Critical care medicine
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Critical care medicine · Oct 1999
Comparative StudyCardiac output can be reliably measured noninvasively after coronary artery bypass grafting operation.
To evaluate the reliability of whole-body impedance cardiography in the measurement of cardiac output after coronary artery bypass grafting operation in comparison with the thermodilution method. ⋯ Whole-body impedance cardiography reliably measures cardiac output in patients after coronary artery bypass grafting operation. The excellent repeatability of whole-body impedance cardiography enhances the value of the method in continuous monitoring of patients after the operation.
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Critical care medicine · Oct 1999
Comparative StudyThe ventilatory effects of auto-positive end-expiratory pressure development during cardiopulmonary resuscitation.
Auto-positive end-expiratory pressure (auto-PEEP) is a physiologic phenomenon defined as the positive alveolar pressure that exists at the end of expiration. Normally, the alveolar pressure is near zero at the end of expiration. However, certain ventilatory and/or physiologic paradigms can cause the development of auto-PEEP during cardiopulmonary resuscitation (CPR). Auto-PEEP has a detrimental cardiovascular effect similar to that of positive end-expiratory pressure that is intentionally applied to the ventilatory circuit in a mechanically ventilated patient. The connection between auto-PEEP and its cardiovascular effects, however, may go undetected. In this study, the effect that ventilatory factors have on auto-PEEP in a simulation of patients with lung disease undergoing CPR was delineated. ⋯ We conclude from our findings that ventilation techniques during CPR may need to be altered to avoid the development of what may be a hemodynamically significant level of auto-PEEP.
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To characterize hospital costs of pediatric intensive care and to determine which demographic and disease characteristics are associated with cost. ⋯ The maintenance of the specialty location and its personnel is the most costly component of pediatric intensive care. The strongest correlate with total cost for pediatric intensive care is LOS, but if costs are normalized for LOS, severity of illness best explains cost variation among patients. These data may serve as the basis for additional studies of resource allocation and consumption in the future.
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Critical care medicine · Oct 1999
Comparative StudyArtifactual elevation of measured plasma L-lactate concentration in the presence of glycolate.
To determine whether glycolate, a toxic metabolite of ethylene glycol that is chemically similar to lactate, can cause artifactual elevation of measured L-lactate concentrations. ⋯ Glycolate causes large artifactual elevations in plasma L-lactate measurements by two analyzers in common use, with potential for misdiagnosis of lactic acidosis in ethylene glycol poisoning. A possible cause of the interference is incomplete specificity of the analytical reagent L-lactate oxidase, allowing cross-reaction with glycolate.
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Critical care medicine · Oct 1999
Comparative StudyGlomerular permeability and trauma: a correlation between microalbuminuria and Injury Severity Score.
To determine if there is a correlation between an increase in glomerular permeability, the magnitude of trauma, and the severity of illness. ⋯ Patients with trauma show an increase in glomerular permeability during the first 24 hrs after injury. The magnitude of this increase is correlated with the extent of trauma but does not seem significant enough to be predictive of severity of illness and/or outcome.