Critical care medicine
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Critical care medicine · May 1994
Ventilatory response to high caloric loads in critically ill patients.
To assess the effect of high caloric loads on CO2 metabolism and ventilation. ⋯ Increased CO2 production, exhaled minute ventilation, and deadspace ventilation values in the overfed group and the lack of difference between alveolar ventilation, PaCO2, and measured energy expenditure, along with correlations between CO2 production and alveolar ventilation suggest that carbohydrate loads increase CO2 production which drives alveolar ventilation, thus preventing hypercapnia. When alveolar ventilation does not increase (and PaCO2 increases) or when the spontaneous breathing rate increases to augment alveolar ventilation, the clinical response of increasing mechanical ventilation may increase deadspace ventilation.
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Critical care medicine · Apr 1994
Comparative StudyAlveolar-arterial oxygen gradients before extracorporeal life support for severe pediatric respiratory failure: improved outcome for extracorporeal life support-managed patients?
Recent reports have described the usefulness of the alveolar-arterial oxygen tension difference (P[A-a]O2) in predicting mortality in children with acute respiratory failure managed with mechanical ventilation. We reviewed our experience with extracorporeal life support for acute pediatric respiratory failure and specifically examined P(A-a)O2 measurements during the 24 hrs before extracorporeal life support to determine if defined cutoffs established with conventional mechanical ventilation were applicable to extracorporeal life-support survival. ⋯ Based on previous reports of the utility of P(A-a)O2 measurements to predict mortality, our preliminary evidence suggests that extracorporeal life support results in 62% survival for pediatric respiratory failure patients predicted to have no chance of survival using conventional mechanical ventilation. Prospective, randomized trials of children with severe acute respiratory failure managed with mechanical ventilation vs. extracorporeal life support may be indicated.
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Critical care medicine · Apr 1994
Comparative StudyUse of pulse oximetry to monitor venous saturation during extracorporeal life support.
To assess the ability of two different pulse oximeters to display continuous venous oxygen saturation through an extracorporeal bypass circuit with a degree of accuracy comparable to direct in-line oximetry. ⋯ In addition to its known clinical usefulness, pulse oximetry may serve as an adequate substitute for in-line oximetry during extracorporeal life support.
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Critical care medicine · Apr 1994
Randomized Controlled Trial Comparative Study Clinical TrialEffect of hydroxyethyl starch on the activity of blood coagulation and fibrinolysis in healthy volunteers: comparison with albumin.
The aim of this study was to investigate whether hydroxyethyl starch of medium molecular weight (200 daltons), compared with albumin, has specific effects on blood coagulation and fibrinolysis. ⋯ a) Medium molecular weight hydroxyethyl starch has a specific lowering effect on factor VIII:C concentrations; this phenomenon may be hazardous to patients who need full hemostatic competence and who receive medium molecular weight hydroxyethyl starch (e.g., as a plasma expander). b) Medium molecular weight hydroxyethyl starch does not specifically influence the activity of the fibrinolytic system.