Critical care medicine
-
Critical care medicine · Apr 2002
Determination of the noise source in the electrocardiogram during cardiopulmonary resuscitation.
During cardiopulmonary resuscitation (CPR), the electrocardiogram (ECG) is often obscured by noise. This noise is in the form of baseline variations in the ECG, which often necessitate stopping chest compressions to adequately assess the ECG. Because survival from cardiac arrest has been shown to be related to blood flow generated during CPR, and because interruption of chest compressions will reduce blood flow, survival may be compromised by these interruptions. ⋯ The thoracic impedance did vary during CPR, but the variations were temporally uncorrelated to the baseline variations in the ECG, and the variations were of similar magnitude as the variations caused by respiration, which produced no baseline changes in the ECG. Finally, the magnitude of the baseline variations in the ECG was substantially different for electrodes of different sizes and shapes, and electrode motion produced baseline variations that were identical to those produced during CPR. Therefore, it was concluded that the source of the noise in the ECG during CPR is the skin-electrode interface and, specifically, that the noise is related to the electrical properties of the electrode.
-
Critical care medicine · Apr 2002
Unexpected high risk of contamination with staphylococci species attributable to standard preparation of syringes for continuous intravenous drug administration in a simulation model in intensive care units.
To determine the risk of bacterial contamination of the infusate in a simulation model of syringes prepared for continuous intravenous drug administration by intensive care unit nurses. Widely accepted standard procedures in the intensive care unit were compared with syringes prepared by pharmaceutical technicians working under standard aseptic conditions according to national guidelines. ⋯ In the intensive care unit, standard procedures for preparing syringes for intravenous administration of drugs lack vigorous aseptic precautions, leading to a high contamination rate of the infusate. This risk is increased when ampules instead of 50 mL-vials are used to prepare the syringes.
-
Critical care medicine · Apr 2002
Comparative StudySystemic endothelial activation is greater in septic than in traumatic-hemorrhagic shock but does not correlate with endothelial activation in skin biopsies.
Sepsis and severe trauma result in endothelial activation and damage. The activated endothelium expresses adhesion receptors that control leukocyte trafficking. After activation, some adhesion molecules are also released into plasma as soluble forms. The present study was designed to compare the expression of soluble cell adhesion molecules (sCAMs) in three groups of patients: those with septic shock, severe sepsis, and traumatic-hemorrhagic shock. In addition, the endothelial expression of these adhesive molecules was examined in skin biopsies. ⋯ The patterns of sCAMs indicate that the systemic activation of the endothelium is different in the three clinical entities, maximum in septic shock, intermediate in severe sepsis, and not different from controls in traumatic-hemorrhagic shock. Comparable endothelial activation as evidenced by skin biopsies suggests that caution is required in the interpretation of CAMs in plasma, which does not necessarily reflect the in situ activation state of endothelium.
-
Critical care medicine · Apr 2002
Sex-related differences in the presentation and outcome of out-of-hospital cardiopulmonary arrest: a multiyear, prospective, population-based study.
To examine whether previously observed sex-related differences in coronary artery disease syndromes also apply to patients with out-of-hospital sudden cardiac arrest, a probable subset of patients with coronary artery disease who are easy to recognize and are treated in a standardized fashion. ⋯ In cases of out-of-hospital sudden cardiac arrest, women have significantly better resuscitation rates than men, especially when controlling for age, particularly among women with non-ventricular fibrillation/ventricular tachycardia presentations. Additional studies are required to validate these observations, not only for long-term survival and external validity, but also for other potential genetic factors and potential discrepancies with other studies.
-
Critical care medicine · Apr 2002
Case ReportsThree patients who asked that life support be withheld or withdrawn in the surgical intensive care unit.
To illustrate some of the difficulties encountered in the transition from restorative to palliative care and in the pursuit of patient autonomy in the intensive care unit. ⋯ Patients' wishes change and are difficult to know, and even when they are known, physicians may have difficulty honoring them. Nevertheless, patient autonomy should be respected whenever possible in the intensive care unit.