Critical care medicine
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Critical care medicine · Aug 1993
Interleukin-6 and acute-phase protein concentrations in surgical intensive care unit patients: diagnostic signs in nosocomial infection.
To determine the value of serum concentrations of interleukin-6 (IL-6), C-reactive protein, and glycosylation of alpha 1-acid glycoprotein as tools for diagnosing nosocomial infection in surgical intensive care unit (ICU) patients. ⋯ Due to the rapid normalization after trauma, a single measurement of the serum IL-6 concentration may be useful to support or refute the clinical suspicion of nosocomial infection.
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Critical care medicine · Aug 1993
Changes in myocardial blood flow rates during hyperdynamic sepsis with induced changes in arterial perfusing pressures and metabolic need.
To determine whether hyperdynamic sepsis is associated with dysregulation in the control of myocardial blood flow rates unrelated to hypotension or the use of anesthetic agents. ⋯ In this model of hyperdynamic sepsis, increases in blood flow to both the left and right ventricles were positively coupled to changes in respective ventricular work. From the interventional PGE1 and zymosan-activated plasma infusion studies, we found no evidence to support previous suggestions that the regulation of myocardial blood flow rates according to changes in perfusing pressure and/or metabolic oxygen need is significantly altered during hyperdynamic sepsis.
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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 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.