Critical care medicine
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Critical care medicine · Dec 1989
Case ReportsHigh dose epinephrine in refractory pediatric cardiac arrest.
Cardiac arrest has a poor prognosis, regardless of age group. Children who fail to respond to two standard doses of epinephrine (0.01 mg/kg) rarely survive to hospital discharge, and most die without the return of spontaneous circulation (ROSC). ⋯ By comparison, in the previous 20 consecutive pediatric patients with cardiac arrest in which there was no response to two standard doses of epinephrine, none had ROSC. Previous animal data as well as anecdotal human experience suggest that the standard epinephrine dose (0.01 mg/kg) may be much too low.
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Critical care medicine · Dec 1989
Randomized Controlled Trial Comparative Study Clinical TrialComparison of prehospital conventional and simultaneous compression-ventilation cardiopulmonary resuscitation.
Nine hundred ninety-four patients were enrolled in a field trial in which ambulance crews were randomly assigned to use simultaneous compression-ventilation (SC-V) CPR or conventional CPR procedures in the prehospital setting. Survival to hospital admission and to discharge was superior in the conventional CPR group vs. the experimental group (p less than .01). In a subset of adult cases whose causes of arrest were nontraumatic, survivor rates still favored the conventional CPR group: 33.5% of 337 vs. 22.5% of 365 (p less than .001). ⋯ There were no statistically significant differences in the Glasgow coma scores between surviving patients in either group at 24 h post-hospital admission or discharge. It is concluded that survival in the SC-V CPR group was lower, likely reflecting a deleterious effect of the experimental technique of resuscitation. Also noted was that 14% of the control patients and 6% of the experimental patients survived with manual CPR alone.
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Critical care medicine · Dec 1989
Incidence, physiologic description, compensatory mechanisms, and therapeutic implications of monitored events.
We described 663 unanticipated monitored circulatory events in 247 high-risk surgical patients by simultaneous invasive and noninvasive hemodynamic and oxygen transport monitoring systems. Unanticipated monitored events were defined as sudden reductions (greater than 20%) in cardiac index (CI), PaO2, SaO2, transcutaneous PO2 (PtcO2), and PtcO2/PaO2 index, or decreases to the lower limits of satisfactory values, specifically: PaO2 less than 70 torr, SaO2 less than 95%, PtcO2 less than 50 torr, and PtcO2/PaO2 less than 0.6. Essentially, monitored events are the small variations superimposed on the overall physiologic patterns that describe the entire course of critical illnesses. ⋯ At the nadir, cardiac functions decreased in about two thirds, perfusion decreased in over half, and lung function fell in only one quarter of the events. Recovery occurred with increased cardiac function in two thirds, improved perfusion in over half, and increased lung function in less than one fifth of these monitored events. Noninvasive and invasive hemodynamic and oxygen transport variables were measured simultaneously to evaluate compensatory and decompensatory patterns.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical care medicine · Dec 1989
Reliability of right atrial pressure monitoring to assess left ventricular preload in critically ill septic patients.
Right atrial pressure (RAP) can be used as a guide to fluid therapy in critical care settings. RAP and pulmonary capillary wedge pressure (WP) were measured in 27 septic patients without cardiac disease and on mechanical ventilation. ⋯ The reliability of various RAP interval values in predicting optimal WP was then studied in these patients. We concluded that RAP values less than or equal to 5 mm Hg were highly specific (97%) in predicting low or normal WP (less than or equal to 12 mm Hg).