Intensive care medicine
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Intensive care medicine · Jan 1985
Comparative StudyThe acute effects of prostaglandin E1 on the pulmonary circulation and oxygen delivery in patients with the adult respiratory distress syndrome.
Prostaglandin E1 was administered intravenously to 10 patients who had the adult respiratory distress syndrome associated with severe infection in order to investigate its hemodynamic effects. Infusion of PGE1 significantly decreased the mean pulmonary arterial pressure, mean systemic arterial pressure, pulmonary vascular resistance and systemic vascular resistance, and increased the cardiac index, oxygen delivery and oxygen consumption. No significant difference was noted in the intrapulmonary shunt fraction. These results indicate that administration of PGE1 improves pulmonary hemodynamics and tissue oxygenation in patients with acute respiratory distress syndrome, by reducing right ventricular afterload and increasing the cardiac index.
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Intensive care medicine · Jan 1984
Blood coagulation and fibrinolytic factors and their inhibitors in critically ill patients.
In a search for new variables, for the diagnosis of disseminated intravascular coagulation (DIC) and for guidelines of therapy in such conditions, 22 severely ill patients were studied. The diagnosis of DIC was based on determinations of platelet counts, prothrombin complex (Normotest), antithrombin (AT), fibrinogen degradation products and fibrinogen. Nine patients were diagnosed as having DIC, eight patients were referred to a suspected DIC group and five to a group of no DIC. ⋯ The inhibitor capacity (AT, APV and KI) was lower in patients who died than in survivors and decreased still further in those of the non-survivors who had DIC. Thus the inhibitors can be used as predictors of outcome and hopefully for guiding therapy. To establish the diagnosis of DIC we suggest measurement of platelet count, prothrombin complex, plasminogen as well as of the inhibitors.
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Intensive care medicine · Jan 1984
Case ReportsUpper airway obstruction caused by massive subcutaneous emphysema.
Acute upper airway obstruction is a potentially life-threatening event. The most common causes include foreign body inhalation, thermal injury, inflammation, angioedema and trauma. Airway obstruction caused by submucosal extension of subcutaneous emphysema has only been previously reported once. We report the case of a patient who suffered a respiratory arrest as a result of hypopharyngeal and laryngeal swelling associated with massive subcutaneous emphysema.
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Intensive care medicine · Jan 1984
Case ReportsSevere pulmonary interstitial emphysema of the right lung treated by selective intubation of the left main bronchus.
As an alternative to surgical treatment, we have selectively intubated the left main bronchus in children with severe pulmonary interstitial emphysema (PIE) of the right lung. Within 12-24 h the unilateral hyperinflation disappeared. We propose that when conservative treatment of unilateral PIE fails, contralateral SBI should be tried before surgical intervention, leading to loss of functioning tissue, is undertaken.