Articles: critical-care.
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Critical care medicine · Sep 1985
Hydrochloric acid infusion for treatment of metabolic alkalosis: effects on acid-base balance and oxygenation.
The effects of hydrochloric acid (HCl) administration were studied in 15 critically ill patients whose metabolic alkalosis caused a significant alkalemia (pH 7.50 to 7.58) unresponsive to sodium and potassium chloride administration. Arterial pH and bicarbonate and chloride concentrations normalized after a 6- to 12-h mean infusion of 200 +/- 54 mmol of .25 N HCl. There were no deleterious vascular, hematologic, or metabolic side-effects. ⋯ This increase was comparable in patients breathing spontaneously and those treated with controlled mechanical ventilation, and was attributed at least in part to a decrease in pulmonary shunt. These results indicate that .25 N HCl, infused at the rate of 100 ml/h into the superior vena cava, can correct metabolic alkalosis safely and rapidly. The persistence of the beneficial effects of this treatment on arterial oxygenation remains to be confirmed.
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Clinical parameters, intensive care unit (ICU) course, abdominal computed tomography (CT) scans, and the clinical decisions of 53 critically ill patients were reviewed to determine the influence of the CT scan. No scans were positive before the eighth day. Sensitivity was 48% and specificity, 64%. ⋯ Hospital charges were +33,408. Personnel time and cost were 497 hours and +3658; of the total +37,066, 77% (+28,541) could be considered wasted. From these data, it was concluded that CT scans should be used to confirm abscesses, not to search for a source of sepsis.
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Critical care medicine · Aug 1985
Does antacid prophylaxis prevent upper gastrointestinal bleeding in critically ill patients?
Sixty-five surgical ICU patients at high risk of developing acute erosive gastritis and bleeding received prophylactic antacid treatment to maintain a gastric pH of at least 5.0. A similar control group of 61 patients received no specific prophylaxis. All patients in both groups developed microscopic bleeding; however, microscopic bleeding did not influence outcome. ⋯ A single patient in the control group developed severe GI bleeding due to acute erosive gastritis. Antacid prophylaxis did not prevent macroscopic bleeding and there was no correlation between the number of risk factors in individual patients and the rate of upper GI bleeding. We conclude that antacid is not required to prevent upper GI bleeding in high-risk critically ill patients.
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Non-invasive measurements of oxygen saturation are attractive because they provide continuous information which may result in improved patient care. We evaluated a new finger pulse oximeter as a measure of arterial oxygen saturation in critically ill patients with respiratory distress. ⋯ Linear regression analysis of these pooled data yielded on excellent correlation (r = 0.97, p less than 0.001, 0.3% accuracy). The results demonstrate that non-invasive oxygen monitoring of patients with respiratory failure is feasible and can reliably detect potential life-threating arterial oxygen desaturation.