Critical care medicine
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Critical care medicine · Sep 1995
Comparative StudyIntrahospital transport of critically ill pediatric patients.
To determine the frequency of adverse events during intrahospital transport; to determine the requirement of therapeutic interventions during transport; to test the hypothesis that adverse events that occur during intrahospital transport are due to the transport process itself; and to determine the factors that predict the occurrence of adverse events and the requirement of major therapeutic interventions during transport. ⋯ Serious physiologic deterioration occurs during intrahospital transport of critically ill children. Severity of illness and the duration of transport are associated with the occurrence of adverse events during transport. The team composition and equipment required on transport must be commensurate with the pretransport severity of illness and the anticipated duration of transport.
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Critical care medicine · Sep 1995
Comparative StudyIntraoperative end-tidal carbon dioxide values and derived calculations correlated with outcome: prognosis and capnography.
To determine how much information concerning resuscitation and outcome is provided by the end-tidal CO2 and derived variables obtained during surgery. ⋯ End-tidal CO2 and derived values should be monitored closely in critically ill or injured patients. Efforts should be made--by increasing cardiac output and core temperature and by adjusting ventilation as needed--to maintain the end-tidal CO2 at > or = 29 torr (> or = 3.9 kPa) and the arterial to end-tidal CO2 difference at < or = 7 torr (< or = 1.0 kPa).
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Critical care medicine · Sep 1995
Comparative StudyOxygen transport and cardiovascular effects of resuscitation from severe hemorrhagic shock using hemoglobin solutions.
To test the short-term efficacy of three hemoglobin solutions in restoring cardiac output, intravascular pressures, oxygen transport (DO2), and oxygen consumption (VO2) after resuscitation from severe hemorrhagic shock. ⋯ Resuscitation from severe hemorrhagic shock with 8% stroma-free hemoglobin, PHP44, or PHP88 is equally effective in restoring cardiac index and vascular pressures as using whole blood. However, resuscitation with the three hemoglobin solutions only transiently restored DO2 after hemorrhagic shock. The subsequent reduction of DO2 compared with the DO2 value using whole blood was due mostly to hemodilution. With the two PHP solutions, formation of red blood cell aggregates probably resulted in sequestration of red cell mass and additional loss of oxygen carrying capacity.
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Critical care medicine · Sep 1995
Withholding and withdrawing of life support from patients with severe head injury.
To characterize the withholding or withdrawing of life support from patients with severe head injury. ⋯ Life support is commonly withheld or withdrawn from patients with severe head injury at San Francisco General Hospital, and usually it is accompanied by death. A reciprocal consideration exists in most cases between the physician and family making the difficult decision to limit care. Care is provided for patients whose families request it despite physician recommendations.
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Critical care medicine · Sep 1995
A liquid perfluorochemical decreases the in vitro production of reactive oxygen species by alveolar macrophages.
To determine whether reactive oxygen metabolite production by alveolar macrophages is affected by liquid perfluorochemical exposure. ⋯ Exposure of alveolar macrophages to perfluorooctylbromide in vitro decreases the responsiveness of macrophages to potent stimuli. This finding may partially explain the decrease in pulmonary inflammation seen in animals treated with partial liquid ventilation during experimentally induced lung injury.