Although low-dose dopamine has been shown to depress ventilation in a variety of conditions, it does not compromise ventilation in COPD patients either breathing spontaneously or when weaned using pressure support ventilation.
Our study demonstrates poor correlation between hemoglobin measured noninvasively by multiwavelength pulse oximetry and a laboratory hematology analyzer. The difference was greater when the pulse oximetry perfusion index was low, as may occur in shock, hypothermia, or vasoconstriction patients. The multiwavelength pulse oximetry is not sufficiently accurate for clinical use in a cardiovascular intensive care unit.
Application of this simple strategy encourages teamwork and may help improve the quality of care received by our intensive care unit patients.
The underlying cause of sepsis is a dysregulated host response to infection, leading to multiple organ failure. Identifying sepsis is crucial because of the associated pathophysiological, practical, and therapeutic implications, which will determine where and how the patient should be managed. In the absence of an end-of-life decision to limit therapies, the patient should be admitted to the intensive care unit immediately. Importantly, not all patients with sepsis are the same and being able to better characterize them is important. The future will focus on phenotypes to characterize critically ill patients, with or without infection, to enable more appropriate targeting of therapeutic interventions.
It is very important to optimize cardiac output and oxygen delivery by optimizing fluid therapy, and pulse pressure variation can help to identify fluid responsiveness. Dr. Sondergaard is right in underlining all the limitations of pulse pressure variation, but anesthesia provides an ideal setting for the use of pulse pressure variation as there is no spontaneous breathing effort during controlled mechanical ventilation and usually no bronchospasm or right heart failure.Dr. Sondergaard reinforces our provocative statement that we may not have to measure cardiac output during surgery1 when he writes that “YES, we have to measure cardiac output in high-risk surgery to optimize oxygen delivery” without detailing how the measurement can help practically; this sounds to us rather like dogma.
