Southern medical journal
-
Southern medical journal · Nov 1990
Complications of extracorporeal membrane oxygenation in neonates.
In cases of severe respiratory failure, cardiopulmonary bypass has been used as support until cardiac and pulmonary recovery occurs. We report the Wilford Hall USAF Medical Center experience with extracorporeal membrane oxygenation (ECMO) and its associated complications. From July 1985 to March 1989, 57 neonates were placed on membrane oxygenators. ⋯ Extracorporeal membrane oxygenation is successful in significantly improving survival of neonates whose predicted mortality approaches 100% with conventional treatment. The rate of infant mortality using the membrane oxygenator is not affected by technical complications related to catheter position, mechanical problems with the circuit, or hemorrhage, excluding intracranial hemorrhage. The major cause of death of infants receiving extracorporeal membrane oxygenation is the underlying disease process leading to cardiopulmonary failure.
-
Southern medical journal · Oct 1990
ReviewA modification of the supraclavicular approach to the central circulation.
Traditional anterior or posterior triangle approaches to the central circulation may be at times unsuccessful in the patient whose anatomy makes cannulation difficult. We used a supraclavicular approach to cannulation of the central circulation in 100 patients for intraoperative monitoring or insertion of renal dialysis catheters. ⋯ Review of the literature reveals a similar history of success with variations of this approach. The supraclavicular approach is an easy cannulation technique for the inexperienced physician and a useful alternative to traditional approaches for the experienced physician.
-
Southern medical journal · Oct 1990
Comparative StudyComparative study of plasma epinephrine and norepinephrine concentrations during hemodialysis: measurement by high-performance liquid chromatography versus radioenzymatic assay.
We measured epinephrine and norepinephrine levels simultaneously using two methods of detection of catecholamines in plasma--radioenzymatic assay and high-performance liquid chromatography with electrochemical detection. Measurements were made in 15 stable patients during hemodialysis. ⋯ No significant decrement in epinephrine or norepinephrine concentrations during the dialysis procedure was detected regardless of the method used. We conclude that the hemodialysis procedure does not affect the concentration of plasma catecholamines and that the two methods of detecting plasma catecholamines in patients with renal failure are equally accurate.
-
Massive transfusion, or the rapid administration of a quantity of blood products that approximates an individual's blood volume, is associated with many potentially lethal complications. If the need for transfusion is immediate, ie, before adequate typing and crossmatching procedures can be completed, O negative RBCs can be given safely in the interim. Hypothermia caused by cold banked blood is aggravated by multiple environmental factors and should be aggressively avoided through the use of heat lamps, warming coils, blankets, and other warming devices. ⋯ Citrate toxicity and hypocalcemia are usually self-limiting disturbances. Prophylactic use of calcium chloride is dangerous and unnecessary. The complexity of the conditions necessitating massive transfusion demands frequent reevaluation of multiple laboratory and clinical factors for effective resuscitation and for safe administration of blood.
-
Over the past several years, there has been growth in the number of training programs in the new subspecialty of critical care medicine. The adoption of subspecialty certifying examinations in critical care medicine has added momentum to the growth of the subspecialty. A personal experience in a critical care medicine fellowship training program is detailed and contrasted with a year of clinical pulmonary fellowship training. ⋯ Technical expertise in intensive care unit procedures and therapy was stressed during the critical care medicine fellowship, whereas the year of clinical pulmonary training was of greater scope, encompassing comprehension of pulmonary pathophysiology, diagnostic procedures, and therapy. "Hands-on" intensive care unit training was limited during the pulmonary fellowship, though didactic instruction and the conceptual approach to critical illness was stronger. Research training opportunities were largely equivalent. From this experience, I present suggestions for selecting fellowship training in critical care medicine.