Critical care medicine
-
Critical care medicine · Jun 1994
Comparative Study Clinical Trial Retracted PublicationCardiopulmonary actions of intravenously administered enalaprilat in trauma patients.
To determine the cardiopulmonary actions of the intravenous administration of the angiotensin-converting enzyme inhibitor enalaprilat in hypertensive trauma patients. ⋯ The intravenous administration of enalaprilat successfully decreased blood pressure in most of our patients. Mechanisms other than the renin-angiotensin system also appear to be involved in hypertensive, critically ill patients. Pulmonary function was not altered; right ventricular function, and both oxygen consumption and oxygen delivery improved in the enalaprilat responder group. Thus, the availability of intravenous enalaprilat seems to enlarge our armamentarium for treating hypertension in the critically ill patient.
-
Critical care medicine · Jun 1989
Retracted PublicationInfluence of acute volume loading on right ventricular function after cardiopulmonary bypass.
The influence of acute volume loading on right ventricular function immediately after extracorporeal circulation (ECC) was investigated in 25 patients undergoing elective aortocoronary bypass grafting. In addition to commonly monitored hemodynamic variables, right ventricular (RV) ejection fraction (EF) was measured by thermodilution technique using a new fast-response thermodilution catheter. In eight patients with concomitant severe stenosis (greater than 89%) of the right coronary artery (RCA), volume loading was followed by a decreased RVEF and cardiac output. ⋯ Increased end-diastolic volume and decreased RV contractility index indicated that patients with myocardial ischemia during cardiac surgery procedures sometimes were unable to make the adaptations required. We conclude that cardiocirculatory dysfunction associated with ECC may be caused by depressed RV function. Acute volume loading in this situation may lead to further deterioration of myocardial function due to RV failure, a condition which cannot be diagnosed readily at the bedside with the usual monitoring techniques.
-
Critical care medicine · Apr 1988
Randomized Controlled Trial Comparative Study Clinical Trial Retracted PublicationInfluence of acute normovolemic hemodilution on extravascular lung water in cardiac surgery.
Preoperative hemodilution (HD) is an established blood-saving method. With HD, however, a concomitant increase in extracellular and interstitial water has been reported. This randomized study was undertaken to compare the effects of acute normovolemic HD (10 ml/kg; n = 15) using hydroxyethyl starch solution (HES) on extravascular lung water (EVLW) with those of an untreated control group (n = 15) of cardiac surgery patients submitted to extracorporeal circulation (ECC). ⋯ Hemodynamic and laboratory variables indicated the typical changes during HD (cardiac index increases while albumin concentration decreases); circulatory stability was maintained during the entire study. We conclude that preoperative normovolemic HD did not increase lung water content significantly nor compromise pulmonary function even in cardiac surgery patients. Although ECC provides an additional HD (crystalloid priming of the heart-lung bypass machine) and possibly damage of capillary integrity, the two groups did not differ.