Critical care medicine
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Critical care medicine · Nov 1997
Randomized Controlled Trial Clinical TrialEffect of intravenous lactated Ringer's solution infusion on the circulating lactate concentration: Part 3. Results of a prospective, randomized, double-blind, placebo-controlled trial.
We previously discovered that small amounts of lactated Ringer's solution, which are inadequately cleared from an intravenous catheter, falsely increase the circulating lactate concentration in blood samples collected from that catheter. That finding prompted us to test the hypothesis that intravenous lactated Ringer's solution, infused at a rate used in resuscitation, would increase the circulating lactate concentration. ⋯ The short-term infusion of lactated Ringer's solution in normal adults (hemodynamically stable) does not falsely increase circulating lactate concentrations when 1 L is given over 1 hr. Therefore, clinicians should not disregard increased lactate concentrations in patients receiving a rapid infusion of lactated Ringer's solution.
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Critical care medicine · Nov 1997
Cardiovascular toxicity of human cross-linked hemoglobin in a rabbit endotoxemia model.
To determine the possible adverse effects of human cross-linked hemoglobin in endotoxemia. ⋯ In an animal model of nonlethal endotoxemia, infusion of alpha alpha Hb significantly increases mortality. Our data suggest that mortality may be due to the acute increased cardiopulmonary toxicity of alpha alpha Hb in animals with underlying endotoxemia.
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Critical care medicine · Nov 1997
Comparative Study Clinical TrialNoninvasive assessment of cardiac output in critically ill patients by analysis of the finger blood pressure waveform.
To assess whether the measurement of cardiac output by computer-assisted analysis of the finger blood pressure waveform can substitute for the thermodilution method in critically ill patients. ⋯ Computer-assisted analysis of finger blood pressure waveform to assess cardiac output is not a substitute for the thermodilution method due to a high percentage (23.2%) of inaccurate readings; however, it may be a useful tool for the detection of relative hemodynamic trends in critically ill patients.
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To teach residents to recognize and treat critically ill or injured infants, children, and adolescents in a 1-month, intensivist-designed, second-year resident pediatric intensive care rotation curriculum while maintaining optimal patient care and resident educational satisfaction. ⋯ During a required pediatric ICU resident rotation, balancing the resident's educational and decision-making autonomy needs and the critical care attending physician's desire to provide consistent bedside care of the critically ill child is an ongoing interactive process that requires substantial personnel, time, and financial commitments. It is possible to maintain patient care in the pediatric ICU and provide residents with a satisfying pediatric ICU experience. Trends in financial reimbursement may limit our present time commitment to the resident pediatric ICU curriculum.