Critical care medicine
-
This article reviews the current body of knowledge regarding lactic acidosis in critically ill patients. The classification of disordered lactate metabolism and its pathogenesis are examined. The utility of lactate as a metabolic monitor of shock is examined and current therapeutic strategies in the treatment of patients suffering from lactic acidosis are extensively reviewed. The paper is designed to integrate basic concepts with a current approach to lactate in critical illness that the clinician can use at the bedside. ⋯ The severity of lactic acidosis in critically ill patients correlates with overall oxygen debt and survival. Lactate determinations may be useful as an ongoing monitor of perfusion as resuscitation proceeds. Therapy of critically ill patients with lactic acidosis is designed to maximize oxygen delivery in order to reduce tissue hypoxia by increasing cardiac index, while maintaining hemoglobin concentration. Buffering agents have not been shown to materially affect outcome from lactic acidosis caused by shock. The benefits of other specific therapies designed to reduce the severity of lactic acidosis remain unproven.
-
Critical care medicine · Jan 1992
Frequency of upper gastrointestinal bleeding in a pediatric intensive care unit.
To determine the frequency of upper gastrointestinal (GI) bleeding in pediatric ICUs. ⋯ The frequency of upper GI bleeding is substantial, but the rate of occurrence of clinically important upper GI bleeding is low, even in a pediatric ICU where most patients do not receive any prophylaxis.
-
Critical care medicine · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of reflection and transmission pulse oximetry after open-heart surgery.
To determine if there was a difference between reflection and transmission pulse oximeters in their ability to regain data display after hypothermia in patients recovering from open-heart surgery. ⋯ The forehead reflection probe regained signal detection earlier than the transmission probe on the ear lobe in patients with compromised peripheral blood flow and cool periphery. This finding may be due to higher skin temperature at the reflection probe site, since the systemic hemodynamic conditions were equal at the time of the data acquisition of both sensors.
-
Critical care medicine · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of continuous versus intermittent furosemide administration in postoperative pediatric cardiac patients.
To compare the effects of furosemide administered by intermittent iv infusion vs. continuous iv infusion on urine output, hemodynamic variables, and serum electrolyte concentrations. ⋯ Furosemide administered by continuous iv infusion is advantageous in the post-operative pediatric patient because of a more controlled and predictable urine output with less drug requirement and less urinary loss in sodium and chloride.
-
Critical care medicine · Jan 1992
Comparative StudyEsophageal electrodes allow precise assessment of cardiac output by bioimpedance.
To analyze the impact of the position of the thoracic external electrodes on the values of cardiac output measured by electrical bioimpedance and to compare the results obtained by bioimpedance with those values determined by thermodilution in critically ill patients. ⋯ a) The values of cardiac output derived from measurements obtained by bioimpedance using internal electrodes were comparable with those values derived from thermodilution. b) Values of cardiac output from bioimpedance studies with external electrodes were dependent on the position of the xiphoid electrodes.