Articles: critical-illness.
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Critical care medicine · Dec 1994
Variability in dobutamine pharmacokinetics in unstable critically ill surgical patients.
To delineate the variability in the pharmacokinetics of dobutamine over time in an unstable critically ill adult surgical patient population concurrently receiving therapeutic interventions to optimize oxygen delivery and consumption variables. ⋯ Dobutamine pharmacokinetics in adult critically ill patients is best described by a first-order model. Pathophysiologic factors may have an effect on the pharmacokinetics of dobutamine which appears to change over time. Both inter- and intrapatient variability in infusion rate administered and resultant serum concentrations were wide, suggesting that infusion rate should be guided by clinical end points rather than by predetermined values.
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Critical care medicine · Dec 1994
Comparative Study Retracted PublicationIs continuous cardiac output measurement using thermodilution reliable in the critically ill patient?
Evaluation of continuous cardiac output monitoring based on the thermodilution technique in the critically ill. ⋯ Continuous monitoring of cardiac output using a modified pulmonary artery catheter with a heated filament has proven to be accurate and precise in the critically ill patient when compared with the "standard" intermittent bolus thermodilution technique. The continuous monitoring technique enhances our armamentarium for more intensive monitoring of these patients under a variety of circumstances.
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Recognition of tissue hypoxia or cumulative oxygen debt is of fundamental importance for the triage and resuscitation of critically ill patients during the 'golden hour' in the emergency department. Vital signs, shock index and invasive monitoring of mean arterial pressure and central venous pressure have limited roles in evaluating cumulative oxygen debt and systemic oxygen balance in an acute critical illness. ⋯ Organ-specific oxygenation indices such as gastric tonometry and renal function can supplement indicators of systemic oxygen balance to detect ischaemia-hypoxia of non-vital organs. Systemic oxygenation and organ-specific indices can guide the choice of therapy to optimize resuscitation of the macro- and microcirculation in critically ill patients in the emergency department.
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Randomized Controlled Trial Clinical Trial
Glutamine dipeptide-supplemented parenteral nutrition maintains intestinal function in the critically ill.
Long-term total parenteral nutrition is accompanied with mucosal atrophy and subsequent malabsorption syndrome. Current information attests the important role of glutamine in maintaining intestinal structure and function. The aim of this study was to investigate the effect of glutamine dipeptide supplementation on small intestinal absorption capacity during critical illness. ⋯ The results strongly suggest that glutamine dipeptide-containing total parenteral nutrition prevents intestinal atrophy and increased permeability associated with glutamine-free parenteral nutrition.
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To describe the pharmacokinetics of midazolam, a water-soluble benzodiazepine with a short half-life, in critically ill neonates. ⋯ The mean midazolam doses required for critically ill neonates are lower than those required for older infants.