Intensive care medicine
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Intensive care medicine · Jan 1988
Central mixed and splanchnic venous oxygen saturation monitoring.
Central mixed venous oxygen saturation (SvO2) monitoring in critically ill patients to estimate adequacy of peripheral perfusion is gaining increasing popularity. However, a number of unexpected responses, one of which is marked depression of regional (splanchnic) venous oxygen saturation which may coexist with normal or high SvO2, makes interpretation of this parameter difficult. The SvO2 and hepatic venous oxygen saturation levels in seven injured (postoperative) and 15 septic patients were measured. ⋯ This reduced oxygen saturation was noted to arise from an increased regional metabolic rate rather than reduced perfusion. Nevertheless, we conclude that a flow limited regional oxygen consumption may potentially exist despite the presence of a normal SvO2 in certain patient subgroups such as septic subjects. Therefore, a normal SvO2 should not be considered as sole criteria to insure optimal oxygen delivery in critically ill patients.
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Intensive care medicine · Jan 1988
Audit of intensive care: a 30 month experience using the Apache II severity of disease classification system.
608 patients admitted to a general Intensive Care Unit (ICU) over a 30 month period were analyzed according to the Apache II Severity of Disease Classification System on day one of admission. Hospital outcome details were available on 583 patients in the series. ⋯ Our higher than predicted mortality (mortality ratio 1.2) in comparison with centres in the United States of America (US) may be partly explained by the high proportion of our population from these unfavourable groups, by our use of the best Glasgow Coma Scale in the first 24 h following admission, and the major differences between our patient population and that of the US upon which the Apache II was based. The presence of these large unfavourable groups indicates a change in our admission policy is warranted.
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Intensive care medicine · Jan 1988
Peripheral, visceral and body nitrogen balance of catabolic patients, without and with parenteral nutrition.
The effect of major trauma and sepsis on skeletal muscle, central tissue and whole body nitrogen (N) metabolism was investigated in 5 patients before and during TPN (30 kcal, 0.30 g N kg-1 day-1). Fasting 3-methylhistidine (MEH) urinary excretion was elevated (407.9 +/- 67.6 mumol m-2 day-1), muscle and body N balances (NB) were markedly negative (-28.2 +/- 4.6 g m-2 day-1 and -15.7 +/- 3.1 g m-2 day-1), while central tissue NB was positive (13.0 +/- 2.4 g m-2 day-1). ⋯ Gathering fasting and TPN data MEH excretion was significantly related to both body (r = 0.89) and muscle (r = 0.73) NB, that were highly related to each other (r = 0.93), being muscle always worse than body NB. In conclusion, the anticatabolic activity of TPN is confirmed, although our setting did not achieve muscle NB, it was consistently improved and seems to be the major determinant of body NB, in contrast central NB and central N utilization (46.4% +/- 5.4 vs 15.8% +/- 8.4 - p less than 0.05) worsened.
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Intensive care medicine · Jan 1988
Case ReportsMiliary tuberculosis presenting as adult respiratory distress syndrome.
We report the history of a 27-year-old Caucasian girl who died of adult respiratory distress syndrome secondary to miliary tuberculosis (MTB), after treatment with antibiotics to which the organism was sensitive, and a long period of ventilation. This case emphasises the importance of considering MTB as the cause of respiratory failure when another aetiology is not apparent.
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Intensive care medicine · Jan 1988
Midazolam infusion for basal sedation in intensive care: absence of accumulation.
This study was designed to: (1) determine plasma midazolam concentrations producing adequate sedation in ICU patients; (2) establish an intravenous regimen to provide continuous sedation and rapid recovery after discontinuation of infusion. Initially, 13 ICU patients were given midazolam as a bolus injection, 0.20 mg.kg-1 over 30 s in order to define the midazolam plasma concentration corresponding to an adequate level of sedation. The optimal level was reached in a mean time of 61 +/- 26 min and the mean corresponding midazolam plasma concentration was 163 +/- 62 ng.ml-1. ⋯ The mean midazolam plasma concentration during infusion was 215 +/- 61 ng.ml-1, and the mean midazolam plasma concentration at the end of infusion was 199 +/- 93 ng.ml-1. The level of sedation was considered as optimal in most patients throughout the study. After discontinuation of infusion, the mean time for normalization of the mental state was 97 min.