Anaesthesia and intensive care
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Over the last six years high-frequency ventilation has been extensively evaluated both in the clinical and laboratory settings. It is now no longer the great mystery it once was, and it is now no longer believed (as many had hoped), that it will solve all the problems associated with mechanical pulmonary ventilation. Although the technique is safe and appears to cause no harm even in the long term, it has not yet been shown to offer any major advantages over conventional mechanical ventilation.
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Anaesth Intensive Care · Feb 1986
ReviewExtracorporeal CO2 Removal in severe adult respiratory distress syndrome.
Sixty-five per cent survival has been achieved in a group of patients with severe ARDS and a predicted mortality of 92%, by the use of Gattinoni's technique of extracorporeal CO2 removal. In patients and animals the technique has usually resulted in rapid improvement in the radiographic appearance and lung function. There are several possible mechanisms by which the technique may facilitate lung repair, including improvement of lung tissue oxygenation, the avoidance of high airway pressures and regional alkalosis in the lung, a reduction in oxygen toxicity, and the frequency observed reduction in pulmonary artery pressure. The apparent effectiveness of the technique and other associated evidence have implications which should lead us to reconsider some aspects of our conventional management of patients with severe ARDS.
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Anaesth Intensive Care · May 1985
Review Comparative StudyRecently developed alternatives to conventional mechanical ventilation.
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A knowledge of pharmacokinetic principles is essential to understand dosage modification for drugs used in patients in renal failure. Dosage modification is indicated either where drugs have a low therapeutic index, or where renal mechanisms play a major role in drug elimination. ⋯ In addition to effects on drug elimination, renal failure may also alter drug absorption, distribution, protein binding and metabolism. Dialysis regimens, by eliminating drugs to a greater or lesser degree, have implications for drug therapy.
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Anaesth Intensive Care · Nov 1981
ReviewPathophysiology and management of raised intracranial pressure.
The mechanism of cerebral homeostasis is reviewed, paying particular attention to the way blood-brain barrier, cerebrospinal fluid and cerebral blood flow contribute to the maintenance of normal intracranial pressure. The pathophysiology of raised intracranial pressure is outlined delineating the different types of cerebral oedema. Guidelines for the management of patients with raised intracranial pressure are presented as well as the techniques of intracranial pressure monitoring.