Critical care medicine
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Critical care medicine · Dec 2000
Physician utilization of a portable computed tomography scanner in the intensive care unit.
To determine the utilization of a portable computed tomography (CT) scanner for critically ill adult patients in an intensive care unit (ICU). ⋯ Access to a portable CT scanner impacts the physician ordering patterns for ICU patients. We found that 100% of surveyed physicians used the portable CT scanner for critically ill patients when the patient was unstable. If the diagnostic study was deemed medically necessary, and the portable scanner was unavailable, most surveyed physicians ordered a "fixed" helical scan and the patient was transported by an experienced transport team for the study. The portable CT offered an alternative and potentially safer means of obtaining diagnostic studies.
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Critical care medicine · Dec 2000
Monitoring of recruitment and derecruitment by electrical impedance tomography in a model of acute lung injury.
To evaluate a noninvasive system for obtaining information about alveolar recruitment and derecruitment in a model of acute lung injury. ⋯ Electrical impedance tomography is a technique that can show impedance changes resembling recruitment and derecruitment of alveoli in the anterior and posterior parts of the lung. Therefore, electrical impedance tomography may help in determining the optimal mechanical ventilation in a patient with acute lung injury.
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Critical care medicine · Dec 2000
Effects of dopamine on posttraumatic cerebral blood flow, brain edema, and cerebrospinal fluid glutamate and hypoxanthine concentrations.
Dopamine is often used in the treatment of traumatic brain injury to maintain cerebral perfusion pressure. However, it remains unclear whether dopamine contributes to secondary brain injury caused by vasoconstriction and resulting diminished cerebral perfusion. The present study investigated the effects of dopamine in different concentrations on posttraumatic cortical cerebral blood flow (CBF), brain edema formation, and cerebrospinal fluid concentrations of glutamate and hypoxanthine. ⋯ Under the present study design, there was no evidence for a dopamine-mediated vasoconstriction, because posttraumatic cortical CBF was increased by dopamine-induced elevation of MABP. However, the increase in CBF did not significantly affect edema formation or cerebrospinal fluid glutamate and hypoxanthine levels.
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Critical care medicine · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialEnteral feeding with a solution enriched with antioxidant vitamins A, C, and E enhances the resistance to oxidative stress.
To assess whether dietary supplementation with the antioxidant vitamins A, C, and E enhances parameters of oxidative stress and influences the course of critically ill patients. ⋯ Supplemental antioxidant vitamins added to enteral feeding solutions are well absorbed. Dietary supplementation with vitamins A, C, and E is associated with an improvement in antioxidant defenses, as assessed by ex vivo tests.
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Critical care medicine · Dec 2000
Randomized Controlled Trial Clinical TrialN-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: results of a prospective, randomized, double-blind study.
In septic shock, decreased splanchnic blood flow is reported, despite adequate systemic hemodynamics. Aacetylcysteine (NAC) was found to increase hepatosplanchnic blood flow in experimental settings. In septic shock patients, NAC improved the clearance of indocyanine green and the relationship of systemic oxygen consumption to oxygen demand. We investigated the influence of NAC on liver blood flow, hepatosplanchnic oxygen transport-related variables, and liver function during early septic shock. ⋯ After NAC treatment, hepatosplanchnic flow and function improved and may, therefore, suggest enhanced nutritive blood flow. The increase of liver blood flow index was not caused by redistribution to the hepatosplanchnic area, but by an increase of cardiac index. Because of its correlation with liver blood flow index, MEGX may be helpful in identifying patients who benefit from NAC treatment in early septic shock.