Critical care medicine
-
Critical care medicine · Jan 1995
Randomized Controlled Trial Multicenter Study Clinical TrialFacilitation of internal jugular venous cannulation using an audio-guided Doppler ultrasound vascular access device: results from a prospective, dual-center, randomized, crossover clinical study.
To determine the utility of an audio-guided Doppler ultrasound device in improving success and decreasing complications in cannulation of the internal jugular vein in high-risk patients. ⋯ The use of an audio-guided Doppler ultrasound vascular access device was associated with increased success of cannulation and a decreased frequency of significant complications in a population of high-risk patients with obesity or coagulopathy.
-
Critical care medicine · Jan 1995
Randomized Controlled Trial Clinical TrialFemoral deep vein thrombosis associated with central venous catheterization: results from a prospective, randomized trial.
To determine the frequency of central venous catheter-induced deep vein thrombosis of the femoral vein. ⋯ Based on the data from this study, we concluded that femoral vein catheterization is associated with a 25% frequency of lower extremity deep vein thrombosis compared with similar patients receiving subclavian or internal jugular vein catheters. The femoral vein remains an important emergency venous access route. Physicians inserting femoral vein catheters should be aware of the risk of lower extremity deep vein thrombosis and should consider performing lower extremity duplex ultrasound examinations on removal of femoral vein catheters.
-
Critical care medicine · Jan 1995
Prediction of outcome in intensive care patients using endocrine parameters.
To determine the ability of various endocrine parameters, measured at the time of intensive care unit (ICU) admission, to predict patient outcome. ⋯ An endocrine prognostic index based on ICU admission measurements of thyroxine, thyrotropin, and cortisol concentrations is a superior discriminator of patient outcome than the APACHE II score.
-
Perfluorocarbon liquid ventilation has been shown to have advantages over conventional gas ventilation in premature newborn and lung-injured animals. To simplify the process of liquid ventilation, we adapted an extra-corporeal life-support circuit as a time-cycled, volume-limited liquid ventilator. ⋯ Liquid ventilation can be performed successfully utilizing this simple adaptation of an extracorporeal life-support circuit. This modification to an existing extracorporeal circuit may allow other centers to apply this new investigational method of ventilation in the laboratory or clinical setting.
-
Critical care medicine · Jan 1995
Calcium and phospholipase A2 appear to be involved in the pathogenesis of hemorrhagic shock-induced mucosal injury and bacterial translocation.
The mechanism by which hemorrhagic shock injures the gut and leads to the translocation of bacteria remains incompletely determined. Since increased free cellular calcium levels and phospholipase A2 activity can lead to cellular injury and both have been documented in certain shock states, the hypothesis that calcium or phospholipase A2 may play a role in hemorrhagic shock-induced gut mucosal injury and bacterial translocation was tested. ⋯ The observation that quinacrine and preshock diltiazem limited the extent of shock-induced mucosal injury and bacterial translocation indicate that calcium and phospholipase A2 are involved in the pathogenesis of shock-induced mucosal injury and bacterial translocation. The fact that preshock but not postshock diltiazem was protective indicates that the process leading to shock-induced calcium-mediated tissue injury and bacterial translocation was initiated during the ischemic rather than the reperfusion period. However, since neither quinacrine nor diltiazem was fully protective, other factors, such as oxidants, are also likely to be involved in the pathogenesis of shock-induced mucosal injury and bacterial translocation.