Intensive care medicine
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Successful organ transplantation offers patients with end stage organ failure the chance of a normal life. The recognition of brain death allowed the use of beating heart donors and this has enabled multiple organ procurement from a single donor. Suitable patients with severe brain injury resulting in brain death, who may be potential organ donors, are to be found on both neurosurgical and general intensive care units. ⋯ The management of brain injury before death often results in abnormalities of fluid balance, due to fluid restriction and diuretic therapy. Other problems such as acute endocrine failure and the impact of their correction on ultimate organ function remains to be elucidated. Good donor maintenance in the intensive care unit and operating theatre is essential if optimal function of the transplanted organ is to occur.
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Intensive care medicine · Jan 1989
Case ReportsEffect of positional change on ventilation-perfusion distribution in unilateral pleural effusion.
The effect of pleural effusion on lung function and gas exchange has not been adequately defined. We used the multiple "inert" gas technique to study gas exchange and ventilation-perfusion relationships in both the left and the right lateral decubitus positions in a patient with a moderate unilateral (left) pleural effusion. ⋯ The ventilation-perfusion relationships were also nearly identical for both body positions. We conclude that a pleural effusion of moderate size has little effect on overall gas exchange and ventilation-perfusion relationships and that complex mechanisms of the respiratory system compensate for the effusion.
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Intensive care medicine · Jan 1989
The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs.
Both tidal volume and effective blood volume may affect the variation in the arterial pressure waveform during mechanical ventilation. The systolic pressure variation (SPV), which is the difference between the maximal and minimal systolic pressure values following one positive pressure breath was analyzed in 10 anesthetized and ventilated dogs, during ventilation with tidal volumes of 15 and 25 ml/kg. The dogs were studied during normovolemia, hypovolemia (after bleeding of 30% of estimated blood volume) and hypervolemia (after retransfusion of shed blood with additional 50 ml/kg of plasma expander). ⋯ Unlike all other hemodynamic parameters it was also affected by the tidal volume and significantly increased at higher tidal volumes during each volume state. We conclude that the SPV and its components are useful parameters in evaluating the intravascular volume state. They also reflect the magnitude of the tidal volume employed.
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Intensive care medicine · Jan 1989
ReviewInfluence of architectural design on nosocomial infections in intensive care units--a prospective 2-year analysis.
Nosocomial infection rates in an old intensive care ward constructed in 1924 were compared with those in a new one constructed in 1986. The nosocomial infection rate in the old unit was 34.2% and that in the new unit 31.9%, with an average of 33%. ⋯ After transfer of the intensive care unit (ICU) the incidence and profile of nosocomial infections remained the same. These findings suggest that the influence of architectural design has little impact on the incidence of nosocomial infections.