Critical care medicine
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Critical care medicine · Jun 2000
Physiologic effects of early administered mask proportional assist ventilation in patients with chronic obstructive pulmonary disease and acute respiratory failure.
To evaluate the physiologic short-term effects of noninvasive proportional assist ventilation (PAV) in patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). ⋯ Noninvasive PAV is able to improve arterial blood gases while unloading inspiratory muscles in patients with acute exacerbation of COPD.
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Critical care medicine · Jun 2000
Comparative StudyHypomagnesemia and hypophosphatemia at admission in patients with severe head injury.
Low serum levels of electrolytes such as magnesium (Mg), potassium (K), calcium (Ca), and phosphate (P) can lead to a number of clinical problems in intensive care unit (ICU) patients, including hypertension, coronary vasoconstriction, disturbances in heart rhythm, and muscle weakness. Loss of these electrolytes can be caused, among other things, by increased urinary excretion. Cerebral injury can lead to polyuresis through a variety of mechanisms. We hypothesized that patients with cranial trauma might be at risk for electrolyte loss through increased diuresis. The objective of this study was to assess levels of Mg, P, and K at admission in patients with severe head injury. ⋯ We conclude that patients with severe head injury are at high risk for the development of hypomagnesemia, hypophosphatemia, and hypokalemia. One of the causes of low electrolyte levels in these patients may be an increase in the urinary loss of various electrolytes caused by neurologic trauma. Mannitol administration may be a contributing factor. Intensivists should be aware of this potential problem. If necessary, adequate supplementation of Mg, P, K, and Ca should be initiated promptly.
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Critical care medicine · Jun 2000
Albuterol delivery by metered-dose inhaler in a pediatric high-frequency oscillatory ventilation model.
To assess albuterol delivery by metered-dose inhaler (MDI) in a pediatric lung model ventilated by high-frequency oscillatory ventilation (HFOV). The percentage albuterol dose lost in the circuit's expiratory limb and the effects of operating frequency, inspiratory time, and use of a spacer were also determined. ⋯ These in vitro results suggest albuterol delivery by MDI in a pediatric model of HFOV is negligible, regardless of the operating frequency, inspiratory time, or use of a spacer or actuator.
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Intensive care unit (ICU) length of stay (LOS) and hospital LOS are common indices used to compare performance of hospitals and are yardsticks used in efforts to contain costs, yet there is no standardized method of quantitating this outcome variable. Attempts have been made to correct LOS according to disease severity. The aim of this study was to quantify and compare ICU LOS using four commonly used methods and to determine the relationship between severity of illness at admission as determined by the Acute Physiology and Chronic Health Evaluation (APACHE) II and APACHE III scoring systems and LOS. ⋯ We suggest that the LOS-midnight be used to record LOS when a hospital/ICU information system is unable to calculate the exact LOS in hours. Furthermore, because the LOS distribution is highly skewed, the geometric mean and median should be reported. Although APACHE II and APACHE III scores are predictive of group outcomes, they should not be used to predict or adjust for LOS.
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Critical care medicine · Jun 2000
Variability in systemic arterial pressure during closed- and open-bridge extracorporeal life support: an in vitro evaluation.
To compare fluctuations in systemic arterial pressure (SAP) resulting from changes in systemic vascular resistance (SVR) during closed- and open-bridge extracorporeal life support (ECLS). ⋯ Open-bridge ECLS decreases the fluctuations in the SAP that occur because of changes in the SVR. Open-bridge ECLS prevents transient iatrogenic changes in blood flow and blood pressure, caused by flashing of the bridge. Other potential advantages and disadvantages of the open-bridge ECLS are discussed. The application of prolonged open-bridge ECLS to the patients needs to be evaluated in animal models.