Abstract:
OBJECTIVES:To determine the accuracy of intramucosal pH (pHi) calculated using arterial bicarbonate instead of mucosal capillary bicarbonate in the Henderson-Hasselbalch equation. DESIGN:Simulation of progressive ischemia in mucosal capillary blood. SETTING:University research laboratory. SUBJECTS:Normal human blood diluted with plasma. INTERVENTIONS:Three venous blood specimens were heparinized and diluted to a mean hemoglobin concentration of 5.0 (+/-0.9) g/dL by addition of plasma (2:1, vol:vol). Mucosal capillary aerobic flow stagnation was simulated by multiple exposures of each cooled specimen to a gas mixture containing 90% nitrogen and 10% CO2. When PCO2 measured at 37 degrees C (98.6 degrees F) was approximately 120 torr (16 kPa), the assigned anaerobic threshold, subsequent anaerobic flow stagnation was simulated by mixing the hypercapnic specimens in sealed syringes with five to six successive small aliquots (<100 microL) of lactic acid (10 g/L). MEASUREMENTS AND MAIN RESULTS:The relationship between Pco2 and pH in the specimens was compared with the relationship between the same PCO2 values and pHi calculated by substituting bicarbonate concentrations of 22 and 26 mmol/L in the Henderson-Hasselbalch equation. As PCO2 rose from 50 torr (8 kPa), conventionally calculated pHi increasingly underestimated simulated mucosal capillary pH, with bias >0.1 pH unit at the simulated anaerobic threshold of 120 torr (16 kPa). As PCO2 rose further the values converged, becoming equivalent at PCO2 approximately 150 torr (20 kPa). From PCO2 > or =200 torr (26.7 kPa), conventional pHi progressively overestimated simulated mucosal pH. The difference was >0.3 pH units at PCO2 = 250 torr (33.3 kPa). CONCLUSIONS:In the mucosal PCO2 range usually encountered clinically, the arterial bicarbonate substitution causes underestimation of mucosal capillary pH. With moderate mucosal capillary lactic acidosis the error becomes small, and in severe regional ischemia there is significant overestimation of mucosal capillary pH.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Morgan TJ,Venkatesh B,Endre ZHdoi
10.1097/00003246-199911000-00028subject
Has Abstractpub_date
1999-11-01 00:00:00pages
2495-9issue
11eissn
0090-3493issn
1530-0293journal_volume
27pub_type
杂志文章abstract::The tradition of clinical ultrasound in the hands of physicians who provide critical care to the most acutely ill patients stretches back into the 1980s and is rich with experiences from surgical, emergency medicine, and other practices. Now, as critical care ultrasound explodes around the world, it is important to re...
journal_title:Critical care medicine
pub_type: 历史文章,杂志文章
doi:10.1097/01.CCM.0000260623.38982.83
更新日期:2007-05-01 00:00:00
abstract:OBJECTIVE:When a patient is incompetent, the family is often considered to be a natural surrogate. The doctors' responsiveness to family wishes may vary. We explored if doctors' personal characteristics were associated with responsiveness to the relatives' wishes when admission to the intensive care unit (ICU) is consi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181958409
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVES:Our understanding of the acute respiratory distress syndrome in children is limited, and literature is dominated by investigations in adult patients. Recent preclinical studies suggest that the susceptibility to and severity of acute respiratory distress syndrome in children could differ from that in adults....
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1097/CCM.0000000000001388
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:To discuss the potential therapeutic value of intraluminal oxygenation of the gut in critical illness. DATA SOURCES:Relevant articles published in the English language literature. STUDY SELECTION:No special study has been carried out for the present presentation. DATA EXTRACTION:Information from the litera...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199302001-00012
更新日期:1993-02-01 00:00:00
abstract::Newer pulmonary function instruments make measurement of small airway function possible as a routine, inexpensive part of preoperative preparation of patients with obstructive lung disease. Patients with early stages of chronic obstructive lung disease have maldistribution of ventilation and perfusion producing an inc...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197507000-00001
更新日期:1975-07-01 00:00:00
abstract:OBJECTIVE:Fibrotic changes are initiated early in acute respiratory distress syndrome. This may involve overproliferation of alveolar type II cells. In an animal model of acute respiratory distress syndrome, we have shown that the administration of an adenoviral vector overexpressing the 70-kd heat shock protein (AdHSP...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000295473.56522.EF
更新日期:2008-01-01 00:00:00
abstract:OBJECTIVES:To assess trends in the use of extracorporeal membrane oxygenation for poisoning in the United States. DESIGN:Retrospective cohort study. SETTING:The National Poison Data System, the databased owned and managed by the American Association of Poison Control Centers, the organization that supports and accred...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004401
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:To provide a comprehensive review of the issue related to the administration of sedative, analgesic, and neuromuscular blocking agents (NMBA) to patients who are receiving ventilatory support for acute respiratory distress syndrome (ARDS) with high-frequency oscillatory ventilation. RESULTS:Sedative, analges...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000156794.96880.df
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the frequency and clinical correlates of ultrafilterable hypomagnesemia in neonates admitted to the neonatal intensive care unit (ICU). DESIGN:Prospective, observational study. SETTING:Massachusetts General Hospital and Mount Auburn Hospital. PATIENTS:A total of 117 patients (84 neonatal ICU pa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199405000-00017
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVES:Capillary refill time is a noninvasive method to assess tissue perfusion to determine shock status. Capillary refill time is defined as the time required to regain skin color after blanching pressure is applied. Although common methods to measure capillary refill time depend on clinicians' visual assessment,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004506
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:Over 2,500 children undergo hematopoietic stem cell transplantation in the United States each year, and up to 35% require PICU support for life-threatening complications. PICU mortality has dropped from 85% to 44%, but interpretation is confounded by significant cohort heterogeneity. Reports conflict regardi...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001085
更新日期:2015-09-01 00:00:00
abstract:OBJECTIVE:To explore ethnic differences in do-not-resuscitate orders after intracerebral hemorrhage. DESIGN:Population-based surveillance. SETTING:Corpus Christi, Texas. PATIENTS:All cases of intracerebral hemorrhage in the community of Corpus Christi, TX were ascertained as part of the Brain Attack Surveillance in ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a56755
更新日期:2009-10-01 00:00:00
abstract:OBJECTIVE:To determine the feasibility of utilizing a scintigraphic technique to differentiate patients with adult respiratory distress syndrome due to sepsis syndrome from control volunteers and patients with congestive heart failure. Gamma scintigraphy was compared with chest roentgenograms to predict mortality rate ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199201000-00012
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:To determine the effects of a hydroxyethyl starch-deferoxamine conjugate on hepatic microcirculation in an isobaric, anesthetized rat model of hemorrhagic shock and asanguineous resuscitation. DESIGN:Prospective, randomized, controlled study. SETTING:Laboratory at a university hospital. SUBJECTS:Twenty-thr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199502000-00018
更新日期:1995-02-01 00:00:00
abstract:OBJECTIVE:To address issues of antibiotic dosing during sustained low-efficiency dialysis by using available pharmacokinetic data, intermittent and continuous renal replacement therapy dialysis guidelines, and our experience with sustained low-efficiency dialysis. DATA RESOURCES:Published clinical trials, case reports...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318206c3b2
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:To investigate relationships between acute adrenergic stress, plasma catecholamine concentrations, and beta 2-adrenergic receptors. DESIGN:Prospective, descriptive study. SETTING:Emergency medical service at a university hospital. PATIENTS:Twenty-seven patients with out-of-hospital cardiac arrest (n = 11),...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199704000-00015
更新日期:1997-04-01 00:00:00
abstract:OBJECTIVE:We hypothesized that the extent of injury and release of xanthine oxidase, an oxidant generator, into the circulation would be less in normal-flow hypoxia-reoxygenation than in equal duration no-flow ischemia-reperfusion. DESIGN:Randomized study. SETTING:University-based animal research facility. SUBJECTS:...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199806000-00034
更新日期:1998-06-01 00:00:00
abstract:OBJECTIVE:To investigate the relationship between behavioral alterations and changes in monoaminergic systems provoked by ischemia-reperfusion liver injury in rats. DESIGN:Prospective, randomized, controlled animal study. SETTING:University animal laboratory. SUBJECTS:Male Wistar rats. INTERVENTIONS:Acute liver fai...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199804000-00021
更新日期:1998-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the use of the selective alpha 1-adrenergic receptor agonist phenylephrine in the hemodynamic support of patients with septic shock. DESIGN:Retrospective analysis of clinical use of phenylephrine. SETTING:Surgical ICU in a university hospital. PATIENTS:Thirteen patients with septic shock (diagn...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199111000-00016
更新日期:1991-11-01 00:00:00
abstract::Previously, we determined that a colloid concentration of about 3% was optimal for resuscitation of lethal ischemic intestinal shock model in rats. Maximal volumes of lactated Ringer's solution (RL) alone only expanded plasma volume (PV) to 80% of preshock level, while increasing volumes of 3% albumin (ALB) in RL line...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199001000-00014
更新日期:1990-01-01 00:00:00
abstract::The right atrial pressure (Pra) was compared to the pulmonary capillary wedge pressure (Pcw) in 54 patients. In patients with heart disease, the correlation of Pra with Pcw was poor. However, in patients without clinical heart disease, Pra approximated Pcw, in both absolute number and change. This finding was independ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197805000-00010
更新日期:1978-05-01 00:00:00
abstract:OBJECTIVE:To describe the experience of pediatric intensive care hospitalization from the perspective of a parents of children with severe, antecedent disability. DESIGN:Qualitative analysis of data obtained through semistructured interviews. SETTING:Pediatric intensive care unit (PICU) in a children's hospital. SUB...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a00578
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:To determine whether the energy expenditure of mechanically ventilated multiple trauma patients correlates with the severity of injury and illness indices before important systemic infection has complicated the clinical course, and to compare the energy expenditure with the energy expenditure expected from th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199912000-00013
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVE:To evaluate the safety and physiologic actions of ibuprofen in patients with severe sepsis. DESIGN:Randomized, double-blind, placebo-controlled trial. SETTING:Three university hospital medical ICUs. PATIENTS:Twenty-nine patients with clinical evidence of sepsis and the need for hemodynamic monitoring with ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00003246-199111000-00006
更新日期:1991-11-01 00:00:00
abstract:OBJECTIVE:Review data obtained from high-frequency oscillatory ventilation (HFOV) and mechanical test lung models with respect to delivered tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical conditions. DESIGN:Review of selected studies from PubMed, published abstracts, an...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000155924.74942.7f
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVES:Acute renal failure is a complication in critically ill patients that has been associated with an excess risk of hospital mortality. Whether this reflects the severity of the disease or whether acute renal failure is an independent risk factor is unknown. The aim of this study was to analyze severity of illn...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-200209000-00016
更新日期:2002-09-01 00:00:00
abstract:OBJECTIVE:Therapeutic hypothermia in the ICU requires mechanical ventilation and sedation. Hypothermia reduces the metabolism of commonly used IV sedatives. The use of long-acting sedative agents may confound neurologic assessment. Volatile anesthetics have been reported to provide protection against ischemia-reperfusi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182a643d7
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVES:Anaphylactic shock is associated with severe hypotension. Potassium channel blockers, such as 4-aminopyridine, induce vasoconstriction. The objective of this study was to test the ability of 4-aminopyridine to restore blood pressure and increase survival in anaphylactic shock. DESIGN:Experimental study. SE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001822
更新日期:2016-11-01 00:00:00
abstract::We studied prospectively 40 critically ill neurosurgical patients who required prolonged mechanical ventilation to determine the current incidence of stress-related gastroduodenal erosions and ulcers, and to assess endoscopically the efficacy of acid-reducing prophylactic treatment. Nineteen patients were randomized t...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199003000-00004
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:To analyze the effects of an extracorporeal bioartificial liver containing alginate bead-entrapped hepatocytes on pigs with ischemia-induced acute hepatic failure. DESIGN:Prospective animal study. SETTING:University and INSERM laboratory. SUBJECTS:Fifteen Large White/Pietrin female pigs weighing 20-30 kg. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200203000-00027
更新日期:2002-03-01 00:00:00