Critical care medicine
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Critical care medicine · Sep 1992
Use of extracorporeal life support in patients with congenital heart disease.
To review a large experience with extracorporeal life support in patients with congenital heart disease. To determine the major causes of mortality and morbidity in order to improve the results of using this technology in this patient population. ⋯ Extracorporeal life support can be useful in supporting patients with congenital heart disease with life-threatening cardiac or pulmonary failure. Improvements in limiting neurologic and bleeding complications may lead to improvements in the use of extracorporeal life support for this indication. However, prospective, randomized studies are needed to appreciate the role of extracorporeal life support in these patients.
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Critical care medicine · Sep 1992
Comparative StudyHyaluronan: relationship to hemodynamics and survival in porcine injury and sepsis.
Hyaluronan is a polysaccharide normally present in low concentrations in the blood, and is rapidly cleared from the blood by the liver. Increased plasma hyaluronan concentrations have been found in patients with sepsis. We studied changes in serum hyaluronan concentrations and their relationship to hemodynamics and survival in a 48-hr porcine model of injury and sepsis. ⋯ Experimental sepsis is associated with an increase in serum hyaluronan values. The relationship between decreased MAP and increased serum hyaluronan concentrations could point to reduced liver perfusion as a cause. An association between high hyaluronan values and nonsurvival in sepsis is possible.
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Critical care medicine · Sep 1992
Acute hypoxemic respiratory failure in infants and children: clinical and pathologic characteristics.
To examine the clinical and pathologic features of acute hypoxemic respiratory failure in children. ⋯ Children with acute hypoxemic respiratory failure represent a heterogeneous subset of patients. In our group of patients, infectious pneumonitis was more commonly encountered than diffuse alveolar damage. The mortality rate of children with acute hypoxemic respiratory failure has not improved since 1980.
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Critical care medicine · Sep 1992
Prediction criteria for successful weaning from respiratory support: statistical and connectionist analyses.
To develop predictive criteria for successful weaning of patients from mechanical assistance to ventilation, based on simple clinical tests using discriminant analyses and neural network systems. ⋯ Use of quadratic discriminant and neural network analyses could be useful in developing accurate predictive criteria for successful weaning based on simple bedside measurements.
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Critical care medicine · Sep 1992
Comparative StudyArterial pH and carbon dioxide tension as indicators of tissue perfusion during cardiac arrest in a canine model.
Previous studies have shown that Paco2 and end-tidal CO2 reflect coronary artery perfusion pressures during cardiac arrest. We investigated the relationship of coronary artery perfusion pressure to central arterial pH and Paco2 values during resuscitation from cardiac arrest in a canine model. Twenty-four mongrel dogs were block randomized to three different resuscitation groups after induction of ventricular fibrillation and cardiac arrest: a) standard cardiopulmonary resuscitation (CPR) and advanced life support (n = 8); b) cardiopulmonary bypass (n = 8); or c) open-chest CPR (n = 8). Central arterial blood gases and perfusion pressures were monitored during cardiac arrest and during resuscitation. ⋯ Central arterial pH and Paco2 monitoring during cardiac arrest may reflect the adequacy of tissue perfusion during resuscitation and may predict resuscitation outcome from ventricular fibrillation.