Critical care medicine
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Critical care medicine · Jan 1997
Randomized Controlled Trial Clinical TrialOxygen delivery, oxygen consumption, and gastric intramucosal pH are not improved by a computer-controlled, closed-loop, vecuronium infusion in severe sepsis and septic shock.
To investigate the influence of the neuromuscular blocking agent vecuronium on oxygen delivery (DO2), oxygen consumption (VO2), oxygen extraction ratio, and gastric intramucosal pH in heavily sedated patients with severe sepsis or septic shock. ⋯ In these patients, vecuronium infusion achieved the targeted level of paralysis and improved respiratory compliance but did not alter intramucosal pH, VO2, DO2, or oxygen extraction ratios. With deep sedation, neuromuscular blockade in severe sepsis/septic shock does not significantly influence oxygen flux and should be abandoned as a routine method of improving tissue oxygenation in these patients.
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Critical care medicine · Jan 1997
Influence of airway pressure on minimum occlusive endotracheal tube cuff pressure.
To examine the in vivo relationship between peak inflation pressure and the minimum occlusive pressure of a "high-volume, low-pressure" endotracheal tube cuff that may in some circumstances promote tracheal ischemic complications. ⋯ Knowledge of the linear relationship between peak inflation pressure and minimum occlusive pressure can help the clinician identify patients who may be at risk for cuff-induced tracheal ischemic complications, such as tracheoesophageal fistula and tracheal stenosis. In our series, a cuff pressure of 25 mm Hg corresponded to a peak inflation pressure of 35.3 mm Hg (48 cm H2O). Patients with higher peak inflation pressures may be at risk for ischemic tracheal injury, despite proper cuff inflation techniques.
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Critical care medicine · Jan 1997
Variability of indices of hypoxemia in adult respiratory distress syndrome.
To determine the usefulness of indices of hypoxemia in assessing patients with the adult respiratory distress syndrome (ARDS). ⋯ All indices of hypoxemia are affected by changes in FIO2 in patients with ARDS. PaO2/FIO2 ratio exhibits the most stability at FIO2 values of > or = 0.5 and PaO2 values of < or = 100 torr (< or = 13.3 kPa), and is a useful estimation of the degree of gas exchange abnormality under usual clinical conditions. Venous admixture varies substantially with alteration of FIO2 in patients who have clinically important ventilation/perfusion abnormalities. Under these circumstances, venous admixture is a poor indicator of the efficiency of pulmonary oxygen exchange, even if venous admixture is calculated from measured arterial and venous oxygen content values. Estimated venous admixture, based on an assumed arterial-venous oxygen content difference, is even more unreliable.
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Critical care medicine · Jan 1997
Quality of life after cardiac surgery complicated by multiple organ failure.
To evaluate quality of life after prolonged multiple system intensive care treatment in cardiac surgical patients. ⋯ Patients treated with prolonged multiple system intensive care after heart surgery have a poor outcome with respect to quality of life measured at least 1 yr after discharge from the ICU.