Critical care : the official journal of the Critical Care Forum
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Bolus thermodilution is the standard bedside method of cardiac output measurement in the intensive care unit (ICU). The Baxter Vigilance monitor uses a modified thermodilution pulmonary artery catheter with a thermal filament to give a continuous read-out of cardiac output. This has been shown to correlate very well with both the 'gold standard' dye dilution method and the bolus thermodilution method. Bioimpedance cardiography using the Bomed NCCOM 3 offers a noninvasive means of continuous cardiac output measurement and has been shown to correlate with the bolus thermodilution method. We investigated the agreement between the continuous bioimpedance and continuous thermodilution methods, enabling acquisition of a large number of simultaneous measurements. ⋯ The Bomed NCCOM 3 bioimpedance monitor shows poor agreement with the Baxter Vigilance continuous thermodilution monitor in a group of general ICU patients and cannot be recommended for cardiac output monitoring in this situation.
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When used during extracorporeal membrane oxygenation (ECMO), jugular venous bulb catheters, known as cephalad cannulae, increase venous drainage, augment circuit flow and decompress cerebral venous pressure. Optimized cerebral oxygen delivery during ECMO may contribute to a reduction in neurological morbidity. This study describes the use of cephalad cannulae and identifies rudimentary data for jugular venous oxygen saturation (JVO2) and arterial to jugular venous oxygen saturation difference (AVDO2) in this patient population. ⋯ Jugular venous saturation and AVDO2 were influenced by systemic pH, ECMO type and patient age. These data provide the foundation for normative values of JVO2 and AVDO2 in neonates and children treated with ECMO.
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To review the effect of enteral nutrition on nosocomial pneumonia in critically ill patients as summarized in randomized clinical trials. STUDY IDENTIFICATION AND SELECTION: Studies were identified through MEDLINE, SCISEARCH, EMBASE, the Cochrane Library, bibliographies of primary and review articles, and personal files. Through duplicate independent review, we selected randomized trials evaluating approaches to nutrition and their relation to nosocomial pneumonia. DATA ABSTRACTION: In duplicate, independently, we abstracted key data on the design features, population, intervention and outcomes of the studies. ⋯ Nutritional interventions in critically ill patients appear to have a modest and inconsistent effect on nosocomial pneumonia. This body of evidence neither supports nor refutes the gastropulmonary route of infection.