Intensive care medicine
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A continuous high flow CPAP system incorporating a turbine blower is described. The system achieves inspiratory flow rates of 150 l/min or more by means of reticulated gas flow and inspired oxygen fractions of 0.21-0.95. ⋯ The mobility of the system also enables its use as an intermittent physiotherapy aid. Work of breathing of the system, as assessed by total pressure fluctuations is at a minimum.
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Intensive care medicine · Jan 1988
The microbiologic risk of invasive haemodynamic monitoring in open-heart patients requiring prolonged ICU treatment.
The microbiologic risk of invasive haemodynamic monitoring and support was prospectively studied in 48 patients undergoing open-heart surgery under antibiotic prophylaxis and requiring intensive care for longer than 4 days. A total of 420 catheter tips were cultured of which 12 (2.9%) were positive. The incidence of positive catheter tip cultures was as follows: intravenous 1.8%, central venous 1.2%, arterial 1.8%, pulmonary arterial 5.9%, direct right atrial 2.4%, direct left atrial 0% and intra-aortic balloon pump catheters 7.7%. ⋯ Complicated surgical procedures, a cardiopulmonary bypass time longer than 3.5 h, mechanical ventilation for more than 7 days, intensive care stay longer than 10 days, positive blood cultures and the use of more than 20 catheters were all individually associated with a significantly higher incidence of patients with positive tip cultures. Nevertheless, no patient developed endocarditis nor major morbidity related to the positive catheter tip cultures. Invasive haemodynamic monitoring does not seem to be an important microbiologic risk in open-heart patients requiring intensive care for longer than 4 days.
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Intensive care medicine · Jan 1988
Case ReportsInadvertent intrathecal administration of amidetrizoate.
Two cases are presented in which amidetrizoate (Urografin) was accidentally introduced into the intrathecal cavity. Intrathecal lavage and continuous administration of thiopentone were very successful in preventing further systemic deterioration.
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Intensive care medicine · Jan 1988
Case ReportsParacetamol-associated coma, metabolic acidosis, renal and hepatic failure.
A case of metabolic acidosis, acute renal failure and hepatic failure following paracetamol ingestion is presented. The diagnostic difficulty at presentation is highlighted. Continuous arteriovenous haemofiltration proved a valuable means of maintaining fluid and electrolyte balance. The patient recovered.
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Intensive care medicine · Jan 1988
Case ReportsPostpartum headache, seizures and bloodstained C.S.F.: a possible complication of dural puncture?
A 32-year-old parturient developed severe headache with subsequent convulsions on the third day after the delivery under epidural anesthesia. Neuroradiological investigations were negative. All complaints disappeared promptly after the performance of an epidural blood patch.