Critical care medicine
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Critical care medicine · Feb 1993
Comparative StudyPreoperative intensive care unit consultations: accurate and effective.
To determine if a structured preoperative ICU consultation would correctly assign patients to preoperative invasive monitoring, postoperative ICU care, or recovery room care, and to compare morbidity, mortality, and resource utilization among all groups. ⋯ A small number of high-risk patients can be selected for preoperative monitoring on the basis of clinical assessment without increasing ICU stay or hospital bills. A structured preoperative consultation correctly identifies those patients who need monitoring and ICU care, but does not overutilize scarce and expensive ICU beds.
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Critical care medicine · Feb 1993
Comparative StudyUnreliability of blood pressure and heart rate to evaluate cardiac output in emergency resuscitation and critical illness.
To evaluate the reliability of the vital signs to evaluate circulatory stability as reflected by cardiac index. ⋯ Observations at the time of acute severe hypotensive crises that show rough correlation of MAP and cardiac index should not be extrapolated throughout the entire hypotensive period or to other less extreme clinical situations. The stress response to hypovolemia, with endogenous catecholamines and neural mechanisms, tends to maintain arterial pressure in the face of decreasing flow for a variable period of time. However, when these mechanisms are overwhelmed by prolonged hypovolemia, the pressure decreases precipitously, but not synchronously, with flow. We conclude that blood flow cannot reliably be inferred from arterial pressure and heart rate measurements until extreme hypotension occurs.
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Critical care medicine · Feb 1993
Physiologic response of stress and aminoglycoside clearance in critically ill patients.
To examine the relationships between aminoglycoside clearance and physiologic parameters associated with the physiologic response to injury. ⋯ Along with renal function estimates, the physiologic response to stress should be considered when treating critically ill patients with aminoglycosides and other, similar, renally eliminated drugs.
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Critical care medicine · Feb 1993
Increased serum concentrations of procollagen type III peptide in severely injured patients: an indicator of fibrosing activity?
To determine the serum concentrations of procollagen type III peptide in severely injured patients with different outcomes and to evaluate the relationship between serum procollagen type III peptide concentrations, sources of increased posttraumatic fibrotic activity (wounds, lung, liver, kidney), and decreased elimination of procollagen type III peptide (liver). ⋯ Serum procollagen type III peptide concentrations in severely injured patients may be considerably increased in correlation with injury severity and outcome. Procollagen type III peptide serum concentrations seem to reflect the sum of increased collagen formation from wound healing and fibrogenesis of mediator-related organ damage (especially lung) and decreased procollagen type III peptide excretion due to impaired liver function. Further data are necessary to evaluate the role of hepatic elimination in these patients.
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Critical care medicine · Feb 1993
Comparative StudyAdequacy of tissue oxygenation in cardiac surgery: regional measurements.
The aim of the study was to measure visceral and peripheral perfusion and oxygenation during and immediately after cardiac surgery. ⋯ These data suggest that the visceral perfusion of patients is well maintained during cardiopulmonary bypass, while, at the same time, these patients develop hypoperfusion and hypoxia of peripheral tissues. After closing the wounds, gastric intramucosal pH, transcutaneous PO2 index (transcutaneous PO2/PaO2), and other peripheral tissue perfusion variables were at the lowest values, indicating impending residual hypothermia and tissue hypoperfusion after rewarming. During the first few hours in the ICU, both the visceral and peripheral oxygenation and perfusion variables reflected hypoperfusion of tissues coinciding in time with the period most vulnerable for hemodynamic disasters and cardiac arrhythmias.