Critical care medicine
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Critical care medicine · Jun 1998
Extracorporeal heparin adsorption following cardiopulmonary bypass with a heparin removal device--an alternative to protamine.
To evaluate the therapeutic efficacy and applicability of a heparin removal device (HRD) based on plasma separation and poly-L-lysine (PLL) affinity adsorption as an alternative to protamine in reversing systemic heparinization following cardiopulmonary bypass (CPB). ⋯ The HRD is capable of reversal of anticoagulation following CPB without significant blood cell damage or changes in hemodynamics. The HRD, therefore, can serve as an alternative to achieve heparin clearance in clinical situations where use of protamine may be contraindicated.
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Critical care medicine · Jun 1998
Clinical TrialA rapid assay for the detection of circulating D-dimer is associated with clinical outcomes among critically ill patients.
To determine whether the results of a rapid, semiquantitative assay for the detection of circulating D-dimer in whole blood (SRDD assay) are associated with the occurrence of clinical outcomes among critically ill patients. ⋯ Our preliminary investigation suggests that the results from a rapid whole blood assay for the semiquantitative detection of circulating D-dimer are associated with clinical outcomes among patients admitted to a medical ICU. In addition, the use of D-dimer to identify the presence of active intravascular thrombosis may identify patients likely to benefit from antithrombotic therapies in the ICU setting.
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Critical care medicine · Jun 1998
Comparative StudyUnplanned extubation: risk factors of development and predictive criteria for reintubation.
To define patients at risk for unplanned extubation; to assess the influence of nursing workload on the incidence of unplanned extubation; and to determine predictive criteria for patients requiring reintubation. ⋯ Patients at risk for unplanned extubation are characterized by oral intubation and insufficient sedation. In the department studied, and with the specific score used, we did not observe a relationship between the nursing workload and the incidence of unplanned extubation. A Glasgow Coma Score of <11, the accidental nature of unplanned extubation, and a PaO2/FiO2 ratio <200 torr (<26.7 kPa) are factors associated with a risk of reintubation.
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Critical care medicine · Jun 1998
Comparative StudyValue of the venous-arterial PCO2 gradient to reflect the oxygen supply to demand in humans: effects of dobutamine.
To test the value of venous-arterial PCO2 gradient (deltaPCO2) measurements to reflect the adequacy of cardiac index (CI) to oxygen demand in patients submitted to rapid changes of CI and oxygen demand. ⋯ deltaPCO2 can be reliably used at the bedside for informing on the adequacy of CI with respect to a given metabolic condition, and particularly for detecting changes in oxygen demand (e.g., the changes accompanying drug-induced changes in CI). In this regard, deltaPCO2, together with O2 ER and SVO2, can help to assess the adequacy of CI to global oxygen demand.
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Critical care medicine · Jun 1998
Editorial CommentIs there an answer to preventing unplanned extubations?