Critical care medicine
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Critical care medicine · Aug 1998
Case Reports Comparative StudyDo autopsies of critically ill patients reveal important findings that were clinically undetected?
To determine if autopsies performed on patients who die in the medical intensive care unit (ICU) provide clinically important new information. ⋯ Although the primary clinical diagnosis was accurate in most cases before death, the cause of death was frequently unknown. Almost all autopsies demonstrated new diagnoses, and knowledge of these new findings would have changed medical ICU therapy in many cases. In the critical care setting, autopsies continue to provide information that could be important for education and quality patient care.
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Critical care medicine · Aug 1998
Comparative StudyComparison of sodium bicarbonate, Carbicarb, and THAM during cardiopulmonary resuscitation in dogs.
During cardiopulmonary resuscitation (CPR), elimination of CO2 was shown to be limited by low tissue perfusion, especially when very low perfusion pressures were generated. It has therefore been suggested that sodium bicarbonate (NaHCO3), by producing CO2, might aggravate the hypercarbic component of the existing acidosis and thereby worsen CPR outcome. The objectives of this study were to evaluate the effects of CO2 producing and non-CO2 producing buffers in a canine model of prolonged ventricular fibrillation followed by effective CPR. ⋯ Buffer therapy promotes successful resuscitation after prolonged cardiac arrest, regardless of coronary perfusion pressure. NaHCO3, and to a lesser degree, Carbicarb, are beneficial in promoting early return of spontaneous circulation. When epinephrine is used to promote tissue perfusion, there is no evidence for hypercarbic venous acidosis associated with the use of these CO2 generating buffers.
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Critical care medicine · Aug 1998
Editorial CommentQuality of care: national or international standards?