Critical care medicine
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Critical care medicine · Aug 1994
Brain death in pediatric intensive care unit patients: incidence, primary diagnosis, and the clinical occurrence of Turner's triad.
To determine the incidence and characteristics of children with brain death in the pediatric intensive care unit (ICU), and to assess the incidence of the clinical triad (Turner's triad) of central diabetes insipidus, low glucose demand, and low CO2 production. ⋯ Our series of brain-dead patients in the pediatric ICU showed a 0.9% incidence of brain death. The most common primary diagnosis was trauma, a finding that is similar to other series. We also demonstrated that the clinical triad (Turner's triad) is present in this patient population, although only 12% of study patients demonstrated all three features.
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Critical care medicine · Aug 1994
Impaired cerebral autoregulation in the newborn lamb during recovery from severe, prolonged hypoxia, combined with carotid artery and jugular vein ligation.
To study the effect of severe prolonged hypoxia combined with ligation of the carotid artery and jugular vein (simulating pre-extracorporeal membrane oxygenation [ECMO] events) on cerebral autoregulation in the newborn lamb. ⋯ These findings indicate that cerebral autoregulation is disrupted during the recovery phase from an insult caused by prolonged, severe hypoxia with carotid artery and jugular vein ligation. This insult results in significant differences in right and left hemispheric cerebral blood flow rates when cerebral autoregulation is lost. If these results can be extrapolated to the human state, they may help to explain the role of pre-ECMO hypoxia combined with vessel ligation as a risk factor in cerebral injury in ECMO patients.
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Critical care medicine · Jul 1994
Comparative StudyEffects of trauma, duration of hypotension, and resuscitation regimen on cellular immunity after hemorrhagic shock.
To determine the effects of: a) surgical trauma, b) crystalloid resuscitation, and c) different durations of hypotension on cellular immunity after hemorrhagic shock. ⋯ Cellular immunity was depressed at 2 hrs after simple hemorrhage and no further depression occurred if hemorrhage was coupled with trauma, pure crystalloid resuscitation was provided, or the shock period was prolonged. Thus, the early immunodepression after hemorrhage was mainly dependent on the severity rather than the duration of shock, resuscitation regimen, or tissue trauma.
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Critical care medicine · Jul 1994
Plasma cytokine determinations in emergency department patients as a predictor of bacteremia and infectious disease severity.
To determine the predictive value of plasma interleukin (IL)-6 and tumor necrosis factor-alpha (TNF) measurements in assessing bacteremia and subsequent morbidity and mortality rates in emergency department patients. ⋯ Measurement of plasma IL-6 concentrations in a population of emergency department patients with apparent bacterial infections predicted bacteremia and death from infection. The characteristics of the test indicated a potential use in selecting patients for the administration of novel therapies for sepsis.
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Critical care medicine · Jul 1994
Comparative StudyWomen are at greater risk than men for malpositioning of the endotracheal tube after emergent intubation.
To investigate the occurrence of endotracheal tube malpositioning after emergent intubation in critically ill adults and to determine the need for a routine postintubation chest radiography to assess endotracheal tube position. ⋯ Emergent endotracheal intubations result in a significant occurrence of malpositioned endotracheal tubes that are undetected by clinical evaluation. Malpositioning is not detected by routine clinical assessment, but only by chest radiograph. Women are at greater risk than men for endotracheal tube malpositioning after emergent intubation; in women, the endotracheal tube is more likely to be positioned too close to the carina. A chest radiograph for confirmation of endotracheal tube position after emergent intubation should remain the standard of practice.