Critical care medicine
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Critical care medicine · Nov 2002
Accuracy of displayed values of tidal volume in the pediatric intensive care unit.
To assess the accuracy of the expired tidal volumes (VT(E)) displayed by one of the most frequently used ventilators that measures exhaled volume at the expiratory valve. ⋯ The accuracy of tidal volume values is crucially dependent on the site of measurement. Unless measured at the airway opening, displayed values are an inconsistent and misleading indicator of the true volumes delivered.
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Critical care medicine · Nov 2002
Clinical TrialAmplification of the pulmonary vasodilatory response to inhaled iloprost by subthreshold phosphodiesterase types 3 and 4 inhibition in severe pulmonary hypertension.
Aerosolized iloprost causes specific pulmonary vasodilation for about 60 mins in patients with severe primary and secondary pulmonary hypertension. Repeated daily inhalations are currently in use for chronic treatment. The aim of the current study was to evaluate if phosphodiesterase type 3 and 4 inhibition might amplify the prostanoid effect on pulmonary vasodilatation by stabilization of intracellular second messenger cyclic adenosine monophosphate. ⋯ These data support the principle that subthreshold selective phosphodiesterase types 3 and 4 inhibition amplifies the lung vasodilatory response to inhaled iloprost, with minute doses being sufficient via the inhalative route.
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Critical care medicine · Nov 2002
Hyperglycemia exacerbates muscle protein catabolism in burn-injured patients.
The purpose of this study was to assess if hyperglycemia influences energy expenditure or the extent of muscle protein catabolism in severely burned adults. ⋯ These findings demonstrate an association between hyperglycemia and an increased rate of muscle protein catabolism in severely burned patients. This suggests a possible link between resistance of muscle to the action of insulin for both glucose clearance and muscle protein catabolism.
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Critical care medicine · Nov 2002
Comparative StudyPulse oximetry during low perfusion caused by emerging pneumonia and sepsis in rabbits.
This study tested the effects of low perfusion caused by emerging sepsis on the reliability of a new pulse oximetry technology (Masimo SET; IVY 405T) compared with a standard pulse oximeter (Nellcor N-200). ⋯ The pulse oximeter equipped with Masimo SET was less prone to signal loss than the standard pulse oximeter in this sepsis model. Episodes of falsely low Spo2 readings may occur, and deviation of Spo2 from Sao2 may be increased with deteriorating hemodynamics with both devices.
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The origins of trauma systems in the United States date to the 1960s when physicians returning from wars abroad realized that lessons learned from managing military casualties could be applied to civilian traumatic injury. Over the next several decades, trauma centers and then trauma systems began to be developed in an attempt to improve prehospital and acute care for these patients. Although studies of trauma system effectiveness are fraught with methodologic difficulties, several types of studies (panel reviews of preventable deaths, registry studies, and population-based studies), suggest that there may be improvements in mortality when trauma systems are established. ⋯ Pediatric trauma systems have by necessity developed within the "adult" systems in place. The history of pediatric system development and studies assessing outcomes are also discussed. Continued system development, assessment, and educational efforts about how childhood injuries are different are essential to combat this leading killer of children.