Abstract:
BACKGROUND:Increased cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) patterns were shown to characterize the physiologic status of surviving high-risk surgical patients, and indicate increased metabolic needs; relatively normal DO2 and VO2 values were found to characterize the sequential pattern of nonsurvivors who developed an early oxygen debt followed by lethal organ failure. The cardiac index, DO2, and VO2 values empirically determined from survivors' patterns were shown to improve outcome in prospective randomized trials. The present study considers these criteria to evaluate the tissue perfusion status as well as the effects of therapy on tissue perfusion and oxygenation. OBJECTIVE:To summarize new information on the temporal patterns of DO2, VO2, and oxygen debt on outcome and the effects of fluids and inotropes on these patterns in a wide range of clinical, temporal, and physiologic conditions. DESIGN:Descriptive analysis based on data gathered prospectively using a specified protocol. PATIENTS:High-risk patients with accidental or elective surgical trauma, and patients with or without sepsis or septic shock and organ failure. SETTING:University-run county hospital with a large trauma service. INTERVENTIONS:Fluids, dobutamine, and dopamine at various times and at various doses throughout critical illness of postoperative, posttraumatic, septic, and hypovolemic patients with and without lethal and nonlethal organ failure. MEASUREMENTS AND MAIN RESULTS:The pattern of DO2 plotted against the corresponding VO2 values in 437 consecutive critically ill surgical patients showed a wide variability and poor correlation probably because complex clinical conditions may obscure the supply-dependent and supply-independent VO2 relationships observed in normal dogs bled or given bacterial infusions. However, the use of specific therapy by well-defined protocols was shown to provide objective evidence of efficacy. Significant increases in DO2 and VO2 were previously shown after whole blood, packed red cells, and colloid administration, but not after crystalloid administration. Dobutamine administration in 715 circumstances in postoperative, traumatic, septic patients and patients with adult respiratory distress syndrome, renal failure, and multiple organ failure significantly improved DO2 and VO2. Dopamine under comparable conditions produced less improvement in DO2 and VO2 than that of dobutamine; most of the VO2 changes were not significant. CONCLUSIONS:The monitored patterns of cardiac index, DO2, and VO2 may be used to evaluate the adequacy of tissue perfusion as well as the relative effectiveness of alternative therapies. Second, these physiologic criteria may be used to titrate therapy in order to achieve optimal outcome. Third, after colloids optimally expand the plasma volume, dobutamine may be used to enhance flow and the distribution of flow in order to improve tissue oxygenation. Vasodilators may be used when hypertensive episodes occur or there is an inadequate response to inotropic agents. Vasopressors are used as a last resort, usually in the terminal or preterminal state.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Shoemaker WC,Appel PL,Kram HBdoi
10.1097/00003246-199105000-00014subject
Has Abstractpub_date
1991-05-01 00:00:00pages
672-88issue
5eissn
0090-3493issn
1530-0293journal_volume
19pub_type
杂志文章abstract::This study evaluates the recall of 100 patients after ICU admission. There was a wide spectrum of race, religion, occupation, and educational levels. The more common diagnoses included asthma, pneumonia, trauma, and adult respiratory distress syndrome. The average Acute Physiology and Chronic Health Evaluation (APACHE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199009000-00012
更新日期:1990-09-01 00:00:00
abstract:OBJECTIVES:To study the relation between nitrite, nitrate, nitrotyrosine, and nitrosothiols as NO indices in human septic shock. DESIGN:A prospective clinical study. SETTING:Intensive care units in a university hospital and a central county hospital. PATIENTS:Sixteen patients admitted for septic shock. Nine healthy ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200008000-00017
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:To determine the impact of the rotation of antimicrobial agents on the rates of infection, intestinal colonization, and acquisition with antimicrobial-resistant Gram-negative bacteria. DESIGN:Pre- and postintervention design. SETTING:A 19-bed, medical intensive care unit. PATIENTS:Individuals admitted to t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000147685.79487.28
更新日期:2004-12-01 00:00:00
abstract:OBJECTIVES:To investigate the frequency, types, and implications of complications during intensive care in patients after status epilepticus has been successfully terminated. DESIGN:Retrospective study. SETTING:ICUs at a Swiss tertiary academic medical care center. PATIENTS:Data were collected from the digital patie...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004642
更新日期:2020-12-01 00:00:00
abstract:BACKGROUND AND METHODS:Twelve adult male albino rabbits were assigned alternately to normotensive and hypotensive groups to assess the effect of hypovolemic shock on spontaneous correction of dilutional coagulopathy. All animals underwent dilutional exchange transfusion with 200 mL of rabbit RBCs and 5% human albumin. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199102000-00022
更新日期:1991-02-01 00:00:00
abstract:OBJECTIVE:Develop a scoring system that can assess the management of septic shock by individuals and teams. DESIGN:Retrospective review of videotapes of critical care house staff managing a standardized simulation of septic shock. SETTING:Academic medical center; videotapes were made in a recreated intensive care uni...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000256849.75799.20
更新日期:2007-03-01 00:00:00
abstract::In the development of triage and bypass protocols, many different scoring systems and triage criteria are being used. Our purpose was to evaluate the Revised Trauma Index (RTI) as a triage tool for both its severity prediction ability and triage accuracy. A total of 2,340 trauma admissions were evaluated using the RTI...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199002000-00010
更新日期:1990-02-01 00:00:00
abstract::Last year, >28,000 people received organ transplants from >14,000 donors in the United States. Unfortunately, the wait list now tops 91,000, with the gap between recipient needs and available donor organs at around 60,000. This has motivated a host of efforts to increase organ supply, including driver's license and do...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000252915.76019.19
更新日期:2007-02-01 00:00:00
abstract::A difference between potassium concentrations in arterial plasma and venous serum was evaluated. The difference was 0.5 mM/litre, with a range of 0.1 to 1.1 mM/liter. Multiple factors operating primarily upon the venous sample are responsible for this difference. The value for arterial plasma potassium is stable and p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197809000-00008
更新日期:1978-09-01 00:00:00
abstract::The Hemoccult slide test is used frequently to test for the presence of occult blood in samples of gastric juice obtained from critically ill patients. The purpose of this study was to investigate the accuracy of this test to determine the presence of blood in human gastric juice at various pH values. Gastric aspirate...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198210000-00016
更新日期:1982-10-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that hyperbaric oxygen therapy ameliorates delayed cognitive impairment after acute carbon monoxide poisoning by promoting neurogenesis through upregulating the brain-derived neurotrophic factor in the hippocampus. DESIGN:Laboratory animal experiments. SETTING:University/Medical cente...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001299
更新日期:2016-01-01 00:00:00
abstract::Although systolic dysfunction of the left ventricle has been characterized in septic shock (SS) and sepsis without shock (SWS), diastolic abnormalities are less well characterized. Diastolic filling was determined using pulsed Doppler transmitral spectral tracings in 13 patients with SS, ten patients with SWS, and 33 ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199007000-00005
更新日期:1990-07-01 00:00:00
abstract:OBJECTIVE:To study the effects of high-dose epinephrine, compared with standard-dose epinephrine, on the dynamics of superficial cortical cerebral blood flow as well as global cerebral oxygenation during experimental cardiopulmonary resuscitation. We hypothesized that high-dose epinephrine might be unable to improve ce...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200005000-00028
更新日期:2000-05-01 00:00:00
abstract:OBJECTIVE:The beneficial effects of hypertonic saline on neuronal survival and on cerebral blood flow have been shown in several animal models of global and focal brain ischemia. Because of the potential benefits of hypertonic solutions, it is hypothesized that hydroxyethyl starch enhances cerebral blood flow and impro...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31824e6750
更新日期:2012-07-01 00:00:00
abstract::We report a case of an amniotic fluid embolism (AFE) causing a cardiorespiratory arrest associated temporally with ingestion of castor oil in a full-term normal pregnancy. Risk factors usually associated with AFE were not found in this patient. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198806000-00016
更新日期:1988-06-01 00:00:00
abstract:OBJECTIVE:To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN:Prospective, observational, cohort study. SETTING:Twelve French medical or surgical intensive care un...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000251134.96055.A6
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVES:Radial artery pressure is known to differ from central arterial pressure in normal patients (distal pulse amplification) and in the early postcardiopulmonary bypass period. The adequacy of the radial artery as a site for blood pressure monitoring in critically ill patients receiving high-dose vasopressors ha...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199810000-00014
更新日期:1998-10-01 00:00:00
abstract:OBJECTIVE:Significant mortality in patients with sepsis results from the development of multiple organ dysfunction syndrome. Small-volume resuscitation with 7.5% NaCl hypertonic saline has been proposed to restore physiologic hemodynamics in hemorrhagic shock. Therefore, we hypothesized that hypertonic saline resuscita...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318173f982
更新日期:2008-06-01 00:00:00
abstract::Previous studies have confirmed the improved tolerance of a peptide enteral compared to standard enteral alimentation in hypoalbuminemic, critically ill patients. Animal studies, including hypoproteinemic, volume-expanded rats, demonstrated that the protein hydrolysate of a peptide enteral formula was responsible for ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198907000-00012
更新日期:1989-07-01 00:00:00
abstract::Traumatic injuries occur in > 20 million children each year and are the leading source of death in children over the age of 1 yr. Mechanisms of injury and subsequent therapies for critically injured children are diverse. This review will focus on resources and management strategies for caring for the severely injured ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200211001-00013
更新日期:2002-11-01 00:00:00
abstract::Computerized gamma scintigraphy revealed a significant (p less than 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both 99mTechnetium-tagged human serum albumin (99mTc-HSA) and 99mTechnetium-tagged red blood cells (99Tc-RBC) after 0.05 or 0.2 ml/kg iv oleic...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198201000-00008
更新日期:1982-01-01 00:00:00
abstract::The relationship between oxygen uptake (Vo2) and delivery (Do2) was examined in 64 patients immediately after cardiopulmonary bypass. In 44 patients with lactate levels below 2.5 mmol/L, Vo2 decreased proportionally when Do2 decreased below 300 ml/min X m2. At a Do2 over this level, Vo2 plateaued at 105 +/- 13 (SD) ml...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198703000-00002
更新日期:1987-03-01 00:00:00
abstract:OBJECTIVES:Thrombotic microangiopathy syndromes are a heterogeneous group of severe diseases that often require ICU admission. Prompt initiation of targeted therapies is required for atypical hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, whereas there is no specific consensus therapy for Shiga toxi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003292
更新日期:2018-09-01 00:00:00
abstract:BACKGROUND:Nutritional support is an essential component of the management of critically ill and injured ICU patients. Optimal provision of calories and protein has been demonstrated to reduce morbidity, mortally, and length of ICU and hospital stay. Yet, a large proportion of ICU patients receive inadequate nutrition....
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0000000000000051
更新日期:2014-04-01 00:00:00
abstract:OBJECTIVE:To examine the pulmonary and cardiac function of children who survived an episode of acute hypoxemic respiratory failure. DESIGN:Descriptive cohort analysis. SETTING:Pediatric clinical research center of a university hospital. PATIENTS:Utilizing the criteria of PaO2 < 75 torr (< 10 kPa) with an FIO2 of > 0...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199601000-00024
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:To compare the classification performance of the Revised Atlanta Classification, the Determinant-Based Classification, and a new modified Determinant-Based Classification according to observed mortality and morbidity. DESIGN:A prospective multicenter observational study conducted in 1-year period. SETTING:F...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001565
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVES:Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fib...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003806
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVES:Extracorporeal membrane oxygenation is increasingly used in the management of severe acute respiratory distress syndrome. With extracorporeal membrane oxygenation, select patients with acute respiratory distress syndrome can be managed without mechanical ventilation, sedation, or neuromuscular blockade. Publ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003354
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients. ...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-199507000-00021
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVE:Inadequate nutrition is common in critical illness due in part to gastric stasis. However, recent data suggest that altered small intestinal mucosal function may be a contributing factor. The aim of this study was to examine the effects of critical illness on sucrose absorption, permeability, and mucosal morp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31827ca2fa
更新日期:2013-05-01 00:00:00