Intensive care medicine
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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
Comparative StudyToe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure.
Measurements of toe temperature and transcutaneous PO2 (PtcO2) have been both suggested for non-invasive assessment of peripheral blood flow in acute circulatory failure. The underlying principle of the two methods is that cutaneous vasoconstriction occurs early when tissue perfusion is altered. In 15 patients, we compared the two measurements during cardiogenic shock (27 measurements) or septic shock (29 measurements). ⋯ Since measurement of PtcO2 is technically more complicated, correlates less well with standard hemodynamic parameters and later reflects cardiovascular improvement, it has no advantage over measurement of toe temperature in circulatory shock. In cardiogenic shock, measurements of toe temperature can reliably track cardiac output changes. In septic states, however, non-invasive assessment of skin perfusion is of limited interest.
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Intensive care medicine · Jan 1988
Comparative StudyTotal inspiratory work with modern demand valve devices compared to continuous flow CPAP.
The inspiratory work exerted by an electromechanical lung model in drawing a 500 ml breath, was assessed by planimetry of pressure/volume loops for six commercial demand valve CPAP devices (Servo B and C from Siemens, EV-A and UV-2 from Dräger, the Puritan Bennett 7200 and the Engström ERICA) and compared to the loading of a conventional high flow CPAP system. The effect of trigger sensitivity and inspiratory pressure support on inspiratory work was also investigated in some cases. The lung model allowed for calibrated changes in compliance and airway resistance. ⋯ Halving compliance doubled the work and exchanging a 7 for a 9 mm i.d. endotracheal tube in the circuit increased work by about 3% regardless of machine. Decreasing trigger sensitivity from 0 to 2 cm H2O for the Servo B increased work by up to 24%. Using 5 cm H2O of inspiratory pressure support decreased work for all machines up to 36% maximally.(ABSTRACT TRUNCATED AT 250 WORDS)