Articles: critical-illness.
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Intensive care patients often require inotropic support to stabilise circulation and to optimise oxygen supply. In this context, the catecholamines norepinephrine (noradrenaline), epinephrine (adrenaline), dopamine and dobutamine are still the mainstay of therapy. They provide, to different extents, a variety of adrenoceptor-mediated actions comprising vasoconstriction (via alpha-receptors) as well as vasodilatation (via beta 1-receptors), and an increase in cardiac output by enhancing inotropy and heart rate (again via beta 1-receptors). ⋯ Depending on the dosage and the speed of intravenous administration, the use of phosphodiesterase inhibitors sometimes results in pronounced decrease of blood pressure which may require vasopressor therapy. Other drugs including histamine H2-agonists are currently under investigation. Their value in the treatment of intensive care patients has still to be evaluated.
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Critical care medicine · May 1993
Dobutamine infusions in stable, critically ill children: pharmacokinetics and hemodynamic actions.
To delineate dobutamine pharmacokinetics and hemodynamic responses in children. ⋯ Dobutamine effectively improves systolic function in critically ill children. Hemodynamic responses to dobutamine generally follow a predicted log-linear dose-response model. Dobutamine clearance in this study was consistent with first-order kinetics. The wide variability in hemodynamic responses and clearance kinetics indicate that dobutamine infusions must be titrated individually.
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Positioning of critically ill patients affects hemodynamic and cardiopulmonary outcomes. A review of clinical studies indicates that backrest elevations up to 60 degrees do not affect measurement of intracardiac pressures or cardiac output, but PaO2 may diminish in sitting positions following surgical procedures. In lateral positions, measurement of intracardiac pressures and cardiac output is not recommended, since a uniform reference point has not been identified for lateral positions. ⋯ Prone positioning may be beneficial in adult respiratory distress syndrome and in weaning of mechanically ventilated patients. When planning positioning maneuvers, critical care nurses should consider these effects in relation to the specific needs of each patient. Hemodynamic and cardiopulmonary responses to positioning should be evaluated in conjunction with other therapeutic modalities such as those designed to preserve skin integrity and improve comfort.
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Critical care medicine · May 1993
Longitudinal analysis of neutrophil superoxide anion generation in patients with septic shock.
To examine polymorphonuclear leukocyte respiratory burst function serially in patients with septic shock. ⋯ In vitro neutrophil respiratory burst function is significantly depressed during early septic shock. As patients improve clinically, as quantitated by decreasing APACHE II scores, neutrophil respiratory burst function recovers, approaching normal values.
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To determine the effects of fat emboli on cardiopulmonary function in critically ill patients. ⋯ Cardiopulmonary dysfunction commonly attributed to fat emboli is likely due to other causes.