Articles: critical-illness.
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Critical care medicine · Jul 1993
Pharmacokinetics of continuous infusions of fentanyl in critically ill children.
To determine the pharmacokinetics of fentanyl when used as a long-term continuous infusion for sedation/analgesia in mechanically ventilated critically ill infants and children. ⋯ Total body clearance of fentanyl is highly variable and it should be dosed to effect. Patients seen in a pediatric ICU may require a ten-fold variability in fentanyl infusion rates to achieve similar levels of sedation.
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Critically ill patients have greater than normal oxygen demands because of enhanced energy requirements placed on them by the stress of acute illness, blood and fluid loss, surgery, wound healing, and hospitalization. Early recognition of major alterations in oxygen transport variables, oxygen delivery, oxygen consumption, and the oxygen extraction ratio, by the critical care team assists in the prevention and treatment of tissue hypoxia in seriously ill and injured patients. ⋯ When deviations from supranormal values of oxygen transport variables in these patients are identified, specific interventions that improve oxygen delivery to peripheral tissues should be implemented and evaluated for their effectiveness in normalizing the oxygen extraction ratio. When serial measurements of oxygen delivery, oxygen consumption, and the oxygen extraction ratio follow each therapeutic intervention that is directed at increasing oxygen delivery, the survival rate of critically ill patients is significantly improved.
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To evaluate the long-term mortality and morbidity of critically ill elderly patients requiring intensive care. ⋯ Age alone is not an adequate predictor of long-term survival and quality of life in critically ill elderly patients.
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Critical care medicine · Jun 1993
Weight changes in critically ill patients evaluated by fluid balances and impedance measurements.
To study simple, rapid, and predictive methods to determine body weight changes in critically ill patients. ⋯ Calculated fluid balances are not predictive for actual weight changes in critically ill patients. Absolute weight measurements are indispensable. Changes in resistance correlated with weight changes in individual patients if weight changes were > 3 kg.
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Minerva anestesiologica · Jun 1993
Comparative Study[The thermodilution determination of right ventricular volumes and ejection fraction in the critical patient. Volumetric vs pressure measurement assessment].
The widespread use of hemodynamic investigation techniques, allowed a better understanding of the right ventricle (RV) pathophysiology and led to progressive reevaluation of its role. A modification of the classical Swan-Ganz catheter, made possible the measurement of the ejection fraction (EF) and of the end-systolic and end-diastolic volumes of RV just by the simple application of the thermodilution technique. In this paper, we first refreshed the basic theoretical principles of the technique and then presented our preliminary results of one-year experience in ICU. ⋯ We conclude that the use of the thermodilution technique to measure the volumes of RV, allows a real evaluation of the preload. At the same time it avoids all the problems associated with the measurement of transmural pressure and with the changes produced by shifting of intrapleural pressure. Finally the end systolic volume may be combined with the pressure data to estimate the contractile status and, in our experience, this parameter has proved more sensitive than EF in order to detect changes of contractility of the right ventricle.