Critical care medicine
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Critical care medicine · May 1995
Comparative StudyAccuracy and reproducibility of the measurement of actively circulating blood volume with an integrated fiberoptic monitoring system.
Bedside monitoring of circulating blood volume has become possible with the introduction of an integrated fiberoptic monitoring system that calculates blood volume from the changes in blood concentration of indocyanine green dye 4 mins after injection. The aim of this investigation was to compare the blood volume estimate of the integrated fiberoptic monitoring system (group 1) with the standard methods of blood volume measurement using Evans blue (group 2), and indocyanine green measured photometrically (group 3). ⋯ The results demonstrate that the blood volume estimate of the fiberoptic monitoring system (group 1) correlates closely with the total blood volume measurement using Evans blue (group 2) and indocyanine green (group 3). Trapped indicator in the packed red cell column after centrifugation of the blood samples may account for an overestimation of group 2 and group 3 of approximately 10% to 14%, but there still remains a proportional difference of 10% between group 1 vs. group 2 and vs. group 3. This difference is due to the longer mixing times of group 3 (16 mins) and group 2 (17 mins), during which they are distributed in slowly exchanging blood pools. It seems that the blood volume estimate of the fiberoptic monitoring system (group 1) represents the actively circulating blood volume and may be useful for bedside monitoring.
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Critical care medicine · May 1995
Comparative StudySubcutaneous oxygen tension: a useful adjunct in assessment of perfusion status.
Using a new fluorescence-quenching optode which, unlike earlier oximeters, neither consumes oxygen nor generates heat, we sought to determine the effects of hemorrhage and resuscitation on subcutaneous PO2. Additionally, we compared the effects of resuscitation with diaspirin crosslinked hemoglobin, an oxygen-carrying solution, on subcutaneous PO2 to that of traditional resuscitative fluids. We also compared mean arterial pressure and central venous oxygen saturation, indirect indices of perfusion, to subcutaneous PO2, a direct index of perfusion. ⋯ The fluorescence-quenching optode consistently followed changes in subcutaneous PO2 during hemorrhage and after resuscitation. Diaspirin crosslinked hemoglobin performed as well as blood in restoring peripheral perfusion, as measured by subcutaneous PO2, while both of these fluids were superior to either lactated Ringer's solution or albumin. Both whole blood and diaspirin crosslinked hemoglobin restored mean arterial pressure to baseline, although the effect of the latter was of a longer duration. The pressor effect of the crosslinked hemoglobin did not affect peripheral perfusion, as reflected by the values for subcutaneous PO2. Subcutaneous PO2 is a useful adjunct in assessment of the adequacy of peripheral perfusion and may help redefine targets for resuscitation.
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Critical care medicine · May 1995
Editorial Comment ReviewResuscitation following trauma and hemorrhagic shock: is hydroxyethyl starch safe?
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Critical care medicine · May 1995
Comparative StudyContinuous versus bolus thermodilution cardiac output measurements--a comparative study.
To compare the methods for continuous and bolus thermodilution cardiac output measurements. ⋯ Continuous thermodilution cardiac output measurement provided higher accuracy and greater resistance to thermal noise than standard bolus measurements. The correct placement of the catheter is essential for precise measurements.
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Critical care medicine · May 1995
Comparative StudyEffects of hydroxyethyl starch after trauma-hemorrhagic shock: restoration of macrophage integrity and prevention of increased circulating interleukin-6 levels.
To determine the effects of resuscitation with the colloidal solution (hydroxyethyl starch) vs. crystalloid solution on cell-mediated immune functions after trauma-hemorrhage. ⋯ Since the use of lactated Ringer's solution and hydroxyethyl starch after hemorrhage did not adversely affect cell-mediated immune functions, but produced salutary effects on macrophage functions, hydroxyethyl starch is a safe and beneficial resuscitation adjunct.