Critical care medicine
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Critical care medicine · May 1992
Dobutamine pharmacokinetics and pharmacodynamics in pediatric intensive care patients.
To evaluate the pharmacokinetics and pharmacodynamics of dobutamine in critically ill children. ⋯ There was no effect of plasma dobutamine concentration or infusion rate on plasma clearance rate. For this group of patients, over the range of the intravenous doses studied, dobutamine pharmacokinetics followed a first-order kinetic model. Threshold values for dobutamine usually show increases in cardiac output before changes in heart rate. These data demonstrate that dobutamine is an effective inotropic agent in critically ill pediatric patients and has minimal chronotropic action.
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Critical care medicine · May 1992
Plasma catecholamine concentrations after successful resuscitation in patients.
To measure plasma catecholamine concentrations after cardiopulmonary resuscitation (CPR) and to correlate catecholamine concentrations with heart rate (HR), BP, and plasma glucose and lactate concentrations. ⋯ After CPR, plasma catecholamine concentrations remained at high values but they did not lead to increases in BP, HR, or circulating glucose concentrations.
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Critical care medicine · May 1992
Use of brainstem auditory-evoked response testing to assess neurologic outcome following near drowning in children.
To determine a correlation between serial brainstem auditory-evoked response measurements and ultimate neurologic outcome in pediatric patients who suffered a cardiac arrest resulting from a submersion accident. ⋯ Brainstem auditory-evoked response testing is useful as an aid in the assessment of neurologic outcome following submersion-induced cardiac arrest. However, standardization of brainstem auditory-evoked response testing and production of normative data are required before this modality can be more widely studied and applied.
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Critical care medicine · May 1992
Validation of bedside measurements of absolute human renal blood flow by a continuous thermodilution technique.
There is a clinical need for a system that would allow rapid assessment of renal blood flow in patients with oliguric circulatory shock. A local, continuous thermodilution technique for the measurement of renal venous blood flow, using readily available equipment, was developed. To test the hypothesis that this system would allow measurement of renal blood flow in clinical situations, we compared simultaneous measurements made by the continuous thermodilution technique with measurements of: a) absolute flow measured by volumetric collection in an in vitro flow model; b) renal arterial blood flow measured by electromagnetic flow probe under changing hemodynamic conditions in nine pigs; and c) calculated renal blood flow derived from a clearance technique in 16 patients after cardiac catheterization. The technique utilizes a short-duration, constant infusion of room temperature normal saline into the renal vein via a retrograde thermodilution catheter, with measurement of flow at a thermistor 1 cm back from the tip of the catheter. ⋯ This technique is simple to use, requires only venous cannulation and injection of normal saline, and allows rapidly repeatable, immediately available measurements of renal blood flow in a wide range of clinical circumstances, including severe renal impairment or anuria.
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Critical care medicine · May 1992
Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment.
Medical decisions concerning the prolongation of life, the right to die, and euthanasia are among the most extensively discussed decisions within medicine and law today. The responses of 360 physicians, housestaff, and medical students to a questionnaire were analyzed to identify attitudes toward these issues. ⋯ Socially and legally created "shades of gray" have blurred the distinctions between withholding or withdrawing therapies and euthanasia and have left physicians without guidelines. Health ethics education should focus on case-based teaching and on reducing the uncertainty at the bedside.