock on spontaneous correction of dilutional coagulopathy. All animals underwent dilutional exchange transfusion with 200 mL of rabbit RBCs and 5% human albumin. Half the animals were then acutely hemorrhaged and subsequent aliquots of blood removed as needed to maintain the mean arterial pressure at 40 mm Hg. ⋯ Dilutional coagulopathy corrects spontaneously within hours. Normovolemic shock prolongs dilutional coagulopathy not by impairment of factor regeneration but because of further (internal) dilution due to plasma expansion. Rapid correction of dilutional coagulopathy is likely to necessitate cryoprecipitate administration.
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Critical care medicine · Feb 1991
Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock.
An experimental canine model of hemorrhagic, hypovolemic shock is described that uses oxygen debt and its metabolic consequences of lactic acidemia and metabolic base deficit as independent variables for the prediction of probability of death. ⋯ Of the single-variable predictors, BE shows the highest explained variability. However, a combined prediction from both lactate and BE appears superior to the use of either alone. Using this regression to compute the oxygen debt, it is possible to estimate accurately the actual level of oxygen debt from the BE and lactate values obtained during hemorrhagic hypovolemia. From serial determinations over time of the increase in these biochemical variables above the oxygen debt baseline, it is possible to estimate the rate of oxygen debt accumulation and the time remaining until the LD50 will be reached as indicators of the severity of the total body ischemia resulting from hemorrhagic shock.
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Critical care medicine · Feb 1991
Comparative Study Clinical Trial Controlled Clinical TrialImproved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities.
To compare outcomes from pediatric intensive care in hospitals with different levels of resources. ⋯ Care of the most seriously ill children in tertiary pediatric ICUs could improve their chances of survival.
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Critical care medicine · Feb 1991
Comparative Study Clinical Trial Controlled Clinical TrialClinical evaluation of closed-loop control of blood pressure in seriously ill patients.
To compare the effectiveness of a new method of closed-loop (automatic) control of BP with usual manual control. ⋯ The new closed-loop system is more effective than the usual manual control in managing acute BP disturbances in the seriously ill patient.
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Critical care medicine · Feb 1991
Mortality prediction models in intensive care: acute physiology and chronic health evaluation II and mortality prediction model compared.
To compare the Acute Physiology and Chronic Health Evaluation (APACHE II) score with the Mortality Prediction Model (MPM). ⋯ Our investigation indicates that both APACHE II and MPM are good predictors of hospital outcome in our population, but the level of intensive care services received before conventional ICU admission modifies accuracy of predictive models. In any study of outcome using comparative studies of classification systems, confounding biases should be measured.