Intensive care medicine
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Inhaled nitric oxide is rapidly gaining popularity as a selective pulmonary vasodilator in patients with acute lung injury and pulmonary hypertension. The development of nitric oxide as a drug has bypassed the usual regulatory and commercial processes, and as a result clinicians have devised a wide range of delivery and monitoring systems. This review describes these systems, and discusses their advantages, disadvantages and safety. The monitoring of nitric oxide metabolites is also discussed.
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Intensive care medicine · Jan 1996
Event-related potentials--neurophysiological tools for predicting emergence and early outcome from traumatic coma.
To determine the prognostic value of multimodal evoked potentials (EPs) and event-related (ERPs) potentials in coma (Glasgow Coma Score <8), after severe traumatic brain injury (TBI). ⋯ Highly significant (P <0.001) correlations exist between long-latency ERP components and 3-month outcome. Short-latency EPs, brainstem (wave I-V) and somatosensory conduction times also correlate significantly with the GOS (P <0.01). Of the clinical measurements, pupillary response patterns, APACHE II and Glasgow Coma Scores (GCS) correlate significantly with outcome, as do the retrospective measures of duration of coma and post-traumatic amnesia (PTA) in survivors. Unfortunately, due to variance of long-latency responses, even in controls, absolute values cannot be relied upon as prognosticators. The presence of "mismatch negativity" predicted the return of consciousness (89.7% sensitivity and 100% specificity) and preceded changes in GCS. Its latency was the single best indicator of 90-day outcome from coma (r = -0.641).
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Intensive care medicine · Jan 1996
Clinical Trial Controlled Clinical TrialSplanchnic oxygen transport after cardiac surgery: evidence for inadequate tissue perfusion after stabilization of hemodynamics.
To evaluate the adequacy of visceral oxygen transport and gastric pHi after open heart surgery in patients with stable hemodynamics. ⋯ We conclude that a mismatch between splanchnic oxygen delivery and demand may be present despite stabilization of systemic hemodynamics after cardiac surgery. This is suggested by the parallel changes in splanchnic oxygen delivery and consumption. Dobutamine is likely to improve splanchnic tissue perfusion at this phase.
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Intensive care medicine · Jan 1996
Randomized Controlled Trial Clinical TrialTransgastric, pulsed Doppler echocardiographic determination of cardiac output.
The aim of this study was to evaluate the accuracy of cardiac output measurement with transesophageal echocardiography (TEE) using a transgastric, pulsed Doppler method in acutely ill patients. ⋯ Transgastric pulsed Doppler measurement across the left ventricular outflow tract with TEE is a very feasible and clinically acceptable method for cardiac output measurement in acutely ill patients.
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Intensive care medicine · Jan 1996
Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock.
To identify early prognostic markers of septic shock among catheterization-derived hemodynamic and metabolic data. ⋯ Changes in mean arterial pressure and arterial blood lactate within the first 24 h of treatment are strong prognostic indicators of short-term survival in patients with septic shock. After 24 h of treatment, maintenance of a mean blood pressure equal to or greater than 85 mmHg correlates with survival at day 10. Data suggest that early reductions in both cardiac function and vascular tone play a determining role in the hypotension observed in fatalities. Persistence of hyperlactatemia in hypotensive patients bodes particularly ill. Blood pressure and lactate level are simple bedside parameters that can enable the clinician to identify patients with a high risk of mortality.