Critical care medicine
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To describe a 10-yr experience with an end-of-life practice in a hospital. ⋯ A hands-on approach to the care of dying patients by this specialty, palliative care service has provided patients, families, and clinicians with the type of support needed for satisfactory end-of-life care. A summary of our experience may be useful to others.
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Critical care medicine · Jan 1997
Effect of continuous venovenous hemofiltration with dialysis on lactate clearance in critically ill patients.
To evaluate the effect of continuous venovenous hemofiltration with dialysis on lactate elimination by critically ill patients. ⋯ Continuous venovenous hemofiltration with dialysis cannot mask lactate overproduction, and its blood concentration remains a reliable marker of tissue oxygenation in patients receiving this renal replacement technique.
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Critical care medicine · Jan 1997
Comparative StudyEfficacy of inhaled nitric oxide in oleic acid-induced acute lung injury.
To assess the efficacy of inhaled nitric oxide in improving pulmonary hypertension and gas exchange following oleic acid-induced acute lung injury. ⋯ The effect of inhaled nitric oxide, restricted to relieving pulmonary vasoconstriction in this model of lung injury, may have limited benefit in improving pulmonary gas exchange when diffusion is impaired by severe lung injury and inflammatory thickening of the alveolar-capillary barrier. Nitric oxide inhalation may have better results when used at an earlier, less severe stage of acute lung injury.
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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
Mortality is directly related to the duration of mechanical ventilation before the initiation of extracorporeal life support for severe respiratory failure.
To investigate the relationship between the period of mechanical ventilation before extracorporeal life support and survival in patients with respiratory failure. ⋯ In severe acute respiratory failure treated with lung rest and extracorporeal life support, a predicted 50% mortality rate was associated with 5 days of preextracorporeal life support mechanical ventilation.