Critical care medicine
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Critical care medicine · Nov 1999
Comparative StudyAcute respiratory distress syndrome: frequency, clinical course, and costs of care.
To define the occurrence rate of acute respiratory distress syndrome (ARDS) using established criteria in a well-defined general patient population, to study the clinical course of ARDS when patients were ventilated using a "lung-protective" strategy, and to define the total costs of care. ⋯ The outcome of ARDS is unpredictable at the time of onset and also at the time of the worst oxygenation. Keeping the inspiratory pressures low (30-35 cm H2O [2.94 to 3.43 kPa]) reduces the frequency of pneumothorax, and might lower the mortality. Most patients are young, and therefore the costs per saved year of life are low.
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Critical care medicine · Nov 1999
Comparative StudyMechanisms for the diminished neutrophil exudation to secondary inflammatory sites in infected patients with a systemic inflammatory response (sepsis).
To determine the mechanism for the reduced polymorphonuclear neutrophil exudation to secondary inflammatory sites in critically ill patients with infection and systemic inflammatory response (sepsis). ⋯ Septic patients deliver fewer PMNs to secondary inflammatory sites. In addition, neutrophil exudation results in loss of the small priming effect for phagocytosis and bactericidal function induced by sepsis. Failure to produce a gradient to C5a and intravascular shedding of L-selectin may be responsible for this sepsis-induced reduction in neutrophil exudation to secondary inflammatory sites.
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Critical care medicine · Nov 1999
Comparative StudyBlood volume determination by the carbon monoxide method using a new delivery system: accuracy in critically ill humans and precision in an animal model.
To evaluate accuracy and repeatability of blood volume determinations made by the carbon monoxide method, using a ventilator-driven administration system. ⋯ This arrangement is a potential bedside method of estimating blood volume and circulating hemoglobin mass. We have rendered the technique more acceptable clinically by creating a ventilator-driven administration system.
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Critical care medicine · Nov 1999
Comparative StudyComparison of jugular venous oxygen saturation and brain tissue Po2 as monitors of cerebral ischemia after head injury.
To compare the characteristics of jugular venous oxygen saturation (Sjvo2) and brain tissue Po2 (Pbto2) as monitors for cerebral ischemia after severe head injury. Sjvo2 has been useful as a monitor for cerebral ischemia, but it is limited by its inability to identify regional cerebral ischemia. Pbto2 may be superior to Sjvo2 for this purpose, because oxygenation in localized areas of the brain can be monitored. ⋯ The two monitors provide complimentary information, and neither monitor alone identifies all episodes of ischemia. The best strategy for using these monitors is to take advantage of the unique features of each monitor. Sjvo2 should be used as a monitor of global oxygenation; but Pbto2 should be used as a monitor of local oxygenation, ideally with the catheter placed in an area of the brain that is vulnerable to ischemia but that may be salvageable with appropriate treatment.