Critical care medicine
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Critical care medicine · Nov 1989
Effects of bicarbonate therapy on tissue oxygenation during resuscitation of hemorrhagic shock.
We investigated the effects of clinically appropriate doses of NaHCO3 on tissue oxygenation when hemorrhagic shock was corrected with hydroxyethyl starch (hetastarch) in 12 piglets. Six animals received colloid only while six received colloid and bicarbonate. ⋯ The delayed increase in tissue PO2 values after bicarbonate infusion may be explained, at least partly, by decreased arterial blood oxygenation and a shift of the oxyhemoglobin curve to the left. NaHCO3 adjunct has no added beneficial effect on hemodynamics and may be harmful to tissue oxygenation in hemorrhagic shock resuscitated with hetastarch.
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Critical care medicine · Nov 1989
Use of survivors' cardiorespiratory values as therapeutic goals in septic shock.
The responses to therapy of 29 patients in septic shock are described. Patients received controlled plasma volume expansion followed by infusions of norepinephrine, dobutamine, and dopamine to achieve appropriate therapeutic goals. ⋯ The overall hospital survival rate was 52%. We suggest that the rational use of adrenergic agents and the achievement of appropriate physiologic end-points for therapy not only result in the reversal of hypotension, but also maintain or increase Do2 and Vo2, and may improve survival.
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Critical care medicine · Oct 1989
Comparative StudyCardiorespiratory function after replacement of blood loss with hydroxyethyl starch 120, dextran-70, and Ringer's acetate in pigs.
The small intestines of 20 anesthetized pigs weighing 12 to 17 kg were exteriorized in a saline-moistened gauze in order to simulate an intra-abdominal operation. During a 2-h period, 4% of the animals' body weight was bled through an arterial cannula in six increments and replaced immediately with one of the following fluids: a) a new medium-MW hydroxyethyl starch (HES 120), b) dextran-70 (DEX), or c) Ringer's acetate (RA). The amount of fluid infused was equal to the amount of blood withdrawn in the plasma substitute groups, but was increased four-fold in the RA group. ⋯ Similarly, stroke volume and arterial pressures were best maintained with HES, but decreased after RA. Oxygen consumption and delivery were highest after HES and lowest in the RA group, where arteriovenous oxygen difference increased throughout the study. We conclude that both colloid solutions were superior to RA, which did not prevent hypovolemia or maintain adequate oxygen transport.
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Critical care medicine · Oct 1989
Hemodynamic and oxygen transport response to modified fluid gelatin in critically ill patients.
The hemodynamic and oxygen transport effects of the rapid infusion of 500 ml of modified fluid gelatin, an artificial colloid widely used in Europe, were studied in a group of critically ill patients suffering from cardiovascular instability. Oxygen consumption tended to increase. ⋯ There were significant decreases in Hgb concentration and arterial oxygen content. The overall circulatory effects of modified fluid gelatin are beneficial.
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Critical care medicine · Oct 1989
Percutaneous central venous catheterization in a pediatric intensive care unit: a survival analysis of complications.
We investigated the relationship between the duration of percutaneous central venous catheterization and the occurrence of catheter-related complications in critically ill children by survival analysis techniques. Data were collected prospectively and analyzed for infectious and noninfectious complications from 379 pediatric patients in whom central venous catheters had been placed in the pediatric ICU over a 45-month period. ⋯ The risk of catheter complication did not increase with increasing daily duration of catheter use as demonstrated by probability density function: catheter complication rates were similar on the first day after insertion (1.06 +/- 0.5%), the seventh day (4.27 +/- 1.6%), and the 24th day (2.48 +/- 2.4%). Therefore, in this population, routine catheter replacement would not be expected to lower the incidence of catheter-related complications, but may unnecessarily increase the number of insertion-related complications.