Critical care medicine
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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.
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Critical care medicine · Feb 1991
Tissue oxygenation in hemorrhagic shock measured as transcutaneous oxygen tension, subcutaneous oxygen tension, and gastrointestinal intramucosal pH in pigs.
Tissue oxygenation, measured in peripheral tissue as transcutaneous PO2 (PtCO2) and subcutaneous PO2, was compared with the oxygenation in GI mucosa, which was measured as intramucosal wall pH (pHi), during experimental hemorrhagic shock and resuscitation in pigs. The pigs were hemorrhaged stepwise to a BP of 80 and 45 mm Hg, followed by retransfusion. PtCO2 was measured in the groin and subcutaneous PO2 was measured in the hip region. Intraluminal PCO2 was measured in the stomach, in the small intestine, and the sigmoid colon using silicone catheters. A simultaneous determination of arterial blood HCO3 concentration allowed pHi to be calculated using Henderson-Hasselbalch equation. Cardiac output was determined by thermodilution, and oxygen delivery (DO2) was calculated. ⋯ PtCO2 and pHi in the small intestine and sigmoid colon were the variables that most rapidly indicated blood volume loss. Subcutaneous PO2 and PtCO2, and small intestine and sigmoid colon pHi were correlated to total body oxygen transport. Peripheral tissue perfusion followed intestinal perfusion to some extent.