Critical care medicine
-
Critical care medicine · Apr 1994
Comparative StudyUse of arterial blood with bedside glucose reflectance meters in an intensive care unit: are they accurate?
To compare blood glucose values obtained from two different sampling sites (arterial catheter and capillary from finger puncture), which were analyzed by a bedside reflectance meter. A sample was also analyzed by standard methods (oxygen electrode oxidation in the laboratory). ⋯ Since arterial whole blood samples give higher glucose results than arterial serum, the use of arterial whole blood in combination with reflectance meters must be recommended with caution. This caution is especially advised if the glucose values obtained with arterial whole blood are used in conjunction with a sliding scale of insulin, which depends on threshold concentrations of glucose. In our hospital, use of arterial whole blood in combination with reflectance meters could have resulted in an incorrect dose of insulin in 31 of 50 patients.
-
Critical care medicine · Apr 1994
Improvised automatic lung ventilation for unanticipated emergencies.
To design an improvised circuit that can be used to extend the capability of a single ventilator to ventilate two or more patients and that can be assembled from readily available parts in times of unanticipated emergency. ⋯ These two improvised circuits can extend the capability of a standard volume-cycled ventilator to provide automatic ventilation of the lungs in times of disaster.
-
Critical care medicine · Apr 1994
Hemodynamic responses to shock in young trauma patients: need for invasive monitoring.
To determine whether early invasive monitoring is necessary in young trauma patients. ⋯ Our data demonstrate that young trauma patients have substantial but clinically occult myocardial depression after shock, and most of these patients require inotropes to optimize and clear circulating lactate. Early invasive monitoring is necessary to precisely define the adequacy of the cardiac response and to individually tailor therapy. Patients who do not optimize and clear their lactate within 24 hrs may not survive.
-
Critical care medicine · Mar 1994
Magnetic resonance imaging of the heart during positive end-expiratory pressure ventilation in normal subjects.
Magnetic resonance imaging was used to assess the effects of ventilation with positive end-expiratory pressure (PEEP) on cardiac volumes, especially on atrial volumes as well as to determine semiquantitative measurements of spatial interactions between heart, lungs and chest. ⋯ Left and right ventricular end-diastolic volumes and stroke volumes decreased significantly during ventilation with PEEP at 15 cm H2O, as did end-systolic atrial volumes. Volume changes in association with changes of chest and heart configuration suggest external cardiac compression by the expanding lungs. Furthermore, this study illustrates the feasibility of magnetic resonance imaging in mechanically ventilated patients.