Critical care medicine
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Critical care medicine · Jul 1992
Hemodynamic and metabolic effects of epinephrine during cardiopulmonary resuscitation in a pig model.
This study was designed to assess the effect of epinephrine during cardiopulmonary resuscitation (CPR) on left ventricular myocardial blood flow, systemic oxygen delivery and consumption, and on plasma glucose and lactate concentrations. Fourteen pigs were allocated to receive either 0.9% saline (n = 7), or 45 micrograms/kg epinephrine (n = 7) after 5 mins of ventricular fibrillation, and 3 mins of open-chest CPR. Left ventricular myocardial blood flow was measured with radiolabeled microspheres. Plasma catecholamine concentrations were measured by high-pressure liquid chromatography. ⋯ At a dose of 45 micrograms/kg, epinephrine caused an increase in left ventricular myocardial blood flow after a total of 8 mins of cardiac arrest, including 3 mins of CPR, while not altering systemic oxygen delivery and consumption, plasma glucose, or lactate concentrations.
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Critical care medicine · Jul 1992
Editorial Biography Historical ArticleGiants of critical care: a tribute to Max Harry Weil, MD, PhD.
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To identify patient variables that were significantly associated with outcome in the ICU. ⋯ For patients who remain in the ICU for greater than 72 hrs, events occurring after ICU admission are negatively associated with ICU outcome, more so than ICU admission status as reflected by such indices as APACHE II scores. Iatrogenic complications, often due to inappropriate drug therapy, have a significant association with adverse outcome by multivariate analysis. We suggest that iatrogenic complications influence ICU outcome, and that they are potentially preventable. By lessening their frequency, ICU outcome may be improved.
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To discuss the relative merits and limitations of living wills and the durable power of attorney for health care. ⋯ We recommend the execution of both a living will and a durable power of attorney for health care to provide the best assurance that patients' desires concerning medical treatments will be respected.
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Critical care medicine · Jul 1992
Nonphysician transport of intubated pediatric patients: a system evaluation.
To evaluate the occurrence of complications and patient deteriorations during the air and ground transportation of intubated pediatric patients, performed by a nonphysician-based team under the direction of an intensive care attending physician or fellow. ⋯ Under proper medical guidance, well-trained nonphysician personnel can provide low-risk transport of intubated pediatric patients. Use of sedatives and paralytic drugs did not increase the risk of complications or patient deterioration.