The Surgical clinics of North America
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When we are concerned about the adequacy of peripheral oxygen delivery, our monitoring efforts focus on cardiac output as the component easiest to manipulate. Thermodilution is the current method of determining cardiac output because of logistic convenience, but by no means should it be considered the gold standard. ⋯ Doppler ultrasound appears to be a valid method in skilled hands, but its accuracy in quantitating cardiac output, especially in the critically ill, remains questionable. Mixed venous oximetry and transcutaneous oxygen monitoring are promising but are still being evaluated.
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Surg. Clin. North Am. · Aug 1991
ReviewCentral nervous system monitoring. What helps, what does not.
The ICU monitoring of CNS function can make a difference in the clinical outcome. No single technique addresses the multiple issues that arise in the ICU setting, especially for the polytrauma patient. ⋯ Experience needs to be gained to establish the best combination of these modalities. Pending this, selected use of intracranial pressure monitoring combined with EEG and transcranial Doppler ultrasound provides reliable immediate assessment and ongoing monitoring of CNS structures.
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Sepsis, shock, and resuscitation may result in various degrees of ischemia-perfusion injury that may produce widespread organ dysfunction through complex interactions and activation of host immunoinflammatory processes. As the pathophysiologic mechanisms of the inflammatory response are better defined, we may be able to modulate the generalized inflammatory state we know as sepsis and prevent the development of multiple organ failure syndrome. At present, however, the mainstay of therapy remains prompt resuscitation to eliminate regions of hypoperfusion and to limit as much as possible those factors that predispose to further organ injury while the source of inflammatory stimulation is being identified and controlled.
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The advances in pediatric intensive care outlined here point out the differences between children and adults that need to be considered when taking care of children with surgical diseases. In the past, advances in pediatric critical care have not kept pace with advances in adult care, but these and other new techniques have rapidly closed this gap in knowledge.
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An understanding of respiratory physiology is helpful when weaning a patient from mechanical ventilation. Various criteria are available that assess pulmonary function and the patient's ability to breathe spontaneously. ⋯ The mode of ventilation during weaning is less important than careful observation during the trial. Simple vital signs and physical findings remain some of the best indicators of success or failure.