Critical care medicine
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Critical care medicine · Jul 1991
Risk factors for the misdiagnosis of pneumothorax in the intensive care unit.
To identify risk factors predisposing to the misdiagnosis of pneumothorax in the ICU. ⋯ Certain medical ICU patients appear to be at higher risk for the initial misdiagnosis of pneumothorax. Familiarity with factors predisposing to this problem should allow for a higher index of suspicion for the diagnosis of pneumothorax in critically ill patients and possibly improve the early detection of pneumothorax.
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Critical care medicine · Jul 1991
Measurement of systolic blood pressure using pulse oximetry during helicopter flight.
Monitoring of vital signs in critically ill patients during helicopter flight is difficult because of the noise and vibrations of the aircraft. We evaluated the use of a pulse oximeter to measure systolic BP intraflight. ⋯ We conclude that a pulse oximeter that displays a plethysmographic waveform can accurately measure systolic BP intraflight.
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Critical care medicine · Jul 1991
Lung fluid dynamics and supply dependency of oxygen uptake during experimental endotoxic shock and volume resuscitation.
We studied the effect of volume resuscitation on lung fluid balance and systemic oxygen extraction during septic shock in eight anesthetized dogs. Sepsis was induced using a 2-hr continuous infusion of Escherichia coli endotoxin at 0.25 micrograms/min.kg. Relationships between oxygen uptake (VO2) and oxygen supply (DO2) were performed acutely during stepwise controlled decrements in cardiac output by progressive inflation of an intracardiac balloon. At each stage, DO2 and corresponding VO2 were measured independently and the individual critical DO2 level was referred to as the point below which the relationship held. The slope of such a constructed relationship was defined as the maximal oxygen extraction ratio. Lung fluid balance was assessed by measurements of extravascular lung water. All values were studied at baseline, after endotoxin insult, and after reversing hypotension by a 10% dextran infusion. ⋯ These data suggest that volume loading may reverse endotoxin-induced peripheral perfusion abnormalities. However, substantial pulmonary edema may occur, possibly jeopardizing the beneficial effects of fluid expansion.