Critical care medicine
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Critical care medicine · Jul 1994
Comparative StudyEffect of carboxyhemoglobin on the accuracy of mixed venous oximetry monitors in dogs.
To assess the accuracy of mixed venous hemoglobin oxygen saturation estimated, using in vivo pulmonary artery reflectance oximetry with ranging concentrations of carboxyhemoglobin. ⋯ Mixed venous oxygen saturation monitoring does not detect the presence of carboxyhemoglobin and progressively overestimates fractional oxyhemoglobin as carboxyhemoglobin increases. Mixed venous oxygen saturation values of the standard pulmonary artery oximetry catheter approximately equal functional hemoglobin saturation. Bench co-oximeter blood analysis is required in patients suspected of having increased carboxyhemoglobin levels.
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Critical care medicine · Jul 1994
Randomized Controlled Trial Comparative Study Clinical TrialMetabolic effects of a D-beta-hydroxybutyrate infusion in septic patients: inhibition of lipolysis and glucose production but not leucine oxidation.
To study the effect of a D-beta-hydroxybutyrate infusion on protein metabolism, lipolysis, and endogenous glucose production in septic patients. ⋯ Exogenous ketone-bodies infusion decreased lipolysis and glucose production in septic patients but had no beneficial effect on protein metabolism, as evaluated with L[1-13C]leucine.
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To review the difficulties associated with defining sepsis and its complications and to characterize the role of the proinflammatory cytokines in the development of human septic shock, adult respiratory distress syndrome, and the systemic inflammatory response syndrome. ⋯ Sepsis and its complications constitute a complex biological cascade that may be defined by specific clinical characteristics. The clinical variability in these events suggests that definitions based on clinical end points be used in combination with assessments of severity of illness to best define patient status, predict clinical course, and guide treatment decision-making.
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Critical care medicine · Jul 1994
Comparative StudyReduction of morbidity in interhospital transport by specialized pediatric staff.
We prospectively compared the occurrence of morbidity during high-risk interhospital transport in two types of transport systems: specialized tertiary center-based vs. nonspecialized, referring hospital-based. ⋯ We conclude that specialized pediatric teams can reduce transport morbidity. This is the first published study to compare two models of pediatric transport using identical definitions of severity and morbidity.
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Critical care medicine · Jul 1994
Comparative StudyClinical recovery of consciousness after traumatic coma.
To describe early clinical stages in the recovery of consciousness, using selected items from the Glasgow Coma Scale and the Liège Coma Scale. ⋯ This study confirms the classical clinical sequence of arousal and recovery of consciousness, with the appearance of stimulated eye opening and the blink reflex first, followed by spontaneous eye opening, and the capacity to obey commands in intubated, traumatized, coma patients. A direct correlation existed between the delay of arousal and the complete recovery of consciousness. When groups of patients with various mean delays for the appearance of stimulated eye opening are considered, reappearance of the blink reflex did not always coincide with stimulated eye opening, suggesting differing structural and functional brain recovery processes.