Critical care medicine
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Critical care medicine · Oct 1996
Bedside sonographic-guided versus blind nasoenteric feeding tube placement in critically ill patients.
To compare a blind manual bedside method for placing feeding tubes into the small bowel vs. a sonographic bedside technique in critically ill patients. ⋯ The sonographic bedside technique for placing feeding tubes into the small bowel in critically III patients has a success rate of 84.6% (confidence interval 71% to 98%) after the failure of the blind bedside manual method, proving that the former is significantly more successful. This sonographic technique facilitates the insertion of the tubes in patients who cannot be moved and in those patients with severe impairment of the peristaltic activity of the stomach.
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Critical care medicine · Oct 1996
Accuracy and reliability of noninvasive continuous finger blood pressure measurement in critically ill patients.
To evaluate the accuracy and reliability of noninvasive continuous finger blood pressure measurement in critically ill patients. ⋯ Our data provide a guide to the accuracy and reliability of noninvasive finger blood pressure measurements in critically ill patients. Although most test instrument measurements were reliable, in 8% of all patients large discrepancies (> 10 mm Hg) between both measurements with a duration of > 3 mins were noted. Concerning the considerable risk for arterial cannulation, our preliminary data demonstrate that the test instrument (PORTAPRES, TNO Biomedical Instrumentation Research Unit; The Netherlands) is an advance in noninvasive monitoring of critically ill patients and may be useful in most emergency clinical settings.
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Critical care medicine · Oct 1996
Comparative StudyA comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure.
To compare the efficacy of venovenous to venoarterial bypass in an unselected cohort of infants with refractory cardiorespiratory failure. ⋯ We conclude that venovenous ECMO using a double-lumen venovenous catheter can provide results comparable with venoarterial bypass without the need for carotid artery ligation in an unselected population of neonatal ECMO candidates. In our experience, reported contraindications to venovenous ECMO did not prove to be valid.
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Critical care medicine · Oct 1996
Starling resistor effects on pulmonary artery occlusion pressure in endotoxin shock provide inaccuracies in left ventricular compliance assessments.
Assessment of left ventricular preload and left ventricular compliance changes in septic shock using pulmonary artery occlusion pressure (PAOP) presumes that this pressure accurately reflects left heart filling pressure. We tested the hypothesis that Starling resistor forces render PAOP inaccurate as an index of left heart filling pressure, resulting in misleading assessments of left ventricular compliance changes. ⋯ The dissociation between PAOP and left atrial pressure, while left ventricular and -diastolic diameter (preload volume) decreased, and changes in pulmonary venous resistance, are strong evidence for Starling resistor forces (venocompression) rather than active venoconstriction. These data indicate that PAOP overestimates left atrial pressure during endotoxin shock, making it an inaccurate index of left ventricular preload. This overestimation can cause misleading assessments of left ventricular compliance.
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Critical care medicine · Oct 1996
Economic impact of prolonged motor weakness complicating neuromuscular blockade in the intensive care unit.
We compared a case-series of ten patients who developed prolonged neuromuscular weakness after continuous, nondepolarizing, neuromuscular blockade with a group of controls without neuromuscular weakness to determine the economic impact of the neuromuscular weakness. ⋯ The development of motor weakness was associated with an increase in ICU and hospital stays, continued mechanical ventilation, and disproportionate healthcare expenditures in excess of $66,000 per patient. A prospective evaluation of the true prevalence of neuromuscular weakness after neuromuscular blockade and of the costs to the healthcare system is needed.