Articles: critical-care.
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Gastrointestinal tonometry is supposed to diagnose gut mucosal hypoxia using gastric luminal PCO2 and arterial bicarbonatemia, which are substituted in a modified Henderson-Hasselbach equation. This article reviews some of the problems inherent to the multiple assumptions underlying this technique. Tonometry is influenced by several local factors and by systemic acid-base imbalances that are unrelated to oxygenation. Tonometry is a rather crude and cumbersome method of gut capnometry, a technology that may provide valuable information regarding visceral perfusion, but not necessarily oxygenation.
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Increasing DO2 to supranormal levels, spontaneously or therapeutically, correlates with better survival in the critically ill patient, but not all patients who attain a DO2I greater than 600 mL/min/m2 survive. Conversely, there is often a 50% or greater survival rate in patients who do not reach normal DO2I values. No investigator has been able to show an incremental increase in survival with increasing DO2I; but studies have shown improved survival rates with increasing SVO2. ⋯ SVO2 should be normalized when low, again by increasing DO2. Data continue to support clinical interventions aimed at optimizing DO2. Does increasing DO2 increase the survival rates of critically ill patients? Sometimes.
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Dimens Crit Care Nurs · Jul 1996
Review Case ReportsAggressive weaning in cardiac surgical patients.
Nursing management of cardiac surgical patients has changed dramatically over the last several years. The need for cost-effective care with quality patient outcomes has forced critical care nurses to re-evaluate the standard of practice for postoperative cardiac patients. ⋯ In the fast-track weaning protocol, the nurses were given more authority to make critical decisions during the weaning process. This article describes the transition from the traditional time-based weaning system to the fast-track system where individual weaning progress is monitored by the critical care nurses.
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Critical care clinics · Jul 1996
ReviewICU scoring systems do not allow prediction of patient outcomes or comparison of ICU performance.
Recent revisions of the major ICU scoring systems have broadened their database markedly and increased their statistical accuracy. For a specific patient, however, the systems cannot be accurate enough to direct management decisions. Significant questions remain about the reliability of these systems for comparing different ICUs and different patient populations, especially in surgical and trauma patients. Current scoring systems, therefore, cannot be used reliably in either the management of the individual patient or in the making of quality comparisons between ICUs.
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Gastric tonometry is gaining acceptance rapidly as a noninvasive method of monitoring tissue dysoxia in a key organ system that previously could not be assessed easily. In addition to being noninvasive, gastric tonometry also identifies dysoxia in shock sooner than currently available monitors. This allows for more timely intervention with a subsequent improvement in prognosis in defined groups of patients. Tonometry data that suggest continued dysoxia despite intervention should signal clinicians to seek alternative diagnoses or to question the efficacy of current therapies, including antibiotics.