Critical care medicine
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Critical care medicine · Apr 1991
Randomized Controlled Trial Clinical TrialChanges in whole body and tissue oxygen consumption during recovery from hypothermia: effect of amino acid infusion.
To study the effects of amino acids on whole body and peripheral energy metabolism during recovery from post-operative hypothermia. ⋯ The amino acid infusions had no effect on the leg uptake of glucose, ketone bodies, and pyruvate and the leg release of lactate, free fatty acids, and triglycerides, which remained constant during the study.
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Critical care medicine · Apr 1991
ReviewIs it time to use evoked potentials to predict outcome in comatose children and adults?
To determine the value of multimodality-evoked potential recordings in predicting outcome in comatose children. ⋯ A bad outcome can be reliably predicted using multimodality-evoked potential recordings with little chance of a false pessimistic prediction. The acceptable error of false optimism occurs frequently, since patients often die of progressive neurologic and nonneurologic problems that may or may not be present at the time of the evoked potential recordings. Thus, in comatose children, multimodality-evoked potential recordings are a useful adjunct to clinical examination and other diagnostic aids in predicting outcome and in making decisions regarding the degree of intervention to offer.
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Critical care medicine · Apr 1991
Persistence of supply dependency of oxygen uptake at high levels of delivery in adult respiratory distress syndrome.
To identify any plateau in oxygen consumption (VO2) when oxygen delivery (DO2) is increased in patients with the adult respiratory distress syndrome (ARDS). ⋯ In no patient was there evidence of a plateau, despite high levels of DO2 being achieved in all patients.
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To evaluate the use of serum lactic acid values to predict flow-dependent increases in oxygen consumption (VO2) in response to increasing oxygen delivery (DO2) after blood transfusion in surgical sepsis. ⋯ Blood transfusion can be used to augment DO2 and VO2 in septic surgical patients. Increased serum lactic acid values do not predict patients who will respond. The absence of lactic acidosis should not be used in this patient population to justify withholding blood transfusions to improve flow-dependent VO2. Patients who have increased lactate concentrations may have a peripheral oxygen utilization defect that prevents improvement in VO2 with increasing DO2.
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Critical care medicine · Apr 1991
Objective assessment of changing mortality risks in pediatric intensive care unit patients.
To develop and validate a mortality risk predictor based on physiologic data that estimates daily the probability of a patient dying within the next 24 hrs as that probability changes with disease and recovery. ⋯ The predictor is valid for assessing the 24-hr mortality risk in pediatric ICU patients hospitalized in other tertiary care institutions, different from those used for predictor development. The predicted mortality risks allow prospective patient stratification into risk groups. The ability of this predictor to follow risk changes over time expands its applicability over static predictors by enabling the charting of patient courses, and permitting ICU efficiency analysis.