Critical care medicine
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Critical care medicine · Jun 1993
Randomized Controlled Trial Clinical TrialEffect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study.
To determine the effects of optimizing oxygen delivery (DO2) to "supranormal" levels on morbidity and mortality in patients with sepsis, septic shock, and adult respiratory distress syndrome. ⋯ Although there was no statistically significant difference in the control vs. treatment groups, subgroup analysis demonstrated a strong, significant difference between patients with supranormal values of oxygen transport vs. patients with normal levels of DO2. Supranormal values of DO2I, whether self-generated or as a result of treatment, resulted in a statistically significant decrease in mortality rate. This study adds to the weight of evidence that current standard of care of treating critically ill patients to normal DO2I should be reconsidered, and that maximizing to high DO2I might be a more appropriate therapeutic end-point.
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Critical care medicine · Jun 1993
Multicenter StudyIntraocular pressure during mechanical ventilation with different levels of positive end-expiratory pressure.
To determine the effect of positive end-expiratory pressure (PEEP) on intraocular pressure. ⋯ Short-term therapy with PEEP of < or = 15 cm H2O does not present a clinically important significant risk for intraocular pressure increase in a population with normal basal ocular tonometry. During prolonged mechanical ventilation with PEEP, increments in intraocular pressure may occur, but these increments appear to not be of a clinically relevant magnitude.
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Critical care medicine · Jun 1993
Comparative StudySimultaneous radial, femoral, and aortic arterial pressures during human cardiopulmonary resuscitation.
To examine the validity of interchanging arterial sites and their responses to graded doses of epinephrine during human cardiopulmonary resuscitation (CPR). ⋯ Radial artery relaxation-phase pressure, although statistically higher, correlated with aortic relaxation-phase pressure. Femoral artery relaxation-phase pressure was not statistically different from aortic relaxation-phase pressure. Aortic pressure was statistically higher and had a lower correlation with radial artery pressures during compression phase. The aortic to radial artery and aortic to femoral artery compression-phase gradients abated with increasing doses of epinephrine therapy. Caution must be used when substituting compression-phase pressure obtained at radial or femoral artery sites for aortic pressure during human CPR. Coronary artery perfusion pressures obtained with radial and femoral arteries correlate with aortic pressure when measuring the response to vasopressor therapy during CPR when an interpretable waveform exists.
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Critical care medicine · Jun 1993
Weight changes in critically ill patients evaluated by fluid balances and impedance measurements.
To study simple, rapid, and predictive methods to determine body weight changes in critically ill patients. ⋯ Calculated fluid balances are not predictive for actual weight changes in critically ill patients. Absolute weight measurements are indispensable. Changes in resistance correlated with weight changes in individual patients if weight changes were > 3 kg.