Critical care medicine
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Critical care medicine · Jun 2000
Comparative StudySimultaneous comparison of thoracic bioimpedance and arterial pulse waveform-derived cardiac output with thermodilution measurement.
To compare the accuracy and reliability of thoracic electrical bioimpedance (TEB) and the arterial pulse waveform analysis with simultaneous measurement of thermodilution cardiac output (TD-CO) in critically ill patients. ⋯ The arterial pulse waveform analysis exhibits a greater accuracy and reliability as compared with the TEB with regard to overall bias, number of inaccurate readings, and phase lags. The arterial pulse waveform analysis may be useful for the monitoring of hemodynamic changes. However, both methods fail to be a substitute for the TD-CO because of a substantial percentage of inaccurate readings.
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Critical care medicine · Jun 2000
Prospective study of airway management of children requiring endotracheal intubation before admission to a pediatric intensive care unit.
To prospectively identify complications related to airway management in children before pediatric intensive care unit (ICU) admission. ⋯ Emergency airway management in children can be fraught with problems. Most variances could be avoided by improved education regarding appropriate ET tube size, appropriate medication use, and improved training for evaluation of ET tube placement.
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Critical care medicine · Jun 2000
Correlating the severity of paraquat poisoning with specific hemodynamic and oxygen metabolism variables.
To investigate the hemodynamics and oxygen metabolism of patients with varying degrees of severity of paraquat poisoning. ⋯ Paraquat poisoning is characterized by high oxygen consumption with high oxygen extraction, with the degree of derangement based on the severity index. The development of a marked imbalance between increased oxygen demand and decreased oxygen supply because of myocardial depression might be a possible cause of death in circulatory failure.
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Critical care medicine · Jun 2000
Case ReportsPyroglutamic acidemia: a cause of high anion gap metabolic acidosis.
To report four cases of pyroglutamic acidemia in adults causing clinically significant acidosis. ⋯ Pyroglutamic acidemia (5-oxoprolinemia) is a rare cause of high anion gap metabolic acidosis that should be suspected in patients presenting with sepsis, hepatic, and/or renal dysfunction who are receiving drugs such as acetaminophen, flucloxacillin, and vigabatrin after the more common causes of a high anion gap acidosis have been excluded. Should pyroglutamic aciduria be present, known precipitants should be ceased, infection should be managed aggressively, and supportive management should be instituted.
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Critical care medicine · Jun 2000
Comparative Study Clinical TrialEndotracheal versus intravenous epinephrine and atropine in out-of-hospital "primary" and postcountershock asystole.
Pulmonary blood flow during cardiac arrest and cardiopulmonary resuscitation (CPR) is <20% of normal, and transalveolar drug absorption is likely to be minimal. Animal and clinical CPR studies have not addressed the use of endotracheal (ET) epinephrine in doses currently recommended for adults (twice the intravenous dose). The purpose of this study was to compare the effects of ET and intravenous drugs on cardiac rhythm in the prehospital setting. ⋯ We conclude that the currently recommended doses of epinephrine and atropine administered endotracheally are rarely effective in the setting of cardiac arrest and CPR.