Critical care medicine
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The conventional method of pleural drainage is tube thoracotomy, accomplished by chest wall dissection and blunt puncture. While this method is successful, it is relatively traumatic. We have designed a pigtail catheter which may be inserted into the pleural space by a modified Seldinger technique. ⋯ All but one pneumothorax was successfully evacuated; however, the pneumomediastinum reaccumulated. Insertion proved to be safe, simple, and atraumatic. This pigtail pleural drainage catheter provides an alternative to standard tube thoracotomy.
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Critical care medicine · Feb 1989
Decision not to treat: "do not resuscitate" order for the burn patient in the acute setting.
For some burn victims who are recognized early to be nonsurvivors, the decision to "make comfortable" is a treatment option. The guidelines for a "do not resuscitate" order must be based on an individual center's experience, but general principles can be formulated.
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Critical care medicine · Jan 1989
Sequential physiologic interactions in pediatric cardiogenic and septic shock.
We report that the pediatric cardiogenic shock and septic shock populations show similar hemodynamic and oxygen utilization physiologic relationships during aggressive intensive care therapy. We examined the mathematical relationships between vascular tone and flow, and oxygen utilization and oxygen delivery (DO2) in the early and middle stages of cardiogenic and septic shock. ⋯ In addition, it appears that the major determinant of VO2 in these populations is DO2, not oxygen extraction. We suggest that patients with cardiogenic or septic shock can be treated according to similar physiologic principles.
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Critical care medicine · Jan 1989
Comparative StudyNoninvasive assessment of cardiac output by impedance cardiography in the newborn canine.
Currently, critical care monitoring of cardiac function in the newborn human consists mainly of measuring heart rate and BP. A noninvasive technique for assessing cardiac output routinely in the critically ill neonate would facilitate clinical management. Impedance cardiography (IC) is a noninvasive technique which measures stroke volume on a beat-by-beat basis. ⋯ There were no significant differences between the two methods for either the absolute value of cardiac output (r = .96) or the percent change in cardiac output (r = .97). Coefficients of variation were 3.0% for TD and 3.6% for IC. These results indicate that IC can be used to assess serially cardiac function in the newborn.
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Critical care medicine · Jan 1989
Blood histamine concentrations are not elevated in humans with septic shock.
Histamine has been suggested as an important mediator of the cardiovascular abnormalities during septic shock. To determine if blood histamine levels were increased during human sepsis and septic shock, plasma histamine was measured using a very sensitive radioenzyme assay employing histamine N-methyltransferase (HNMT) in the following patient groups: normal controls (n = 76), nonseptic critically ill (n = 12), nonseptic shock (n = 2), sepsis without shock (n = 28), and septic shock (n = 41). Using this enzyme binding assay, all these groups had similar, normal plasma histamine concentrations, except those patients with septic shock whose mean histamine measurements were significantly reduced (p less than .002). ⋯ After removal of this inhibitor from plasma, septic shock plasma histamine levels were normal. Thus, septic shock patients may have a circulating inhibitor of the HNMT enzyme, but plasma histamine concentrations are normal. Histaminemia is unlikely to play an important role in the pathogenesis of septic shock in humans.