Critical care medicine
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Critical care medicine · Mar 1993
Enteral nutrition with simultaneous gastric decompression in critically ill patients.
Early enteral nutrition is an important adjunct in the care of critically ill patients. A double-lumen gastrostomy tube with a duodenal extension has been reported to enable early enteral feeding with simultaneous gastroduodenal decompression. We tested the ability of this device to achieve these goals in critically ill patients. ⋯ These data do not support the use of this device for early enteral feeding and simultaneous gastric decompression in critically ill patients.
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Critical care medicine · Mar 1993
Laser bronchoscopy in respiratory failure from malignant airway obstruction.
To examine the value of laser bronchoscopy in patients with inoperable carcinoma of the lung who required ventilatory assistance for acute respiratory failure. ⋯ In nine of 17 patients, laser bronchoscopy appeared to improve the clinical status, permitting removal of mechanical ventilation and extubation and provided the opportunity for further treatment modalities in seven of the nine patients. Survival was improved in this subgroup, and requirement for mechanical ventilatory support was shortened. The improved outcome after laser therapy was related to the presence of obstructing endobronchial tumor as the cause of the respiratory insufficiency. Patients with inoperable carcinoma of the lung and respiratory failure should be evaluated for the presence of an endobronchial lesion that might be responsive to laser bronchoscopy.
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Critical care medicine · Mar 1993
Cardiovascular effects of dopamine and dobutamine in conscious pigs with chronic heart failure.
To test the hypothesis that the cardiovascular responses of dopamine and dobutamine might be affected by the cardiovascular conditions. ⋯ Both dopamine and dobutamine increased cardiac output in conscious pigs with chronic heart failure. Unlike the response in normal conscious pigs, in which only heart rate increased, in animals with heart failure, these agents enhanced both stroke volume and heart rate.
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Critical care medicine · Mar 1993
Effects of norepinephrine and dobutamine on oxygen transport and consumption in a dog model of endotoxic shock.
Severe septic shock is associated with an imbalance between oxygen demand and oxygen supply (DO2) in the presence of an impaired oxygen extraction. Vasopressors are often used to restore a minimal perfusion pressure and inotropic agents are often used to increase myocardial contractility. However, optimal adrenergic support remains controversial. The present study investigated the effects of norepinephrine and dobutamine on DO2, oxygen consumption (VO2), and oxygen extraction in a dog model of endotoxic shock. ⋯ In this endotoxic shock model, both norepinephrine and dobutamine can increase DO2 and VO2 but dobutamine caused a more consistent increase in these parameters. The decrease in oxygen extraction was relatively similar with dobutamine and norepinephrine. The present study does not support a significant beneficial effect of norepinephrine on the tissue extraction capabilities in endotoxic shock.
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Critical care medicine · Mar 1993
Use of vitamin B12 in the treatment and prevention of nitroprusside-induced cyanide toxicity.
To review the mechanism of action, safety, and efficacy of hydroxocobalamin in the treatment and prevention of nitroprusside-induced cyanide toxicity. ⋯ Hydroxocobalamin is a safe and effective agent in the prevention and treatment of nitroprusside-induced cyanide toxicity. Prolonged or high-dose infusions of nitroprusside should be minimized in critically ill patients, especially if hepatic and/or renal dysfunction is present.