Intensive care medicine
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Intensive care medicine · Jan 1990
ReviewVentilatory management of ARDS: can it affect the outcome?
Animal studies have demonstrated that mechanical ventilation with high peak inspiratory pressure (PIP) results in acute lung injury characterised by hyaline membranes, granulocyte infiltration and increased pulmonary and systemic vascular permeability. This can result in progressive respiratory failure and death. In surfactant deficient lungs this occurs with tidal volumes (Vt) as low as 12 ml/kg, and PIP as low as 25 cm H2O, values which are frequently used clinically. ⋯ It can be prevented or reduced in severity in some animal models by the use of PEEP. It is suggested that the use of high PIP in some patients may result in progressive deterioration of their ARDS, possibly contributing to mortality both from respiratory failure and other causes. It may be very important to limit PIP by reducing Vt even if this results in hypercapnia and a deterioration of oxygenation in the short term.
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Intensive care medicine · Jan 1990
Comment Letter Case ReportsRewarming by extracorporeal circulation.
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We studied five patients in the intensive care unit (ICU) with acute polyneuropathy. All had previously presented severe infectious processes, accompanied by diverse organ failure accompanied by the Adult Respiratory Distress Syndrome (ARDS) in all cases. Two patients died and the three survivors suffered severe motor deficiencies. ⋯ The common causes of polyneuropathy were excluded, but in all cases a nutritional disorder was detected, based on laboratory values of proteins, serum albumin and transferrin. We conclude that polyneuropathy is relatively frequent among critically ill patients and must be closely monitored because of diagnostic difficulties and the repercussions on the progress of these patients. In spite of uncertainties about its cause, it appears to be related to severe infectious processes, ARDS, and nutritional disorders.
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Intensive care medicine · Jan 1990
European attitudes towards ethical problems in intensive care medicine: results of an ethical questionnaire.
A questionnaire was sent to the 590 members of the European Society of Intensive Care Medicine to define both the current practices and the opinions of these specialists on various ethical issues. The answers from 242 (41%) European members were collected and analysed. The first part of the questionnaire was designed to define the criteria for admission to Intensive Care throughout Europe. ⋯ Only 24 (10%) of the respondents stated that they always delivered complete information to their patients and only 31 (13%) thought they should do so. When an iatrogenic incident occurred, only 39 (16%) claimed to relate exactly what had happened, to the patient or their relatives but 121 (50%) thought they should. Informed consent was usually required for surgery or gastroscopy and the administration of a new medication.
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Intensive care medicine · Jan 1990
Measurement of extravascular lung water by thermal-dye dilution technique: mechanisms of cardiac output dependence.
The extent to which extravascular lung water (EVLW) is dependent on cardiac output was analysed in anaesthetized and mechanically ventilated pigs. EVLW was measured by thermal-dye dilution technique, by a fibreoptic thermistor catheter system (system 1), and by a thermistor catheter-external optical cuvette system (system 2). During baseline conditions, at which cardiac output was 3.65 l/min, and EVLW was 11.7 and 7.7 ml/kg b.w. with systems 1 and 2 respectively. ⋯ With system 1 the CO dependence was due to different time constants in thermistor and optical systems, and with appropriate phasing the dependence could be eliminated. With system 2 a large overestimation of the mean transit time difference between the two indicators was seen when cardiac output was low, resulting in overestimation of EVLW. It is concluded that the dependence of EVLW volume on cardiac output is an artefact due to technical problems in the design of the recording equipment rather than a reflection of pulmonary or vascular effects.