Critical care medicine
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Critical care medicine · Feb 1990
Practical use of immunosuppressive drugs in autoimmune rheumatic diseases.
Immunosuppressive drugs are frequently used in the treatment of autoimmune rheumatic diseases when more conventional therapy, including corticosteroids, fail to control the manifestations of disease. The practical use of these drugs in rheumatoid arthritis, systemic lupus erythematosus, and vasculitis (including Wegener's granulomatosis and Sjögren's syndrome) are reviewed. The focus is on the indications for the administration of these agents and proper monitoring of their effect on disease activity.
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Critical care medicine · Feb 1990
Left and right ventricular output in newborn infants undergoing extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) has gained a place as an alternative mode of treatment for newborn infants with life-threatening respiratory failure who do not respond to maximal conventional ventilatory support. To determine any possible changes in cardiac performance during the course of ECMO treatment, we evaluated left and right ventricular output in 10 newborn infants with pulsed Doppler ultrasound before, during, and after ECMO. ⋯ During ECMO, left and right ventricular output decreased proportionally to the amount of bypass flow provided (r = -.82 and -.83, respectively; p less than .001), and were accompanied by a decrease in left ventricular contractility. Pulsed Doppler echocardiography provides a noninvasive method to estimate ventricular outputs during ECMO and to evaluate the response of both ventricles to volume loading during weaning from ECMO.
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Critical care medicine · Feb 1990
Factors affecting accidental extubations in neonatal and pediatric intensive care patients.
All patients intubated in the neonatal (NICU) and pediatric (PICU) ICUs over a 3-yr period were evaluated prospectively to determine the incidence of accidental extubation (AE) and contributing factors. Two thousand two hundred patients (age range 26 wk gestation to 18 yr) were intubated for a total of 21,222 days. In the PICU and NICU, a total of 153 patients experienced 195 AE. ⋯ One death occurred as an indirect consequence of AE. The data are being reported as a function of number of days intubated in an attempt to standardize reporting techniques. The use of standardized reporting and the identification of high-risk factors may be useful for education and modification of patient care practices.