2,833 publications from this institution
Dobutamine administration has been shown to increase oxygen delivery in various conditions, but there are little data to document its effects in septic shock. We investigated the effects of dobutamine infusion at a rate of 5 micrograms/kg.min in 18 patients (mean 60 +/- 16 yr) with septic shock initially characterized by hypotension, oliguria, and hyperlactatemia in the presence of a documented source of sepsis. Early resuscitation had consisted of fluid administration and vasopressors when required. When added to this standard regimen, dobutamine had no significant effect on mean arterial pressure (MAP) (from 71 +/- 12 to 73 +/- 13 mm Hg), but markedly increased cardiac index (from 3.0 +/- 0.7 to 3.9 +/- 1.0 L/min.m2, p less than .001), stroke index (from 32 +/- 8 to 37 +/- 9 ml/m2, p less than .001) and oxygen transport (from 410 +/- 105 to 530 +/- 146 ml/min.m2, p less than .001). Oxygen consumption (VO2) increased concurrently (from 137 +/- 42 to 162 +/- 66 ml/min.m2, p less than .002). MAP increased (from 68 +/- 9 to 76 +/- 11 mm Hg) in 12 patients and decreased moderately (from 76 +/- 18 to 69 +/- 17 mm Hg) in six patients. The two subgroups of patients had similar hemodynamic profiles before the dobutamine infusion, but vasopressor therapy was already used in one of the 12 patients in the first subgroup and in three of the six patients in the second subgroup (p less than .05).(ABSTRACT TRUNCATED AT 250 WORDS)
Critically ill patients are carefully and closely monitored to assess the nature and severity of their disease process and to assess the need for and impact of different therapies. All organs can be monitored, some more easily than others, with hemodynamic monitoring of the cardiovascular system being the most frequent. Hemodynamic monitoring techniques have progressed immensely since thevery early days of intensive care and perhaps particularly over the past 50 years, moving from the very earliest, bulky sphygmographs to measure arterial pressure, to invasive catheters to assess cardiac output, to the more recent development of noninvasive, digital monitors providing continuous values ofmultiple hemodynamic variables. Concepts have also changed as we move from global macrohemodynamic monitoring toward a more regional, microcirculatory perfusion approach and frommaximal monitoring for all, to a much more individualized approach. Here, we will briefly review these changes.
Traditional argument theories focus on how the structure of statements determinestheir contribution to an argument. Such theories are useful in analysing arguments asproducts, or for analysing the sub-arguments that are generated during anargumentation. This paper outlines a method for analysing an argumentation as aprocess, focusing on the social interactions between pairs of Year 8 students and theteacher-researcher in the context of geometric reasoning
Acute renal failure often has a complex origin, especially in critically ill patient. Moreover, the tools for investigation of renal failure are generally unspecific, so that the work-up must be based on several elements. It is particularly important to differentiate failure of the kidney itself from prerenal or postrenal failure, since the therapeutic implications are very different. We propose to base the investigation of acute renal failure on some elements to be evaluated in a rapid succession. The complete evaluation should also take into account the consequences of renal failure, which also have therapeutic implications.
