Critical care medicine
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Critical care medicine · Sep 1983
Comparative StudyGabexate mesilate (FOY) therapy of disseminated intravascular coagulation due to sepsis.
Gabexate mesilate (FOY), a synthetic serine proteinase inhibitor, has an anticoagulant activity in the absence of antithrombin-III. We investigated FOY therapy for the treatment of disseminated intravascular coagulation (DIC) associated with sepsis in 15 patients (group F), and compared it with heparin therapy in 8 patients (group H). ⋯ However, in patients whose antithrombin-III values were less than 20 mg/dl at the initiation of the therapy, FOY therapy was successful in 6 of 7 patients, whereas heparin therapy was not at all successful in 4 patients (rho less than 0.05). We conclude that FOY can be used as effectively as heparin for the treatment of DIC, and that FOY therapy is superior to heparin therapy in DIC associated with decreased antithrombin-III.
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Critical care medicine · Sep 1983
Comparative StudyElastic properties of the human chest during cardiopulmonary resuscitation.
Sternal displacement during CPR was measured in 11 adults and 2 manikins (Recording Resusci Anne) while the chest was compressed with variable maximum pulse compression force at a rate of 60/min with compression duration of 0.5-0.6 sec. In 10 patients, the pulsatile sternal elastic characteristic can be satisfactorily described with a 2nd degree polynomial F = beta Ds + gamma D2s, where beta = 54.9 +/- 29.4 (mean +/- SD) N/cm is the pulsatile initial elasticity and gamma = 10.8 +/- 4.1 N/cm2 is the posterior resiliency. ⋯ Therefore, the manikins tested differ significantly in elasticity characteristics from the human chest during resuscitation. In general, the manikin: (1) has markedly greater stiffness at the onset of compression, and (2) maintains a linear stiffness throughout the usual range of displacement, rather than becoming stiffer with greater chest displacement.
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Critical care medicine · Aug 1983
Comparative Study Clinical Trial Controlled Clinical TrialClinical trial of an emergency resuscitation algorithm.
Clinical trials of a resuscitation algorithm for patients entering the Surgical Emergency Department (ED) with acute hypotension were conducted for a 30-month period. The intent was not to compare good management with bad, but rather university-run county hospital services with and without an algorithm. The study group was comprised of 603 hypotensive patients out of 6833 consecutive admissions. ⋯ The mean resuscitation time of the protocol group was markedly and significantly less than that of the control group indicating that the policy of using the algorithm facilitated resuscitation even though it was not always properly followed. Patients with trauma, hemorrhage, and sepsis, whose care was in satisfactory compliance with the algorithm had shorter resuscitation times, lower MAP-time deficits, and less shock-related complications. The algorithm which is primarily directed toward fluid resuscitation did not appear to be efficacious for patients whose trauma was primarily head injury, where fluid restriction may be the therapy of choice.
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Critical care medicine · Aug 1983
Comparative StudyThermodilution cardiac output determination in hypothermic postcardiac surgery patients: room vs ice temperature injectate.
In normothermic patients, room temperature and ice temperature injectate have been shown to result in comparable thermodilution cardiac output measurements. However, room temperature injectate may give inaccurate results in hypothermic patients, particularly if the injectate volume is small, because of the lower injectate-to-blood temperature differential. ⋯ Regression analysis demonstrated a close relationship between the cardiac outputs measured using room temperature injectate compared to those using ice temperature injectate (0.951 for the 10-ml volumes, 0.925 for the 5-ml volumes). We conclude that the room temperature injectate method is acceptable for determining thermodilution cardiac outputs in moderately hypothermic patients.
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Critical care medicine · Aug 1983
Static pressure-volume curves and effect of positive end-expiratory pressure on gas exchange in adult respiratory distress syndrome.
Fifteen patients with adult respiratory distress syndrome (ARDS) were studied: 11 in the early stage of ARDS (group 1); 4 in the late stage (group 2). The inspiratory and expiratory static pressure-volume (P-V) curves of the respiratory system were compared to the pulmonary shunt (Qsp/Qt) when PEEP was increased; cardiac output was kept constant. ⋯ Expiratory P-V curve can be used to determine: first, whether a patient should be ventilated with PEEP; second, the PEEP level which can be set on the respirator. In group 1 patients, when PEEP was set to a value corresponding to the inflexion point, i.e., the point of departure from the exponential shape (mean value 14.6 +/- 2.8 cm H2O), Qsp/Qt compared to zero PEEP was abruptly decreased to 87.6 +/- 6%; further increase in PEEP had little advantage.