Intensive care medicine
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Intensive care medicine · Jan 1990
Review Randomized Controlled Trial Clinical TrialMeasurement of tissue perfusion by oxygen transport patterns in experimental shock and in high-risk surgical patients.
Survivors of high-risk general (noncardiac) surgery were observed to have cardiac index (CI) values averaging 4.5 l/min.m2, oxygen delivery (DO2) of greater than 600 ml/min.m2, and oxygen consumption (VO2) of 170 ml/min.m2. In contrast, these values were relatively normal in patients who subsequently died. ⋯ The optimal goals were more easily attained with colloids, red cells, dobutamine, and vasodilators, according to their capacity to improve tissue perfusion, as reflected by increased flow and oxygen transport. The extremely complex interactions between DO2 and VO2 are reviewed.
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Intensive care medicine · Jan 1990
Randomized Controlled Trial Clinical TrialPlasma catecholamine concentration during sedation in ventilated patients requiring intensive therapy.
The effects of isoflurane and midazolam sedation on the catecholamine responses of ventilated patients were studied over a 24-h period. Sixty ventilated patients admitted to our intensive therapy unit were allocated randomly to receive either isoflurane or midazolam sedation. ⋯ Patients sedated with midazolam showed no significant changes of adrenaline or noradrenaline concentrations. Overall, a more satisfactory degree of sedation was achieved with isoflurane.
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Intensive care medicine · Jan 1990
Randomized Controlled Trial Clinical Trial Retracted PublicationThe new phosphodiesterase inhibitor enoximone in patients following cardiac surgery--pharmacokinetics and influence on parameters of coagulation.
Enoximone is a selective inhibitor of the phosphodiesterase-III enzyme (PDE-III) and possesses positive inotropic and vasodilatory properties. The PDE-inhibitor amrinone has been associated with adverse effects on coagulation by decreasing platelets. To investigate the influence of enoximone on hemostasis, 18 patients undergoing elective aorto-coronary bypass grafting and receiving enoximone were compared to a control group (n = 18). ⋯ Continuous infusion, however, maintained effective plasma levels of enoximone; sulfoxide levels were twice as high as enoximone concentrations up until the end of the investigation period. It is concluded that enoximone can be judged to be safe in respect to its effects on coagulation even following ECC and at relatively high doses. The use of continuous infusion results in plasma levels which remain at an effective concentration through to the time that the patient is transferred to the intensive care unit.
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Intensive care medicine · Jan 1987
Randomized Controlled Trial Comparative Study Clinical Trial Retracted PublicationInfluence of nimodipine and nifedipine on intrapulmonary shunting--a comparison to other vasoactive drugs.
This study was assigned to investigate the influence of calcium channel blockers (nimodipine and nifedipine) in comparison to other vasoactive drugs (nitroglycerin, dopamine) on pulmonary shunting (Qs/Qt). Fifty anesthetised patients scheduled for aortocoronary bypass operation were randomly allocated to 5 groups receiving one of the following drugs: nimodipine 1.0 microgram X kg-1 X min-1; nifedipine 0.7 microgram X kg-1 X min-1; nitroglycerin (TNG) 0.5 microgram X kg-1 X min-1; dopamine; micrograms X kg-1 X min-1; placebo (0.9% NaCl). ⋯ In contrast, the increase in cardiac output induced by dopamine (+27%) was accompanied by a significant increase in shunting (+34%). TNG application did not alter Qs/Qt, but pulmonary artery pressure (PAP) decreased markedly (-19%).
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Intensive care medicine · Jan 1982
Randomized Controlled Trial Comparative Study Clinical TrialThe significance of colloid osmotic pressure measurement after crystalloid and colloid infusions.
Colloid osmotic pressure (COP) was followed postoperatively in 55 randomized patients. After minor operations and short-term infusion therapy only small changes of the COP could be observed and it was concluded that after such operations COP measurement is unnecessary. After major surgical interventions, however, COP measurement gave valuable hints. ⋯ The same applied also to preoperative hemodilution. It was unnecessary to substitute the withdrawn blood with a colloid solution. In addition, COP measurement helped to avoid expensive albumin administrations, and indicated colloid overload in cases of pulmonary edema.