Critical care medicine
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Critical care medicine · Jun 1992
Comparative StudySeptic shock in patients with cirrhosis: hemodynamic and metabolic characteristics and intensive care unit outcome.
To examine the hemodynamic and metabolic characteristics and ICU outcome of septic shock in patients with cirrhosis. ⋯ In patients with cirrhosis, septic shock was characterized by severe liver dysfunction, low blood temperature, marked increases in cardiac index and lactic acidemia, and a 100% ICU mortality rate. These findings should be taken into account if patients with cirrhosis are to be included in controlled studies on septic shock.
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Critical care medicine · Jun 1992
Comparative StudyLung mechanics during and after extracorporeal membrane oxygenation for meconium aspiration syndrome.
To determine whether abnormalities in lung mechanics detected in infants during the acute phase of meconium aspiration syndrome persist after treatment with extracorporeal membrane oxygenation (EMCO). ⋯ We conclude that improvements in the clinical condition and oxygenation, permitting successful decannulation from ECMO, are achieved before clinically important improvements in lung mechanics.
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Critical care medicine · Jun 1992
Comparative StudyLack of relationship between the true airway pressure and the pressure displayed with an infant ventilator.
To establish if the pressure indicated in the manometer of an infant ventilator (IV 100B, Sechrist, Anaheim, CA) reflects the true pressure delivered to the proximal airway during mechanical ventilation in the neonatal ICU. ⋯ These data demonstrate that it is impossible to know the true pressure delivered to the proximal airway of a neonate during mechanical ventilation by observing the ventilator pressure manometer. The manometer readings consistently underestimate the true peak inspiratory pressure values and are very unpredictable regarding positive end-expiratory pressure values. These findings support the use of other methods to monitor the proximal airway pressure besides the ventilator's manometer in the neonatal ICU. Furthermore, mean airway pressure should not be calculated from the pressure readings obtained from the tested ventilator's manometer.
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Critical care medicine · Jun 1992
Comparative StudyEffect of a human immunoglobulin preparation for intravenous use in a rabbit model of meningococcal endotoxin-induced shock.
Endotoxin shock is mediated by various cytokines, including tumor necrosis factor. Treatment of patients with i.v. immunoglobulin has been shown to reduce the concentration of circulating cytokines. The purpose of this study was to determine the protective effects of immunoglobulin for i.v. use on meningococcal endotoxin-induced shock in a rabbit model. Experimental animals were challenged with i.v. meningococcal endotoxin (lipo-oligosaccharide) 10 micrograms/kg, and treated with either a 2-hr i.v. immunoglobulin infusion (400 mg/kg) or a similar saline infusion that was initiated 30 mins before endotoxin challenge. Control animals were challenged with saline alone. ⋯ In this model of circulatory shock in rabbits, i.v. immunoglobulin: a) does not significantly alter the physiologic responses to endotoxin challenge; b) significantly reduces endotoxin concentrations; c) reduces tumor necrosis factor concentrations, but not significantly; and d) does not improve survival rate.
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Critical care medicine · Jun 1992
Femoral arteriovenous extracorporeal carbon dioxide elimination using low blood flow.
Conventional extracorporeal CO2 removal systems require blood flow rates of 1 to 2.5 L/min in the extracorporeal circuit. We hypothesized that standard hemofiltration equipment can be combined with a high-performance extracorporeal lung to achieve high rates of CO2 removal at lower blood flow rates. To test this hypothesis, we performed experiments on nine sheep to examine the extent to which CO2 elimination can be achieved at blood flow rates less than 600 mL/min using a 5-m2 hollow fiber membrane lung with countercurrent gas flow, combined with a hemofiltration blood pump, and connected to femoral arterial and venous hemodialysis catheters. ⋯ Standard hemofiltration equipment may be combined with a hollow fiber membrane lung to remove the equivalent of a high proportion of the basal metabolic CO2 production of an adult human at low blood flow rates. Use of this technology would bring extracorporeal CO2 removal within the budget and capability of more ICUs.