Articles: critical-illness.
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American heart journal · May 1994
Transesophageal echocardiography in critically ill patients: feasibility, safety, and impact on management.
Transesophageal echocardiography (TEE) is being used with increasing frequency in critically ill patients in whom transthoracic echocardiography (TTE) is often unsatisfactory in providing much needed information. We reviewed the indications, feasibility, and clinical impact of TEE in the intensive care setting at our institution. TEE was performed in 77 critically ill patients (age range 19 to 83 years) in whom TTE was inadequate or inconclusive. ⋯ In these patients (n = 37), the TEE findings led to a change in medical management in 19% and to surgical intervention in 29%. While TTE remains the first line of diagnostic ultrasound and Doppler in critically ill patients, it can be technically difficult or inconclusive. In this setting, TEE provides a safe and powerful diagnostic tool that can help guide patient management.
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Critical care medicine · May 1994
Ventilatory response to high caloric loads in critically ill patients.
To assess the effect of high caloric loads on CO2 metabolism and ventilation. ⋯ Increased CO2 production, exhaled minute ventilation, and deadspace ventilation values in the overfed group and the lack of difference between alveolar ventilation, PaCO2, and measured energy expenditure, along with correlations between CO2 production and alveolar ventilation suggest that carbohydrate loads increase CO2 production which drives alveolar ventilation, thus preventing hypercapnia. When alveolar ventilation does not increase (and PaCO2 increases) or when the spontaneous breathing rate increases to augment alveolar ventilation, the clinical response of increasing mechanical ventilation may increase deadspace ventilation.
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Comparative Study
[Failure of prediction of results with APACHE II. Analysis of prediction errors of mortality in critical patients].
The evaluation of the prognosis of critically ill patients by the APACHE II method is common in intensive care units (ICU). The aim of the present was to analyze the possible factors associated to errors in prediction. ⋯ The factors analyzed did not demonstrate that they may influence or be associated with errors in prediction of the prognosis of patients admitted to an intensive care unit, with these errors probably being due to errors in the system used.
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Comparative Study
Arterial or mixed venous lactate measurement in critically ill children. Is there a difference?
Seven critically ill children had simultaneous measurement of whole blood lactate concentrations obtained from a systemic arterial and mixed venous (pulmonary artery) site. An excellent correlation was found (r = 0.995). The mean difference between arterial and mixed venous values was 0.02 mmol/l and the limits of agreement (+/- 0.22) were -0.20 to 0.24. The differences found were clinically insignificant (two-tailed paired Student's t-test; p = 0.36) and therefore support the continued use of arterial sampling for blood lactate measurement.