Critical care medicine
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Critical care medicine · Apr 1996
Comparative StudyNociceptive somatic nerve stimulation and skeletal muscle injury modify systemic hemodynamics and oxygen transport and utilization after resuscitation from hemorrhage.
To examine if either nociceptive somatic nerve stimulation or skeletal muscle injury modified systemic hemodynamics and oxygen transport and utilization after resuscitation from hemorrhage in anesthetized pigs. ⋯ Neither nociceptive brachial nerve stimulation nor skeletal muscle injury attenuated the increase in plasma volume, cardiac index, or the repayment of systemic oxygen debt after resuscitation from hemorrhage. Brachial nerve stimulation was associated with augmented cardiac index, systemic Do2, and increased Vo2 requirements related to increased sympathetic nervous system activation. Skeletal muscle injury produced early systemic arterial hypotension and vasodilation, and a decrease in Vo2 that was suggestive of pathologic supply dependency on systemic Do2.
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Critical care medicine · Apr 1996
Comparative StudyMechanical ventilation and arterial blood gas measurements 24 hours postextracorporeal life support for survivors of pediatric respiratory failure.
To summarize our institutional experience concerning mechanical ventilation support and blood gas measurements in the 24-hr period following extracorporeal life support (ECLS) for pediatric acute respiratory failure. ⋯ Successful decannulation from ECLS for > 24 hrs resulted in long-term survival in 97% (36/37) of children. Ventilator parameters and arterial blood gas measurements during the 24-hr period following bypass have been described for this population. Such conventional support may indicate safe levels of oxygen and mechanical ventilation pressures for the postbypass recovering lung.
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Critical care medicine · Apr 1996
Comparative StudyPrediction of outcome in patients with anoxic coma: a clinical and electrophysiologic study.
To evaluate and compare the predictive powers of clinical examination, electroencephalography (EEG), and studies of short-latency somatosensory evoked potentials in determining the prognosis in anoxic coma. ⋯ Based on the present data and a literature review, we propose that clinical examination combined with the results of EEG and somatosensory evoked potentials can be used to establish an early, definitive prognosis in a significant proportion of patients in anoxic coma. On day 3 or thereafter, patients with motor response of extension to pain or worse and malignant EEG, or those patients with flexor posturing or worse and bilaterally absent cortical somatosensory evoked potentials invariably have poor outcome. However, some patients with initially malignant EEG and normal somatosensory evoked potentials may recover and should be supported until their prognoses become more definitive.
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Critical care medicine · Apr 1996
Comparative StudyA descriptive study of skeletal muscle metabolism in critically ill patients: free amino acids, energy-rich phosphates, protein, nucleic acids, fat, water, and electrolytes.
To characterize biochemical changes in skeletal muscle in critically ill patients. ⋯ Although critically ill patients are a very heterogeneous group from a clinical point of view, there is a remarkable homogeneity in many of the biochemical parameters regardless of the severity of illness and the length of the ICU admission. The three most consistent differences were the skeletal muscle low glutamine concentration, the decrease in protein content, and the increase in extracellular water in the patients.
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Critical care medicine · Apr 1996
Randomized Controlled Trial Comparative Study Clinical TrialCapnography facilitates tight control of ventilation during transport.
We tested the hypothesis that Paco2 would be more tightly controlled if end-tidal CO2 monitoring was used during hand ventilation for transport of intubated patients. ⋯ These data do not support routine monitoring of end-tidal CO2 during short transport times in adult patients requiring mechanical ventilation. However, the monitor may prevent morbidity in patients requiring tight control of Paco2.