Critical care medicine
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Critical care medicine · Aug 1993
Influence of infusion pump operation and flow rate on hemodynamic stability during epinephrine infusion.
To determine whether variations in the flow rate of epinephrine solutions administered via commonly available infusion pumps lead to significant variations in blood pressure (BP) in vivo. ⋯ Factors inherent in the operating mechanisms of infusion pumps may result in clinically important hemodynamic fluctuations when administering a concentrated short-acting vasoactive medication at slow infusion rates.
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Critical care medicine · Aug 1993
Editorial Comment Comparative StudyThoracic electrical bioimpedance measurement of cardiac output--not ready for prime time.
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Critical care medicine · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialIntraoperative and postoperative effects of vancomycin administration in cardiac surgery patients: a prospective, double-blind, randomized trial.
In response to an increased frequency of Staphylococcus epidermidis infections in postoperative cardiac surgery patients, antibiotic prophylaxis was changed to include both vancomycin and cefazolin pre- and intraoperatively. Subsequent to the addition of vancomycin prophylaxis, clinical impression and retrospective analysis supported a correlation between vancomycin administration and post-cardiopulmonary bypass norepinephrine use. ⋯ The results show that a significantly greater number of patients who received vancomycin required a norepinephrine infusion and that, despite norepinephrine infusion therapy, systemic vascular resistance was not normalized in this group of patients. The study supports the conclusion that perioperative administration of vancomycin in cardiac surgery patients may result in hypotension requiring the use of a vasopressor in an attempt to normalize hemodynamic indices.
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Critical care medicine · Aug 1993
Comparative StudyInfrared tympanic thermometry in the pediatric intensive care unit.
To determine the performance of two different commercially available, noncontact infrared tympanic thermometers in predicting core body temperature as measured by pulmonary artery catheters in pediatric intensive care unit (ICU) patients. The performance of the tympanic thermometers was compared with the performance of an indwelling rectal probe and digital axillary temperature determinations. ⋯ In a pediatric ICU population, rectal probes reflect core temperature better than axillary determinations and both infrared tympanic models estimated core body temperature better than digital axillary temperature. One of the tympanic systems (Thermoscan Pro-1 infrared tympanic thermometer) performed in a similar way to the indwelling rectal probes and may be used to estimate core temperature in situations where a pulmonary artery catheter is not in place. The other test tympanic system (First Temp) had greater variability than the rectal probes.
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Critical care medicine · Aug 1993
Active core rewarming in neurologic, hypothermic patients: effects on oxygen-related variables.
To determine in hypothermic patients if a) the decrease in oxygen consumption (VO2) is exclusively dependent on the decrease in metabolic rate, or b) as a consequence of the greater hemoglobin affinity for oxygen, hypothermic tissues have impaired oxygen extraction. ⋯ These data show that VO2 was reduced to half of normal values during hypothermia. Active core rewarming produced an average 4.5% increase in VO2 per 1 degree C that was characterized by the wide variation observed in this metabolic response between different patients and for individual cases. Despite the rightward shift of P50 observed during rewarming (mainly due to the Bohr effect), no change was reflected on the oxygen extraction ratio.