J Trauma
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Comparative Study
Hemodynamic, plasma volume, and prenodal skin lymph responses to varied resuscitation regimens.
The theoretical efficacy of hypertonic saline (HS) resuscitation for hemorrhagic shock purportedly stems from the osmolar extraction of intracellular fluid into the plasma. This hypothesis presumes a concomitant expansion of the interstitial fluid space. Colloid resuscitation, in theory, expands the plasma volume by extracting interstitial fluid. ⋯ Wet/dry skin ratios were greatest at 60 minutes in the LR group but similar at 120 minutes in all four groups. These data suggest that interstitial fluid space remains contracted during the first hour after HS, HSD, and Dex resuscitation compared with LR resuscitation, even though the restoration of plasma volume, MAP, and cardiac output is greatest with the Dex regimen. Further studies with total body water and intracellular water are needed in this model.
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Percutaneous tracheostomy has been advocated as a faster, safer, and less invasive method of placing tracheostomy tubes in ventilated patients. To compare outcome differences, as measured by complication rates, between percutaneous and open tracheostomy, a retrospective cohort study was performed. ⋯ The minor complication rates did not differ significantly between percutaneous and open tracheostomy (12/31 vs. 12/29, respectively; p > 0.05), nor did there appear to be a difference in rates of major complications between the two groups (7/31 vs. 5/29; p > 0.05). This study identified a trend towards an increased risk of delayed airway loss in the percutaneous tracheostomy group.
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Polyvalent antivenin remains the most recommended treatment of crotalid envenomation, including copperhead snakebites. Because of the significant morbidity associated with antivenin therapy, some have proposed conservative therapy for less serious envenomations. Few if any studies have separated the treatment of the less serious copperhead bite from the more serious bite of a rattlesnake or a water moccasin. ⋯ Conservative treatment resulted in no deaths, limb loss, or residual disability. The mean hospital stay was 2.15 days compared with 3.9 days in patients with systemic symptoms. These data support a conservative approach to most copperhead envenomations and suggest that the treatment for copperhead bites should be segregated from the more serious rattlesnake and water moccasin snakebites.
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Randomized Controlled Trial Clinical Trial
The relationship of oxygen consumption measured by indirect calorimetry to oxygen delivery in critically ill patients.
The existence of oxygen supply dependency, defined as oxygen consumption (VO2) limited by oxygen delivery (DO2), is still questioned. This study examined the relationship between VO2 and DO2 in two groups of critically ill surgical patients 50 years and older in the first 24 hours of resuscitation after pulmonary artery catheter insertion. Group 1 patients had systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock, and adult respiratory distress syndrome (ARDS). Group 2 patients had hemorrhagic shock. ⋯ Six to 18 measurements collected on all study patients during a period within the first 24 hours were analyzed using a linear regression analysis. Statistical significance was set at p < or = 0.05. Seven of nine patients in group 1 demonstrated positive, statistically significant relationships between VO2 and DO2. Of six patients in group 2, one patient demonstrated a positive, significant relationship of VO2 and DO2, three demonstrated inverse relationships, and two patients did not show a DO2/VO2 relationship. Supply dependency did not exist in all patients but was present in seven out of nine patients with systemic inflammatory response syndrome, sepsis, severe sepsis, septic shock, and adult respiratory distress syndrome in the first 24 hours of treatment.
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Randomized Controlled Trial Clinical Trial
The use of oxygen consumption and delivery as endpoints for resuscitation in critically ill patients.
Oxygen consumption (VO2I) and delivery (DO2I) indices have been stated to be superior to conventional parameters as endpoints for resuscitation. However, another interpretation of published data is that inability to increase VO2I/DO2I given adequate volume resuscitation reflects inadequate physiologic reserve and poor outcome. ⋯ No difference was found in the incidence of OF or death in patients resuscitated based on oxygen transport parameters compared to conventional parameters. These data suggest that given adequate volume resuscitation, oxygen-based parameters are more useful as predictors of outcome than as endpoints for resuscitation.