Intensive care medicine
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Intensive care medicine · Sep 1996
Randomized Controlled Trial Clinical TrialPostextubation laryngeal edema in adults. Risk factor evaluation and prevention by hydrocortisone.
To evaluate the risk factors for postextubation laryngeal stridor and its prevention by hydrocortisone in adult patients. ⋯ Hydrocortisone did not significantly reduce the incidence of postextubation laryngeal edema or stridor. From the risk factors evaluated, we were unable to demonstrate a statistical correlation between postextubation stidor and the duration of the intubation, the patient's age, the internal diameter of the endotracheal tube, or the route of intubation. However, female patients were more likely to develop this complication.
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Intensive care medicine · Sep 1996
Randomized Controlled Trial Clinical TrialN-acetylcysteine pretreatment of cardiac surgery patients influences plasma neutrophil elastase and neutrophil influx in bronchoalveolar lavage fluid.
Study of leukocyte activation and release of toxic mediators during extracorporeal circulation (ECC). ECC can be used to study the potential protective effect of a pharmacon against neutrophil-mediated lung injury. Clinical studies have indicated that N-acetylcysteine (NAC) may improve systemic oxygenation and reduce the need for ventilatory support when given to patients with acute lung injury. ⋯ Pretreatment with NAC may prevent lung injury by diminishing elastase activity. Since the release of mediators, especially MPO, is not affected, this diminished activity of elastase may be achieved by enhanced inactivation by antiproteases after initial treatment.
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Intensive care medicine · Sep 1996
Comparative Study Clinical Trial Controlled Clinical TrialA comparison of the adrenocortical response during septic shock and after complete recovery.
To compare the adrenocortical response to corticotropin during septic shock and after complete recovery. ⋯ Adrenocortical response to corticotropin is attenuated in patients with septic shock and high-output circulatory failure compared to the response in the much less stressful condition after recovery. The attenuated adrenocortical responsiveness may be explained by effects of circulating mediators from the systemic inflammatory response.
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Intensive care medicine · Sep 1996
Effects of positive end-expiratory pressure on right ventricular function in COPD patients during acute ventilatory failure.
To examine the effects of external positive end-expiratory pressure (PEEP) on right ventricular function in chronic obstructive pulmonary disease (COPD) patients with intrinsic PEEP (PEEPi). ⋯ In COPD patients an external PEEP exceeding 90% of PEEPi causes lung hyperinflation and reduces the CI due to a preload effect. The reduction in RVEDVI seems related to changes in EELV, rather than to changes in transmural pressures, suggesting a lung/heart volume interaction in the cardiac fossa. Thus, in COPD patients, application of an external PEEP level lower than PEEPi may affect right ventricular function.
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Intensive care medicine · Sep 1996
Percutaneous dilatational cricothyroidotomy: outcome with 44 consecutive patients.
To assess the value of the percutaneous dilatational technique in elective cricothyroidotomy. ⋯ Percutaneous dilatational cricothyroidotomy can be a quick, safe technique, as good as the percutaneous subcricoidal approach in ventilated, critically ill patients.