Critical care medicine
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Critical care medicine · Jun 1997
Randomized Controlled Trial Clinical TrialOxygen transport patterns in patients with sepsis syndrome or septic shock: influence of treatment and relationship to outcome.
To investigate the relationship between oxygen transport patterns and outcome in patients with sepsis syndrome or septic shock managed according to two different treatment regimens. ⋯ Survivors of sepsis syndrome or septic shock are characterized by an ability to increase both DO2 and VO2. In contrast, nonsurvivors typically have reduced cardiac reserve, they fail to increase VO2 following resuscitation, and when delivery is enhanced with aggressive inotropic support, oxygen extraction falls. These patterns of response were similar in both treatment and control groups, although the magnitude of the changes was exaggerated in the treatment group. These observations may help to explain the findings by some investigators that treatment aimed at achieving survivor values of cardiac index, DO2, and VO2 fails to improve outcome when instituted following admission to intensive care.
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Critical care medicine · Jun 1997
Measurements of total plasma nitrite and nitrate in pediatric patients with the systemic inflammatory response syndrome.
The systemic inflammatory response syndrome (SIRS) is typified by the presence of fever, hemodynamic changes, and end organ dysfunction. Endothelial cell activation leads to overproduction of nitric oxide, which results in sustained vasodilation and hypotension. This study was undertaken to determine the sensitivity, specificity, and positive and negative predictive values of plasma nitrite/nitrate measurements in identifying patients with clinical characteristics of SIRS, as defined by criteria based on physician diagnosis. ⋯ Clinical diagnosis of SIRS is strongly associated with increased total plasma nitrite/nitrate concentrations in pediatric patients in the pediatric ICU. Many patients with increased nitrite/nitrate concentrations have inflammation without having a clinical diagnosis of SIRS. Our data suggest that increased plasma nitrite/nitrate concentrations are the standard for identifying patients with inflammation in the pediatric ICU.
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Critical care medicine · Jun 1997
Case ReportsProlonged extracorporeal life support (ECLS) for varicella pneumonia.
To review the institutional experience of a national tertiary referral center for extracorporeal life support (ECLS) in severe varicella pneumonia. ⋯ Early recognition of imminent pulmonary failure and rapid institution of ECLS are critical in the successful management of severe, life-threatening varicella pneumonia.
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Critical care medicine · Jun 1997
Utilization and diagnostic yield of blood cultures in a surgical intensive care unit.
To evaluate the diagnostic yield of blood cultures obtained in a surgical intensive care unit (ICU) and to assess factors potentially influencing yield. ⋯ Blood culture yield in this surgical ICU was relatively low in comparison with other published studies. The data further suggest that concurrent use of systemic antibiotics and inappropriate or excessive culturing may negatively influence blood culture yield.
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Critical care medicine · Jun 1997
Variation of inhaled nitric oxide concentration with the use of a continuous flow ventilator.
To investigate the homogeneity of nitric oxide concentrations at different ventilator settings in a delivery system using a continuous flow ventilator. ⋯ Mixing a nitrogen/nitric oxide gas mixture 20 cm before the Y-connector results in an increase of the mean nitric oxide concentration with increasing ventilator rates. This phenomenon does not occur with the nitrogen/nitric oxide gas mixture mixed at the inlet of the humidifier, using a ventilator with a throughout constant flow at the inspiratory outlet of the ventilator. The fluctuations of the main ventilator circuit flow result in changing ratios of nitrogen/nitric oxide gas mixture and the ventilator gas flow. We speculate this changing flow ratio produces the increase in mean nitric oxide concentration within the ventilatory circuit. To ensure a constant concentration of nitric oxide by blending a nitrogen/nitric oxide gas mixture in the ventilator circuit of a continuous flow ventilator, the site of injection of the nitrogen/nitric oxide gas mixture should be at the point where ventilator circuit flow fluctuations are minimal.