Anaesthesia and intensive care
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Anaesth Intensive Care · Nov 1992
Fibreoptic bronchoscopy in the critically ill: a prospective study of its diagnostic and therapeutic value.
A prospective study was undertaken to assess the diagnostic value and therapeutic usefulness of fibreoptic bronchoscopy in the critically ill. ⋯ The use of fibreoptic bronchoscopy in the Intensive Care Unit, in combination with the technique of broncho-alveolar lavage, results in a clinically useful outcome in the majority of cases. Fibreoptic bronchoscopy is an effective and safe diagnostic and therapeutic tool in critically ill patients.
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Anaesth Intensive Care · Nov 1992
A clinical evaluation of the Hemocue haemoglobinometer using capillary, venous and arterial samples.
The 'Hemocue' device for rapid estimation of haemoglobin concentration was evaluated in a clinical setting. Repeatable accuracy of capillary, venous and arterial samples was examined and then compared with standard laboratory venous haemoglobin estimates using a 'Coulter JT' analyser in 42 patients. The mean values for haemoglobin (g/l) and coefficient of variation were capillary 108.2 (8.0); venous 104.9 (2.2); arterial 105.9 (2.0); and laboratory venous 104.6 (1.3). ⋯ Peripheral skin temperature did not influence the accuracy of capillary samples. Hemocue estimations of venous samples were found to be as accurate as laboratory estimations. The lack of repeatable accuracy of capillary estimations was sufficiently large that their use cannot be recommended in clinical practice.
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Anaesth Intensive Care · Nov 1992
Comparative StudyDerived oxygen saturations are not clinically useful for the calculation of oxygen consumption.
In critically ill patients, oxygen consumption (VO2) and delivery (DO2) are used to determine optimal haemodynamic management and to grade severity of illness. VO2 may be measured by indirect calorimetry with metabolic gas monitoring systems or derived using the reverse Fick principle. Oxygen saturation (SaO2) may be measured directly by co-oximetry or derived by equations for incorporation into reverse Fick equations. ⋯ When SaO2 was calculated from three logarithmic equations and incorporated into the reverse Fick equations, calculated VO2's were significantly greater (P < 0.001) than those measured by indirect calorimetry. Correlation was poor and wide limits of agreement (-118 to +350 ml/min) were demonstrated. VO2 should ideally be measured by indirect calorimetry in the critically ill, or if reverse Fick is used, SaO2 should be measured by co-oximetry as the use of equations for clinical measurement of SaO2 is clinically suspect.