Intensive care medicine
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Intensive care medicine · Aug 1996
Clinical TrialRight ventricular myocardial function in ARF patients. PEEP as a challenge for the right heart.
To examine the hemodynamic effects of external positive end-expiratory pressure (PEEP) on right ventricular (RV) function in acute respiratory failure (ARF) patients. ⋯ PEEP affects RV function in ARF patients. The decrease in cardiac output is more often associated with a preload decrease and no change in RV contractility. On the other hand, the finding of increased RV volumes with PEEP may be associated with a reduction in RV myocardial performance. Thus, these results suggest that assessment of RV function by PEEP and preload recruitable stroke work may disclose otherwise unpredictable alterations in RV function.
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Intensive care medicine · Aug 1996
Clinical TrialThe influence of weight on stroke volume determination by means of impedance cardiography in cardiac surgery patients.
Obesity is thought to be one of the conditions in which the impedance cardiographic method is less reliable for estimating stroke volume (SV). This led to the introduction of a weight correction factor, sigma, into the equation according to Sramek and Bernstein. However, no scientific evidence has been published to support the use of this factor. The objectives of the present study are to evaluate the influence of body weight on the accuracy of impedance cardiography and to validate Bernstein's weight correction factor by comparison with thermodilution in patients after coronary bypass surgery. ⋯ Weight significantly influences Sramek and Bernstein's method of impedance cardiography, whereas Kubicek's method is not biased by this factor.
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Intensive care medicine · Aug 1996
Clinical TrialWeaning and extubation in the intensive care unit. Clinical or index-driven approach?
To assess the outcome of a clinical judgement-based approach to weaning and extubation and to adduce the predictive accuracy of various mechanical respiratory indices measured in parallel. ⋯ Bedside clinical judgement of weaning and extubation produces satisfactory outcomes. As a routine, mechanical predictive indices have limited utility.
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Intensive care medicine · Aug 1996
Intermittent hemodialysis in critically ill patients with multiple organ dysfunction syndrome is associated with intestinal intramucosal acidosis.
Conventional intermittent hemodialysis in the critically ill patient can be associated with hemodynamic and respiratory instability. Intermittent hemodialysis induced arterial hypotension might be detrimental. We therefore studied the influence of intermittent hemodialysis on systemic and regional oxygen transport in critically ill patients. ⋯ In critically ill patients with multiple organ dysfunction syndrome intermittent hemodialysis induces an increase in oxygen consumption. Despite higher inotropic support to maintain systemic calculated oxygen delivery intestinal intramucosal acidosis occurs during intermittent hemodialysis and may even persist after the procedure is terminated.
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Intensive care medicine · Aug 1996
Early and late onset bacteremia have different risk factors in trauma patients.
The aim of this study was to identify risk factors and to describe epidemiological patterns for early-(EOB) and late-onset bacteremias (LOB) after trauma. ⋯ Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.