Critical care medicine
-
Critical care medicine · Sep 1999
The open lung during small tidal volume ventilation: concepts of recruitment and "optimal" positive end-expiratory pressure.
To test the hypotheses that during small tidal volume ventilation (5 mL/kg) deliberate volume recruitment maneuvers allow expansion of atelectatic lung units and that a high positive end-expiratory pressure (PEEP) above the lower inflection point of the pressure/volume (PV) curve is not necessarily required to maintain recruited lung volume in acute lung injury. ⋯ The observation that ventilation occurs on the deflation limb of the tidal cycle-specific PV curve allows placement of the ventilatory cycle, by means of a recruitment maneuver, onto the deflation limb of the PV envelope of the optimally recruited lung. This strategy ensures sufficient lung volume recruitment to maintain the lungs during the tidal cycle while using relatively low airway pressures.
-
Critical care medicine · Sep 1999
Comparative StudyRelationship between mixed venous oxygen saturation and markers of tissue oxygenation in progressive hypoxic hypoxia and in isovolemic anemic hypoxia in 8- to 12-day-old piglets.
To examine the hypothesis that mixed venous oxygen saturation (SvO2) values, which reflect the residual oxygen after tissue oxygen extraction, would be similar during hypoxic and anemic hypoxia. ⋯ In comparison with hypoxic hypoxia, critical values of SvO2 are higher in anemic hypoxia, indicating that oxygen unloading from blood to tissues is impaired in anemic hypoxia. These characteristics in oxygen transport and capillary hemodynamics should be taken into consideration when SvO2 is used in clinical critical care.
-
Critical care medicine · Sep 1999
Comparative StudySimulated mouth-to-mouth ventilation and chest compressions (bystander cardiopulmonary resuscitation) improves outcome in a swine model of prehospital pediatric asphyxial cardiac arrest.
To compare the efficacy of four methods of simulated single-rescuer bystander cardiopulmonary resuscitation (CPR) in a clinically relevant swine model of prehospital pediatric asphyxial cardiac arrest. ⋯ In this pediatric asphyxial model of prehospital single-rescuer bystander CPR, chest compressions plus simulated mouth-to-mouth ventilation improved systemic oxygenation, coronary perfusion pressures, early return of spontaneous circulation, and 24-hr survival compared with the other three approaches.
-
Critical care medicine · Sep 1999
Results of a collaborative quality improvement program on outcomes and costs in a tertiary critical care unit.
To demonstrate that by using the knowledge and skills of the primary care provider and by applying statistical and scientific principles of quality improvement, outcomes can be improved and costs significantly reduced. ⋯ A focused quality improvement program in the ICU can have a beneficial impact on care and simultaneously reduce costs.
-
Critical care medicine · Sep 1999
Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-alpha and interleukin-6 in patients with sepsis.
To determine correlations and predictive strength of surrogate markers (body temperature, leukocyte count, C-reactive protein [CRP], and procalcitonin [PCT]) with elevated levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in septic patients. ⋯ PCT may be an early and better marker of elevated cytokines than the more classic criteria of inflammation.