Intensive care medicine
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Intensive care medicine · Jan 1984
The role of total static lung compliance in the management of severe ARDS unresponsive to conventional treatment.
A group of 36 patients with severe adult respiratory distress syndrome (ARDS) meeting previously established blood gas criteria (mortality rate 90%) became candidates for possible extracorporeal respiratory support [low frequency positive pressure ventilation with extracorporeal CO2 removal (LFPPV-ECCO2R)]. Before connecting the patients to bypass we first switched the patients from conventional mechanical ventilation with positive end expiratory pressure (PEEP) to pressure controlled inverted ratio ventilation (PC-IRV), and then when feasible, to spontaneous breathing with continuous positive airways pressure (CPAP). Forty eight hours after the patients had entered the treatment protocol, only 19 out of the 36 patients in fact required LFPPV-ECCO2R, while 5 were still on PC-IRV, and 12 were on CPAP. ⋯ No patients with a TSLC lower than 25 ml (cm H2O)-1 tolerated either PC-IRV or CPAP, while all patients with a TSLC higher than 30 ml (cm H2O)-1 were successfully treated with CPAP. Borderline patients (TSLC between 25 and 30 ml (cm H2O)-1) had to be treated with PC-IRV for more than 48 h, or were then placed on LFPPV-ECCO2R if Paco2 rose prohibitively. We conclude that TSLC is a most useful measurement in deciding on the best management of patients with severe ARDS, unresponsive to conventional treatment.
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Six patients with acute respiratory failure were treated with high-frequency jet ventilation (HFJV): 3 because they developed barotrauma while on conventional mechanical ventilation (CMV), 2 because of sedative- or PEEP-induced hypotension on CMV, and 1 because of bronchopleural fistula. In all patients, except the one with bronchopleural fistula, who was treated from the start with HFJV, gas exchange before (while on CMV) and after institution of HFJV could be compared. In these five patients, including the two with acute respiratory failure not complicated by barotrauma, gas exchange was better during HFJV than during CMV for the same levels of FIO2 and PEEP. HFJV therefore seems the method of choice for ventilatory support, not only in patients with bronchopulmonary disruption, but also in patients with hemodynamic embarrassment during CMV.
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Intensive care medicine · Jan 1984
Blood coagulation and fibrinolytic factors and their inhibitors in critically ill patients.
In a search for new variables, for the diagnosis of disseminated intravascular coagulation (DIC) and for guidelines of therapy in such conditions, 22 severely ill patients were studied. The diagnosis of DIC was based on determinations of platelet counts, prothrombin complex (Normotest), antithrombin (AT), fibrinogen degradation products and fibrinogen. Nine patients were diagnosed as having DIC, eight patients were referred to a suspected DIC group and five to a group of no DIC. ⋯ The inhibitor capacity (AT, APV and KI) was lower in patients who died than in survivors and decreased still further in those of the non-survivors who had DIC. Thus the inhibitors can be used as predictors of outcome and hopefully for guiding therapy. To establish the diagnosis of DIC we suggest measurement of platelet count, prothrombin complex, plasminogen as well as of the inhibitors.
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Intensive care medicine · Jan 1984
Case ReportsRecurrent torsade de pointes type ventricular tachycardia in intracranial hemorrhage.
Two out of 72 cases of intracranial hemorrhage-induced polymorphous ventricular tachycardia with typical Torsade de Pointes morphology are presented. Both patients had marked QTc prolongation more than 550 ms. ⋯ Even though polymorphous Torsade de Pointes type ventricular tachycardia is rare during the clinical course of intracranial hemorrhage, attention should be given to the QT interval. QTc prolongation more than 550 ms may carry a high risk of Torsade de Pointes type ventricular tachycardia and ventricular fibrillation.
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Intensive care medicine · Jan 1984
Case ReportsUpper airway obstruction caused by massive subcutaneous emphysema.
Acute upper airway obstruction is a potentially life-threatening event. The most common causes include foreign body inhalation, thermal injury, inflammation, angioedema and trauma. Airway obstruction caused by submucosal extension of subcutaneous emphysema has only been previously reported once. We report the case of a patient who suffered a respiratory arrest as a result of hypopharyngeal and laryngeal swelling associated with massive subcutaneous emphysema.