Critical care medicine
-
Critical care medicine · Mar 1992
Randomized Controlled Trial Comparative Study Clinical TrialUltrasound-facilitated central venous cannulation.
To compare the conventional method for cannulation of the internal jugular vein with the ultrasound-aided technique. ⋯ Ultrasound guidance reduces both the duration of time and the number of punctures required to cannulate the internal jugular vein. The Seldinger technique appears safer for catheterization of the internal jugular vein.
-
Critical care medicine · Mar 1992
Case ReportsInfluence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.
To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. ⋯ Surgical attending physicians rarely used other open inhouse ICU beds when surgical ICU beds were unavailable. Political power, medical provincialism, and income maximization overrode medical suitability in the provision of critical care services.
-
Critical care medicine · Mar 1992
Frequency of chronic lung disease in infants with severe respiratory failure treated with high-frequency ventilation and/or extracorporeal membrane oxygenation.
To assess the frequency of chronic lung disease and factors associated with its development in term infants with severe respiratory failure who receive high-frequency oscillatory ventilation, or high-frequency oscillatory ventilation, and extracorporeal membrane oxygenation (ECMO). ⋯ The frequency of chronic lung disease in ECMO candidates is clinically important. Factors associated with chronic lung disease in ECMO candidates are: the presence of lung hypoplasia, delayed referral, and the need for ECMO to support gas exchange.
-
Critical care medicine · Mar 1992
Comparative StudyContinuous measurement of cardiac output by the Fick principle: clinical validation in intensive care.
To compare continuous measurement of cardiac output by the Fick principle with the thermodilution cardiac output technique in hemodynamically unstable patients. ⋯ Continuous measurement of cardiac output by the Fick principle offers a convenient, reproducible method for hemodynamic monitoring of unstable patients. The variation between the two tested thermodilution techniques is likely to reflect relatively rapid dynamic variation of cardiac output, which is filtered in the 1-min average of cardiac output obtained by the continuous Fick technique.
-
Critical care medicine · Mar 1992
Evaluation of hypoxic brain injury with spinal fluid enzymes, lactate, and pyruvate.
To investigate the prognostic importance in neurologic recovery of the lumbar cerebrospinal fluid (CSF) variables creatine kinase (CK) and brain-type creatine kinase isoenzyme (CK-BB), lactate dehydrogenase (LDH) and its isoenzymes (LDH 1-5), CSF acid phosphatase, beta-D-N-acetylglucosaminidase activity, and CSF lactate, pyruvate, sodium, potassium, and calcium concentrations in patients who experienced cardiac arrest. ⋯ CSF CK, CK-BB, and CSF lactate concentrations reflect a patient's outcome most reliably when measured within 28 to 76 hrs of the cardiac arrest. Similarly, CSF LDH, its isoenzymes 1-3, and CSF acid phosphatase concentrations, when measured at 76 hrs, can be used to monitor the patient's outcome after cardiac arrest. When correlated with Glasgow Coma Scale scores, the closest negative correlation was again seen in CSF CK and CK-BB at 28 and 76 hrs, as well as in LDH, LDH1-3, and acid phosphatase values at 76 hrs. The negative correlation between CSF lactate and Glasgow Coma Scale scores was most distinct at 28 hrs.