Critical care medicine
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Critical care medicine · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialRenal support in critically ill patients: low-dose dopamine or low-dose dobutamine?
Low-dose dopamine has been used in critically ill patients to minimize renal dysfunction without sufficient data to support its use. The aim of this study was to determine whether low-dose dopamine improves renal function, and whether dobutamine, a nondopaminergic inotrope, improves renal function. ⋯ In stable critically ill patients, dopamine acted primarily as a diuretic and did not improve creatinine clearance. Dobutamine improved creatinine clearance without a significant change in urine output.
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Critical care medicine · Dec 1994
Randomized Controlled Trial Comparative Study Clinical TrialMechanical ventilators optimized for pediatric use decrease work of breathing and oxygen consumption during pressure-support ventilation.
a) To investigate whether the patient work of breathing needed to trigger inspiration is affected by the type of ventilator delivering pressure-support ventilation for mechanically ventilated pediatric patients. b) To determine whether changes in oxygen consumption (VO2) trend with changes in work of breathing and would thus be helpful in tracking work of breathing. ⋯ We conclude that VO2 and work of breathing may be reduced significantly using the latest generation of mechanical ventilators optimized for infant and pediatric use. Because work of breathing is less with the Bird VIP than the other two ventilators tested, leading to a corresponding decrease in VO2, we suggest that the Bird VIP better adapts the patient to the ventilator and may facilitate weaning from ventilatory support. We also suggest that changes in VO2 might be helpful in tracking changes in work of breathing.
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Critical care medicine · Dec 1994
Comparative StudyCritical care medicine: observations from the Department of Veterans Affairs' intensive care units.
To study the critical care medicine programs of the Department of Veterans Affairs. ⋯ The results of this study suggest that the Department of Veterans Affairs would benefit from increasing the number of critical care medicine board eligible/certified directors, and increasing the program's participation in accredited critical care medicine fellowship training programs and research endeavors. Overall, however, we conclude that the Department of Veterans Affairs' critical care medicine program is at least comparable to nationwide ICUs in the parameters evaluated.
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Critical care medicine · Dec 1994
Comparative StudyPeak systolic pressure/end-systolic volume ratio, a load-independent measure of ventricular function, is reversibly decreased in human septic shock.
To evaluate left ventricular performance in patients with septic shock, using a load-independent measure of left ventricular systolic function, the peak systolic pressure/end-systolic volume index ratio. ⋯ This study confirms that survivors and nonsurvivors of septic shock have significant depression of myocardial performance as measured by a load-independent technique. Survivors have greater depression of myocardial performance than nonsurvivors, and, with recovery, the ventricular performance in survivors increases toward normal values.
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Critical care medicine · Dec 1994
Comparative StudyReversal of vagal tone in conjunction with high-dose epinephrine in a canine asphyxial pulseless electrical activity model.
To investigate the effects of surgical vagotomy in conjunction with high-dose epinephrine (0.2 mg/kg) on return of spontaneous circulation rates in a canine model of asphyxial pulseless electrical activity. ⋯ In conjunction with high-dose epinephrine, vagotomy did not improve the return of spontaneous circulation rate in this pulseless electrical activity arrest model. Additionally, the hemodynamic effects of high-dose epinephrine overshadowed the effects of vagotomy.