Critical care medicine
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Critical care medicine · Jan 1993
Relationship between supranormal circulatory values, time delays, and outcome in severely traumatized patients.
To describe the temporal patterns of hemodynamics and oxygen transport in survivors and nonsurvivors of severe trauma in relation to time delays, mortality, and morbidity. ⋯ Reaching supranormal circulatory values, especially within 24 hrs of injury, may improve survival and reduce the frequency of shock-related organ failure in severely traumatized patients.
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Critical care medicine · Jan 1993
Comparative StudyImpaired beta-adrenergic receptor stimulation of cyclic adenosine monophosphate in human septic shock: association with myocardial hyporesponsiveness to catecholamines.
To determine whether myocardial hyporesponsiveness to administered catecholamines occurs in human sepsis and whether this phenomenon is associated with impaired beta-adrenergic receptor stimulation of cyclic adenosine monophosphate. ⋯ In patients with septic shock, impaired beta-adrenergic receptor stimulation of cyclic adenosine monophosphate is associated with myocardial hyporesponsiveness to catecholamines, suggesting that beta-adrenergic receptor dysfunction may contribute to the reduced myocardial performance observed in this shock state.
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To determine what data are currently being collected at the critical care bedside, the role of flow sheets in storing these data, and what other forms and locations are used to store critical care data. ⋯ The lack of standardization regarding key information that should be collected and archived in critical care units identifies important risk management and quality assurance issues. There is a need for agreement on what information should be collected and maintained at the bedside in order to provide quality patient care.
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Critical care medicine · Jan 1993
Randomized Controlled Trial Multicenter Study Comparative Study Clinical TrialContinuous intravenous cimetidine decreases stress-related upper gastrointestinal hemorrhage without promoting pneumonia.
To determine whether a continuous i.v. infusion of cimetidine, a histamine-2 (H2) receptor antagonist, is needed to prevent upper gastrointestinal (GI) hemorrhage when compared with placebo and if that usage is associated with an increased risk of nosocomial pneumonia. Due to the importance of this latter issue, data were collected to examine the occurrence rate of nosocomial pneumonia under the conditions of this study. ⋯ The continuous i.v. infusion of cimetidine was highly effective in controlling intragastric pH and in preventing stress-related upper GI hemorrhage in critically ill patients without increasing their risk of developing nosocomial pneumonia. While the number of risk factors and intragastric pH may have pathogenic importance in the development of upper GI hemorrhage, neither the risk factors nor the intragastric pH was predictive. Therefore, short-term administration of continuously infused cimetidine offers benefits in patients who have sustained major surgery, trauma, burns, hypotension, sepsis, or single organ failure.
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Critical care medicine · Jan 1993
Relationship between oxygen consumption and oxygen delivery during anesthesia in high-risk surgical patients.
To identify critical oxygen delivery (DO2) and oxygen extraction ratio in high-risk surgical patients studied preoperatively and intraoperatively. ⋯ Our data show that the intraoperative period might be associated with a reduction in tissue ability to extract oxygen. If this reduction in oxygen extraction is proportionately higher than the reduction in metabolic oxygen demand produced by anesthetic agents and hypothermia, then the critical value for DO2 may be similar to, or higher than, that value in the preoperative period. Thus, the intraoperative period represents, for this patient population, a high-risk condition for the development of a tissue oxygenation debt in the presence of a limitation in DO2. Cautious dosing of inhaled agents, maintenance of normothermia, and early optimization of the oxygen delivery/oxygen consumption relationship seem to constitute reasonable measures in the intraoperative handling of these patients in order to reduce perioperative morbidity and mortality.