Clinical intensive care : international journal of critical & coronary care medicine
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Clin Intensive Care · Jan 1994
Oxygen extraction in patients with sepsis and heart failure: another look at clinical studies.
We collected all complete sets of measurements of cardiac index and oxygen-derived variables available in the recent literature (1975-1991; computerised Medline search) on critically ill patients with sepsis (n=21 studies), septic shock (n=20 studies) or severe heart failure (n=13 studies). For each study, the mean value for cardiac index, oxygen delivery (DO 2), oxygen uptake (VO 2), oxygen extraction ratio (O 2ER) and lactate concentration (when available) were analysed together with mortality rates. There was a significant relationship between VO 2 and DO 2 for the studies on patients with severe heart failure (r=0.79, p less than 0.001) or septic shock (r=0.55, p less than 0.01), but not in patients with sepsis (r=0.3, p=NS). ⋯ Furthermore, the positive relationship between O 2ER and lactate suggests that, despite the alterations in oxygen extraction capabilities in severe sepsis, mean O 2ER may be higher in the most severe cases of septic shock. This could reflect an attempt to maintain VO 2 when DO 2 is insufficient. The prevailing opinion that 0 2ER is a meaningless variable in septic shock needs to be reassessed.
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Clin Intensive Care · Jan 1994
Comparative StudyContinuous invasive cardiac output monitoring--the Baxter/Edwards Critical-Care Swan Ganz IntelliCath and Viligance system.
We evaluated the Baxter/Edwards Critical-Care Swan Ganz IntelliCath continuous cardiac output catheter and Vigilance continuous cardiac output monitor in critically ill adult intensive care patients, and compared cardiac output measurements obtained from this new system with those from a standard bolus thermodilution technique using cold normal saline. Nine Swan Ganz IntelliCath catheters were inserted into patients selected at random, following the decision that pulmonary artery catheter monitoring was required. A total of 100 comparisons were made in nine patients. ⋯ These larger than anticipated limits of agreement may not reflect any inaccuracy in the continuous measurement system, rather they may highlight the extent of well recognised potential errors inherent in the intermittent bolus technique. The availability of a system to measure cardiac output continuously provides a major improvement in intensive care monitoring. This system will permit the rapid and accurate assessment of the response of patients to therapy while providing increased diagnostic facilities and a new research tool.