Critical care medicine
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Critical care medicine · Aug 1993
Combined continuous monitoring of systemic and cerebral oxygenation in acute brain injury: preliminary observations.
To continuously evaluate the relationship between global systemic and cerebral oxygenation during temporary profound hypocapnia, which was attempted for prompt management of posttraumatic intracranial hypertension. ⋯ In young adults with severe acute brain trauma who require prompt management of intracranial hypertension, transient profound hypocapnia is effective in lowering the intracranial pressure, as well as in offsetting the cerebral luxury perfusion, while improving or maintaining adequate systemic oxygenation. The systemic-cerebral oxygenation index and the systemic-cerebral ventilatory index are potentially useful, physiologically monitorable variables for the combined assessment of global systemic and cerebral oxygenation in a variety of areas involving physiologic and/or therapeutic approaches.
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Critical care medicine · Aug 1993
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialAccurate placement of central venous catheters: a prospective, randomized, multicenter trial.
a) To define the frequency of dangerous (intracardiac) central venous catheter placement in a multicenter study of large community hospital intensive care units (ICUs) and to evaluate physician responses to this finding. b) To validate right atrial electrocardiography as a technique to assure adherence with recent Food and Drug Administration (FDA) guidelines regarding the location of central venous catheter tips. c) To conduct a literature review of vascular cannulation and its associated potentially lethal complications. ⋯ a) The FDA guidelines regarding catheter tip location (catheter tip should not be in the right atrium) have not been widely publicized. b) The average safe insertion depth for a central venous catheter from the left or right internal jugular vein or subclavian vein is 16.5 cm for the majority of adult patients; a central venous catheter should not be routinely inserted to a depth of > 20 cm. Catheters longer than this size are rarely needed, and potentially dangerous. Catheter tip location is important to document following central venous catheter insertion. Thirty-centimeter central venous catheters should not be used when accessing the central circulation via internal jugular or subclavian veins. c) Right atrial electrocardiography is a technique that assures initial tip position outside the heart in accordance with FDA guidelines. This technique would virtually eliminate the major risk of death (i.e., cardiac perforation) associated with this procedure. d) Recently available, 15- and 16-cm central venous catheters have significant potential to minimize intracardiac placement of central venous catheters by either the internal jugular or subclavian vein route and may become the standard of care.
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Critical care medicine · Aug 1993
Randomized Controlled Trial Comparative Study Clinical TrialInfluence of long-term oro- or nasotracheal intubation on nosocomial maxillary sinusitis and pneumonia: results of a prospective, randomized, clinical trial.
To compare the occurrence rate of nosocomial maxillary sinusitis and pneumonia in patients who have undergone nasotracheal vs. orotracheal intubation. ⋯ In patients undergoing prolonged mechanical ventilation, there was no statistically significant difference in the occurrence rate of nosocomial sinusitis or pneumonia between patients undergoing tracheal intubation via the nasal vs. oral route. A trend (p = 0.008) suggests less sinusitis in the orotracheal group.
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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
Randomized Controlled Trial Comparative Study Clinical TrialThoracic electrical bioimpedance measurement of cardiac output in postaortocoronary bypass patients.
To assess the degree of correlation and agreement between cardiac output by thermodilution and bioimpedance using the BoMed NCCOM3-R7 monitor in postaortocoronary bypass patients. ⋯ Use of the BoMed NCCOM3-R7 bioimpedance monitor as a replacement for thermodilution-derived cardiac output cannot be recommended in postaortocoronary bypass patients. The distortions of patients' normal anatomy and physiology, coupled with the presence of endotracheal tubes and mechanical ventilation, mediastinal tubes and chest tubes, result in only fair correlation, significant bias, and poor precision between the two measures of cardiac output.