Articles: critical-illness.
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This paper reviews presently available techniques for monitoring the adequacy of tissue oxygenation, emphasizing the practical and theoretical problems that exist with presently used measurements. ⋯ In attempting to develop tools to assess adequate tissue oxygenation, emphasis should be placed on the monitoring of individual tissues that are felt to be highly susceptible to reduced oxygen delivery and key to overall survival. Preliminary data involving measurements of the interstitial pH of the gastrointestinal tract suggest that this measurement may be one approach to pursue.
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AACN Clin Issues Crit Care Nurs · Feb 1993
Using continuous SVO2 to assess oxygen supply/demand balance in the critically ill patient.
To ensure that tissues are well oxygenated, oxygen supply and demand are now targets of therapy for the critically ill patient. This chapter reviews the physiologic determinants of oxygen supply, how it is threatened by respiratory or cardiac dysfunction or by hemorrhaged or anemic states, and how it can be assessed in individual patients. ⋯ Failure of tissues to consume enough oxygen is explained in patients with critically low delivery or with the maldistributed blood flow state seen in sepsis. The monitoring of mixed venous oxygen saturation is examined as a method of tracking the threats to supply/demand balance and of guiding treatment that can support the adequate oxygenation of tissue.
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Critical care medicine · Jan 1993
Comparative StudyPharmacokinetics of exogenous epinephrine in critically ill children.
This study was designed to determine the steady-state plasma concentrations and clearance rates of epinephrine in critically ill children, to examine if epinephrine pharmacokinetics conform to a linear model, and to compare epinephrine clearance rates with clearance rates of dopamine and dobutamine. ⋯ Epinephrine infusions produce pharmacologic plasma concentrations of epinephrine in critically ill children. The plasma concentration of epinephrine correlates with the infusion rate, suggesting linear pharmacokinetics. Epinephrine clearance rates in critically ill children appear to be lower than the reported clearance rates in healthy adults. The clearance rates of two other inotropic catecholamines, dopamine and dobutamine, are significantly correlated with the clearance rate of epinephrine.
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Intensive care medicine · Jan 1993
Randomized Controlled Trial Clinical TrialParenteral nutrition in the critically ill: use of a medium chain triglyceride emulsion.
The study investigated the use of an intravenous lipid emulsion containing medium chain triglycerides (MCTs) in critically ill patients, and compared the effects with those of a conventional long chain triglyceride (LCT) preparation. ⋯ MCTs are rapidly hydrolysed and oxidised to fatty acids and ketones which can be readily utilised. This study indicates that intravenous lipid emulsion containing MCT are safe in critically ill patients and may have advantages over LCT. The number and range of patients studied was, however, small and larger studies are needed.
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Randomized Controlled Trial Clinical Trial
Effects of iced and room temperature injectate on cardiac output measurements in critically ill patients with low and high cardiac outputs.
To determine the effect of injectate temperature (iced or room temperature) on cardiac output values in critically ill adults with low and high cardiac outputs. ⋯ Although research is clearly needed to substantiate these findings, we suggest that nurses use iced injectate in patients with low and high cardiac outputs (< or = 3.5 L/min or > or = 8.0 L/min) to ensure accurate measurement of cardiac output.