Critical care medicine
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Critical care medicine · Feb 1997
Randomized Controlled Trial Clinical TrialEffects of preoperative intentional hemodilution on the extravasation rate of albumin and fluid.
To evaluate the effects of preoperative intentional hemodilution with 4% albumin solution on the extravasation rate of intravascular albumin and fluid in surgical patients. ⋯ These results suggest that preoperative hemodilution using 4% albumin on a 1:1 volume basis for blood substitution during a prolonged surgical procedure with reduced blood losses enhances the extravasation rate of albumin and fluid to the interstitial tissues, impeding the maintenance of isovolemia. These findings support the use of a volume of infused colloid solution higher than that of withdrawn blood during preoperative hemodilution.
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Critical care medicine · Feb 1997
Spectral analysis of systemic arterial pressure and heart rate signals as a prognostic tool for the prediction of patient outcome in the intensive care unit.
To evaluate the applicability of changes in spectra of systemic arterial pressure and heart rate signals in the prediction of patient outcome in an adult intensive care unit (ICU). To compare the prognostic predictability of this method with the Acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system. ⋯ Power spectral analysis of systemic arterial pressure and heart rate signals offers a reasonable means of monitoring acute, critically ill patients, and may be used as an alternative prognostic tool for the prediction of patient outcome in the ICU.
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Critical care medicine · Feb 1997
Comparative StudyIntratracheal pressure monitoring during synchronized intermittent mandatory ventilation and pressure controlled-inverse ratio ventilation.
To directly measure airway pressures proximal and distal to endotracheal tubes during conventional synchronized intermittent mandatory ventilation (SIMV) and pressure controlled-inverse ratio ventilation (PC-IRV), and to compare them with these values measured by the ventilator. ⋯ A pressure gradient exists during inspiration from the ventilator to the trachea in mechanically ventilated patients. Tracheal pressures cannot be predicted from proximal airway pressure monitors because of marked variation in endotracheal tube resistance in vivo. Initiation of PC-IRV does not result in a decrease in peak airway pressure when measured intratracheally.
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Critical care medicine · Feb 1997
Unloadiing of the work of breathing by proportional assist ventilation in a lung model.
Proportional assist ventilation is devised to increase airway pressure in proportion to inspiratory effort. A systematic study of the performance of this new mode of ventilation has not been presented. We tested in the laboratory the capability of proportional assist ventilation to unload the work of breathing in proportion to ventilatory drive, under a variety of mechanical loads. ⋯ In a lung model, a prototype system delivering proportional assist ventilation provided uniform unloading of the work of breathing as the ventilatory drive was varied within a tidal volume range of 0.5 to 1.2 L. These findings confirm the theoretical modeling of proportional assist ventilation. This system, however, failed to properly unload low tidal volumes of 0.2 to 0.4 L.
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Critical care medicine · Feb 1997
Inhaled nitric oxide reduces the utilization of extracorporeal membrane oxygenation in persistent pulmonary hypertension of the newborn.
To determine if the use of inhaled nitric oxide therapy reduces the need for extracorporeal membrane oxygenation (ECMO) in persistent pulmonary hypertension of the newborn. ⋯ In neonates with persistent pulmonary hypertension, therapy with inhaled nitric oxide reliably and safely improves oxygenation, thereby resulting in a decreased need for ECMO therapy, improved patient outcome, and lower hospital costs.