Critical care medicine
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Critical care medicine · Dec 1994
Comparative StudyReversal of vagal tone in conjunction with high-dose epinephrine in a canine asphyxial pulseless electrical activity model.
To investigate the effects of surgical vagotomy in conjunction with high-dose epinephrine (0.2 mg/kg) on return of spontaneous circulation rates in a canine model of asphyxial pulseless electrical activity. ⋯ In conjunction with high-dose epinephrine, vagotomy did not improve the return of spontaneous circulation rate in this pulseless electrical activity arrest model. Additionally, the hemodynamic effects of high-dose epinephrine overshadowed the effects of vagotomy.
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Critical care medicine · Dec 1994
Comparative StudyNeurologic outcome and heart resuscitability with closed-chest cardiopulmonary bypass after prolonged cardiac arrest times in rabbits.
To observe the influence of prolonged cardiac arrest times on neurologic outcome and heart resuscitability, using a resuscitation model with cardiopulmonary bypass in the rabbit, and to determine whether the changes in the plasma concentrations of lactate and lipoperoxide correlate with the severity of global brain ischemia. ⋯ Cardiopulmonary bypass can be used to establish a resuscitation model in rabbits. Neurologic outcome worsens progressively in proportion to the prolonged cardiac times, especially when it exceeds 10 mins. Cardiac resuscitability is still possible, even when arrest time exceeds 15 mins. Changes in plasma concentrations of lactate and lipoperoxide do not correlate with the neurologic outcome and heart resuscitability following cardiac arrest.
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Critical care medicine · Dec 1994
Comparative StudyFederal and nationwide intensive care units and healthcare costs: 1986-1992.
To establish Department of Veterans Affairs' intensive care unit (ICU) costs from a database and to use this information to validate the Russell equation, the most commonly used method of calculating ICU costs. To compare and trend Department of Veterans Affairs' and nationwide (USA) ICU and healthcare costs. ⋯ The Department of Veterans Affairs has the only national ICU line item cost database available. For the Russell equation calculation to be accurate, inpatient only costs should be used. Until customized Health Care Financing Administration analyses become available, nationwide ICU costs are best determined by the Russell equation. Department of Veterans Affairs' ICUs have a consistent cost advantage over nationwide ICUs. Increases in United States healthcare delivery costs continue to exceed the increase in gross domestic product. Cost containment is already occurring in critical care.
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Critical care medicine · Dec 1994
Variability in dobutamine pharmacokinetics in unstable critically ill surgical patients.
To delineate the variability in the pharmacokinetics of dobutamine over time in an unstable critically ill adult surgical patient population concurrently receiving therapeutic interventions to optimize oxygen delivery and consumption variables. ⋯ Dobutamine pharmacokinetics in adult critically ill patients is best described by a first-order model. Pathophysiologic factors may have an effect on the pharmacokinetics of dobutamine which appears to change over time. Both inter- and intrapatient variability in infusion rate administered and resultant serum concentrations were wide, suggesting that infusion rate should be guided by clinical end points rather than by predetermined values.
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Critical care medicine · Dec 1994
Comparative Study Retracted PublicationIs continuous cardiac output measurement using thermodilution reliable in the critically ill patient?
Evaluation of continuous cardiac output monitoring based on the thermodilution technique in the critically ill. ⋯ Continuous monitoring of cardiac output using a modified pulmonary artery catheter with a heated filament has proven to be accurate and precise in the critically ill patient when compared with the "standard" intermittent bolus thermodilution technique. The continuous monitoring technique enhances our armamentarium for more intensive monitoring of these patients under a variety of circumstances.