Intensive care medicine
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Intensive care medicine · Sep 2001
Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate.
The indications for the use of thrombolytic agents in massive pulmonary embolism (MPE) remain controversial and it has been suggested that transthoracic echocardiographic (TTE) examination, which is able to detect an associated right ventricular dysfunction, may cast light on this question. The goal of this study was to examine the incidence of acute cor pulmonale (ACP) in MPE, diagnosed on the basis of TTE criteria, its clinical implications and its resolution rate. ⋯ Because none of the TTE measurements in ACP could be used to stratify the severity of MPE, TTE was of no help in deciding on medical thrombolysis. However, depending on its severity, metabolic acidosis could justify a large cooperative study to assess the impact of thrombolytic therapy on mortality rate in this specific group.
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Intensive care medicine · Sep 2001
Letter Case ReportsGemcitabine-associated diffuse alveolar hemorrhage.
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Intensive care medicine · Sep 2001
Comparative Study Clinical Trial Controlled Clinical TrialAspiration of dead space allows isocapnic low tidal volume ventilation in acute lung injury. Relationships to gas exchange and mechanics.
In acute lung injury (ALI) mechanical ventilation damages lungs. We hypothesised that aspiration and replacement of dead space during expiration (ASPIDS) allows normocapnic ventilation at higher end-expiratory pressure (PEEP) and reduced tidal volume (V(T)), peak and plateau pressures (Paw(peak), Paw(plat)), thus avoiding lung damage. ⋯ ASPIDS allowed the use of higher PEEP at lower V(T) and inflation pressure and constant PaCO(2). Multiple Pel/V curves gave insight into the tendency of lungs to collapse.
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Intensive care medicine · Sep 2001
Randomized Controlled Trial Clinical TrialSmoking cessation through comprehensive critical care.
There has been little research on smoking cessation after critical illness. Smokers make up a high percentage of patients admitted to intensive care (ICU) and stopping smoking is one message that should be clearly given to recovering patients. The recovery period provides an important opportunity for patients to quit smoking as the period of sedation and ventilation allows patients to start nicotine withdrawal. ⋯ Twenty out of thirty-one intervention patients and 16/30 control patients were smokers pre-ICU admission. At the 6-month follow-up, previous smokers given the rehabilitation package had a relative risk reduction for smoking of 89% (CI 98%-36%). Smoking cessation after critical illness is aided by the provision of a rehabilitation programme.