Critical care medicine
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Critical care medicine · Mar 1997
Comparative Study Clinical Trial Controlled Clinical TrialEpinephrine impairs splanchnic perfusion in septic shock.
To assess the effects of epinephrine on splanchnic perfusion and splanchnic oxygen uptake in patients with septic shock. ⋯ We conclude that undesirable splanchnic effects on patients in whom that region is particularly fragile should be considered when using epinephrine for septic shock treatment.
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Critical care medicine · Mar 1997
Clinical Trial Controlled Clinical TrialDobutamine increases cerebral blood flow velocity and jugular bulb hemoglobin saturation in septic patients.
To evaluate the effects of dobutamine on cerebral hemodynamics in septic patients with stable hemodynamic status. ⋯ These measurements of middle cerebral artery flow velocity and jugular bulb oximetry suggest that dobutamine increases cerebral blood flow but not cerebral VO2 in stable septic patients.
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Critical care medicine · Mar 1997
A proposed relationship between increased intra-abdominal, intrathoracic, and intracranial pressure.
To determine the effect of acutely increased intra-abdominal pressure on pleural pressure, intracranial pressure, and cerebral perfusion pressure, and to clarify the relationship between these parameters. ⋯ Acutely increased intra-abdominal pressure causes a significant increase in intracranial pressure and a decrease in cerebral perfusion pressure. Increased intra-abdominal pressure appears to produce this effect by augmenting pleural and other intrathoracic pressures and causing a functional obstruction to cerebral venous outflow via the jugular venous system. It is possible that the same phenomenon may be why persons with chronically increased intra-abdominal pressure, such as the morbidly obese, suffer from a high frequency rate of idiopathic intracranial hypertension.
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Critical care medicine · Mar 1997
L-canavanine, an inhibitor of inducible nitric oxide synthase, improves venous return in endotoxemic rats.
To investigate the hemodynamic effects of L-canavanine (an inhibitor of inducible, but not of constitutive, nitric oxide synthase) in endotoxic shock. ⋯ Six hours after an endotoxin challenge in rats, low cardiac output develops, which appears to be primarily related to relative hypovolemia. L-canavanine, a selective inhibitor of the inducible nitric oxide synthase, increases the mean systemic filling pressure, thereby improving venous return, under these conditions.
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Critical care medicine · Mar 1997
Dose-response relationship between aortic infusions of polymerized bovine hemoglobin and return of circulation in a canine model of ventricular fibrillation and advanced cardiac life support.
Return of spontaneous circulation after cardiac arrest may be a function of vital organ perfusion. Selective aortic perfusion and oxygenation with oxygenated ultrapurified polymerized bovine hemoglobin improves vital organ perfusion and is an effective adjunct in the treatment of cardiac arrest. This study determined the dose-response relationship between intra-aortic oxygenated ultrapurified polymerized bovine hemoglobin and return of spontaneous circulation. ⋯ There is a dose-response relationship between the volume of oxygenated ultrapurified polymerized bovine hemoglobin administered by selective aortic perfusion and oxygenation and return of spontaneous circulation after prolonged cardiac arrest. This result supports the hypothesis that vital organ flow is causally related to improved outcome.