Intensive care medicine
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Intensive care medicine · Jan 1987
The direct measurement of plasma colloid osmotic pressure is superior to colloid osmotic pressure derived from albumin or total protein.
Plasma colloid osmotic pressure (COP) has been calculated from both serum albumin concentration and plasma total protein concentration. These values have been compared to those measured directly using a membrane-transducer oncometer in a group of normal subjects, in a group of critically-ill patients with a variety of primary diagnoses and in a group of hypovolaemic patients before and after plasma volume replacement with 6% hydroxyethyl starch solution. In the normal samples, COP calculated from albumin (COPalb) underestimated the measured COP (COPm) by mean of 2.0 mmHg (p less than 0.002), with correlation coefficient r = 0.39(n/s). ⋯ We conclude that COPalb is an inadequate estimate of COPm particularly in patients where its use may have important clinical consequences. COPtp provides a reasonable estimate of COPm in normal subjects but in patients samples, where albumin: globulin ratio is low COPtp overestimates substantially in many cases. We advocate the direct measurement of COP in critically-ill patients.
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Intensive care medicine · Jan 1987
ReviewFluid resuscitation in diabetic emergencies--a reappraisal.
The first objective in diabetic ketoacidosis is to restore the circulating volume and improve tissue perfusion. In any form of hypovolaemic shock the most efficient way of restoring circulating volume is to be use colloid solutions rather than crystalloids. At least three times the amount of crystalloid must be used to achieve the same effect. ⋯ Although currently difficult to define precisely in their more subtle forms, they all produce adverse pathophysiological effects. The fluid loss in diabetic ketoacidosis is equivalent to "half-normal" saline, a relatively hypotonic solution. As well as causing extensive oedema, resuscitation with isotonic saline can increase serum sodium and osmolarity while not providing free water to replace the intracellular losses.
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Intensive care medicine · Jan 1987
Comparative StudyEvaluation of pediatric intensive care in Europe. A collaborative study by the European Club of Pediatric Intensive Care.
There are no reports analyzing the results of pediatric intensive care in Europe. We evaluated quantitatively the severity of illness and the amount of care required for 714 consecutively admitted patients. We used simultaneously the Clinical Classification System (CCS) the Acute Physiology Score (APS) and the Therapeutic Intervention Scoring System (TISS). ⋯ Among these 3 groups the highest mortality was observed in cardio-vascular patients (p less than 0.01 v.s. respiratory, p less than 0.05 v.s. neurologic). The death rate was 22% among the 264 neonates, 9.7% among the 247 infants (p less than 0.01) and 12.6% among the 198 children. APS and TISS scores increased significantly with the CCS classes.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1987
Case ReportsPost lobectomy atelectasis: the use of a Servo 900 B as a high-frequency ventilator.
High-frequency ventilation (HFV) has been used with good results in a variety of clinical situations where conventional ventilation has proved ineffective. However, all of the reports so far have involved the use of a specially purchased specifically designed ventilator which tends to be unfamiliar to most medical and nursing staff responsible for its use. A case where HFV was used in combination with differential lung ventilation in the treatment of unilateral pulmonary atelectasis is described using a Servo 900B as the high-frequency ventilator. It serves to demonstrate that the Servo 900B can be used as an occasional high-frequency ventilator as required, thus avoiding the expense of purchasing a specialized ventilator.
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Intensive care medicine · Jan 1987
Case ReportsBicarbonate haemodialysis: an adequate treatment for lactic acidosis in diabetics treated by metformin.
Lactic acidosis in diabetics on metformin therapy is rare but still associated with poor prognosis. The authors report here five cases. Three patients were initially with a cardiovascular collapse and all had an acute renal failure. ⋯ All patients survived. However, blood metformin levels remained abnormally high at the end of the dialytic therapy. In conclusion, (1) bicarbonate dialysis is an adequate treatment of lactic acidosis observed in diabetic patients treated with metformin since it rapidly corrects the acid-base disorders and partially removes metformin; (2) the sole accumulation of metformin is not sufficient to explain lactic acidosis since this latter might be corrected in spite of persisting high levels of blood metformin.