Intensive care medicine
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Abnormalities in coagulation and fibrinolysis are frequently observed in septic shock. The most pronounced clinical manifestation is disseminated intravascular coagulation. ⋯ Also in patients with septic shock a dynamic process of coagulation and fibrinolysis is ongoing with evidence of impaired fibrinolysis. These abnormalities have prognostic significance; the extent of disturbances of coagulation and fibrinolysis is related to the development of multiple organ failure and death.
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Intensive care medicine · Jan 1993
Comparative StudyThe use of neuromuscular blocking drugs in the intensive care unit: a US perspective.
Surprisingly little is known about the use of neuromuscular blockers (NMBs) in intensive care units (ICUs) in the USA. Recently, Klessig et al. surveyed anesthesiologists/intensivists in the USA and found that the 55% who responded used NMBs in the ICU in an average of 10 patients per ICU per month. Anxiolytics and analgesics were administered concomitantly with NMBs, but a majority of respondents did not use electrophysiologic measures of the degree of blockade. ⋯ More than half the patients were treated for < or = 24 h, the remainder for 2 days to > 3 weeks. Twitch monitors were used for monitoring the degree of neuromuscular blockade in adult patients, and all patients received sedatives/analgesics. We estimated that the risk of clinically significant, prolonged neuromuscular blockade following the discontinuation of NMBs was 5% per year.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1993
Comparative StudyIntrinsic PEEP determined by static pressure-volume curves--application of a novel automated occlusion method.
Evaluation of new computer-controlled occlusion procedure for determination of intrinsic PEEP in mechanically ventilated patients and comparison with the standard end-expiratory occlusion method. ⋯ Since no significant difference between PEEPi values measured by the inspiratory and expiratory occlusion method (SCASS) was seen, this indicates that no alveolar recruitment occurred during the respiratory cycle. This study demonstrates that the automated occlusion method for measuring Cstat system can also be used with high accuracy for determination of intrinsic PEEP in mechanically ventilated patients.
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Intensive care medicine · Jan 1993
Case ReportsAssessment of lung volume and alveolar pressure during combined high-frequency jet ventilation in a child with adult respiratory distress syndrome.
Lung volume and alveolar pressure were assessed using inductance plethysmography, airway occlusion and pneumotachography in a child with severe adult respiratory distress syndrome during both conventional mechanical and combined high-frequency ventilation (HFJV). The results suggest that improved oxygenation during combined HFJV is associated with higher end-expiratory lung volume and lower peak and mean lung volume and alveolar pressure.
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Intensive care medicine · Jan 1993
Influence of constant sustained positive airway pressure on right ventricular performance.
The detrimental effect of positive airway pressure on right ventricular (RV) performance is controversial and the aim of this study was to determine the effects of constant positive airway pressure without ventilatory fluctuation on RV performance with the aid of a pulmonary arterial catheter equipped with a rapid response thermistor for measuring RV ejection fraction (RVEF) and RV end-diastolic volume index (RVEDVI). ⋯ In most patients, the changes in RVEF, SVI, and RVEDVI did not occur under constant positive airway pressure, therefore the changes reported in mechanically ventilated patients may not attributable to the extent of positive airway pressure but rather to abrupt increases in airway pressure. These appears, however, to be patients whose RV function is so disturbed that they cannot cope with increased afterloads.