Critical care medicine
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Critical care medicine · Mar 1993
The Acute Physiology and Chronic Health Evaluation II classification system is a valid marker for physiologic stress in the critically ill patient.
To compare the Acute Physiology and Chronic Health Evaluation (APACHE II) score with resting energy expenditure obtained from indirect calorimetry to determine whether the APACHE II scoring system is an accurate, objective measure of the degree of critical illness and physiologic stress between groups of patients. ⋯ The APACHE II classification may be a valid marker of physiologic stress as demonstrated by its statistically significant (although weak) relationship with indirect calorimetric measures of energy expenditure associated with varying degrees of critical illness.
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Critical care medicine · Mar 1993
Near drowning: is emergency department cardiopulmonary resuscitation or intensive care unit cerebral resuscitation indicated?
a) To report the neurologic outcome of a series of near-drowning victims treated with supportive management without aggressive cerebral resuscitation; and b) to identify patient characteristics that indicate prognosis and guide therapy at the scene, the Emergency Department, and in the intensive care unit (ICU). ⋯ Our results cast further doubt on the utility of aggressive forms of cerebral monitoring and resuscitation and emphasize the need for initial full resuscitation in the Emergency Department.
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Critical care medicine · Mar 1993
Volume recruitment maneuvers are less deleterious than persistent low lung volumes in the atelectasis-prone rabbit lung during high-frequency oscillation.
To test whether the pulmonary risk of repeated volume recruitment is greater or less than the risk associated with unreversed atelectasis during 6 hrs of high-frequency oscillatory ventilation in the atelectasis-prone rabbit lung. ⋯ These data demonstrate that the potential pulmonary risk of repeated lung stretch during volume recruitment is significantly less than the damage arising from the avoidance of such maneuvers in lungs in which alveolar recruitment is possible. We conclude that sustained inflations during high-frequency oscillatory ventilation produce the benefits of increased oxygenation for a given mean airway pressure plus decreased progression of lung injury.
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Critical care medicine · Mar 1993
Effects of norepinephrine and dobutamine on oxygen transport and consumption in a dog model of endotoxic shock.
Severe septic shock is associated with an imbalance between oxygen demand and oxygen supply (DO2) in the presence of an impaired oxygen extraction. Vasopressors are often used to restore a minimal perfusion pressure and inotropic agents are often used to increase myocardial contractility. However, optimal adrenergic support remains controversial. The present study investigated the effects of norepinephrine and dobutamine on DO2, oxygen consumption (VO2), and oxygen extraction in a dog model of endotoxic shock. ⋯ In this endotoxic shock model, both norepinephrine and dobutamine can increase DO2 and VO2 but dobutamine caused a more consistent increase in these parameters. The decrease in oxygen extraction was relatively similar with dobutamine and norepinephrine. The present study does not support a significant beneficial effect of norepinephrine on the tissue extraction capabilities in endotoxic shock.
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Critical care medicine · Mar 1993
Randomized Controlled Trial Clinical TrialImproved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure.
To determine whether continuous modes of renal replacement therapy result in improved cardiovascular stability compared with standard daily intermittent treatment in critically ill patients. ⋯ In critically ill patients, in whom DO2 is impaired, the use of continuous forms of renal replacement therapy is preferred for its improved cardiovascular tolerance compared with daily intermittent machine treatments.