Critical care medicine
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Critical care medicine · Jul 1984
Clinical evaluation compared to pulmonary artery catheterization in the hemodynamic assessment of critically ill patients.
Although pulmonary artery (PA) catheterization is frequently employed in the management of critically ill patients, there is little documentation that the information obtained alters patient management. This study evaluated prospectively this question in 103 PA catheterizations. Before catheterization, physicians were asked to predict the range of several hemodynamic variables, the presumed diagnosis, and their plan for therapy. ⋯ This study documents the difficulty of predicting accurately hemodynamics based solely on clinical evaluation. Thus, the information obtained by catheterization often leads to alterations in the therapeutic plan. We suggest that PA catheterization is both indicated and useful in the management of critically ill patients.
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Critical care medicine · Jul 1984
Case ReportsCardiac tamponade associated with a multilumen central venous catheter.
Two patients experienced cardiac tamponade after catheterization with a multilumen central venous catheter. The authors review the problem, including recommendations for central line placement to decrease the incidence of this potentially lethal complication.
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Critical care medicine · Jun 1984
Relation of inspired oxygen fraction to hypoxemia in mechanically ventilated adults.
To evaluate the recommendation that all adult patients started on mechanical ventilation (MV) should have an initial fraction of inspired oxygen (FIO2) of 1.0, 207 consecutive adult patients started on MV in the critical care units were studied. The initial FIO2, the resultant PaO2, and the level of training of the physician ordering the initial ventilator settings were recorded for each patient. ⋯ Staff-level physicians tended to employ an initial FIO2 less than 1.0 more often than did physicians-in-training, and the latter had a 19% incidence of PaO2 less than 60 torr, while staff-level physicians had no PaO2 values less than 60 torr when using an initial FIO2 less than 1.0. It is concluded that all adult patients started on MV should receive an initial FIO2 of 1.0, especially when the physician ordering the initial FIO2 is a physician-in-training.