Critical care medicine
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Critical care medicine · Oct 1996
Comparative StudyA comparison of venovenous and venoarterial extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure.
To compare the efficacy of venovenous to venoarterial bypass in an unselected cohort of infants with refractory cardiorespiratory failure. ⋯ We conclude that venovenous ECMO using a double-lumen venovenous catheter can provide results comparable with venoarterial bypass without the need for carotid artery ligation in an unselected population of neonatal ECMO candidates. In our experience, reported contraindications to venovenous ECMO did not prove to be valid.
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Critical care medicine · Oct 1996
How to keep up with the critical care literature and avoid being buried alive.
To provide practical suggestions for accessing, utilizing, and storing the rapidly expanding literature on critical care. ⋯ Efficient access, appraisal, and application of the literature on intensive care are basic skills for intensivists, who have adopted a variety of resourceful and pragmatic methods for "keeping up."
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Critical care medicine · Oct 1996
Decreasing catheter-related infection and hospital costs by continuous quality improvement.
a) To reduce the rate of catheter-related infection, using improved skin preparation and catheters impregnated with silver sulfadiazine and chlorhexidine; b) to decrease the number of unnecessary guidewire exchanges of existing catheters by substituting suspected catheter-related sepsis for fever alone as an indication to change an indwelling catheter; and c) to decrease the hospital costs associated with guidewire exchanges and new catheter insertions. ⋯ Catheters impregnated with silver sulfadiazine and chlorhexidine had a smaller proportion of catheter-related infection compared with unprotected catheters. Fever alone as an indication for guidewire exchange resu
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Critical care medicine · Oct 1996
Dopaminergic receptor-mediated effects in the mesenteric vasculature and renal vasculature of the chronically instrumented newborn piglet.
To determine the effects of stimulation of vascular dopaminergic receptor subtype 1 (dopamine-1) receptors in the renal and mesenteric vascular beds of a neonatal model. ⋯ These data demonstrate the absence of dopaminergic receptor-mediated vasodilation in the porcine neonatal renal vascular bed. In the mesenteric artery, dopamine-1 receptor-mediated vasodilation may be obtained. Dopamine itself, probably because of stimulation of other receptors, causes renal artery vasoconstriction and does not increase superior mesenteric artery blood flow.
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Critical care medicine · Oct 1996
Severe head injury in the United Kingdom and Ireland: a survey of practice and implications for management.
To study the current intensive care management of patients with severe head injury (defined as a Glasgow Coma Scale score of < or = 8) in neurosurgical referral centers in the United Kingdom (UK) and ireland. ⋯ We conclude that there are wide variations in the management of the severely head-injured patient in the UK and Ireland. Some of the therapies employed are not supported by available research findings. Rationalization (using rational management, i.e., based on good evidence) of the intensive care management of severe head injury with the development of widely accepted guidelines may result in an improvement in the quality of care of the head-injured patient.