The availability of circulating blood volume values alters fluid management in critically ill surgical patients.

Background: This study evaluated whether commercially available blood volume measurements in critically ill surgical patients altered fluid management.

Methods: Patients admitted to the surgical intensive care unit of a tertiary care teaching hospital were prospectively evaluated. The frequency of changes in fluid management when results of blood volume measurements were available was determined.

Using transcutaneous oxygen pressure measurements as selection criteria for activated protein C use.

Background: Limited resources and the expense of Activated Protein C (APC) (drotrecogin alfa) may contribute to the reluctance to utilize this drug in sepsis. Employing the PROWESS criteria resulted in absolute reduction in 28-day mortality of 6.1%, representing a relative risk reduction of 19.

Peripheral blood hematocrit in critically ill surgical patients: an imprecise surrogate of true red blood cell volume.

Background: Peripheral blood hematocrit (red blood cell volume/total blood volume) is conventionally used to determine the need for blood transfusions. In critically ill surgical patients, this variable may not accurately approximate true red blood cell volume. We compared peripheral blood hematocrit to (1) plasma volume, (2) estimated circulating blood volume, and (3) a normalized hematocrit to clarify their relationships.

Circulating blood volume measurements correlate poorly with pulmonary artery catheter measurements.

Background: Determination of the intravascular volume status of a critically ill surgical patient is paramount for appropriate fluid and cardiovascular management. Many clinical parameters have been utilized to estimate intravascular volume but none are precise indicators of circulating blood volume. The purpose of this observational pilot study was to compare measured blood volume with hemodynamic parameters obtained from the pulmonary artery catheter and to determine if incorporation of these measurements altered treatment decisions in critically ill surgical patients.

Traumatic brain injury: outcomes from rural and urban locations over a 5-year period (Part 1).

The national death rates from rural trauma are disproportionately higher compared to urban areas. Traumatic brain injury is a major cause of hospital admissions in Hawai'i. This is the first in a two part series to explore this significant public health concern.

Hypothyroidism and adrenal insufficiency in sepsis and hemorrhagic shock.

Hypothesis: We hypothesized that hypothyroidism and adrenal insufficiency frequently occur together in critically ill patients.

Design: A prospective observational study.

Setting: Surgical intensive care unit of a university-affiliated tertiary referral center.