Critical care medicine
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To describe an unusual case of acute eosinophilic pneumonia (AEP) associated with hemodynamic instability. ⋯ AEP with respiratory failure was first reported in 1989 as a distinct clinical entity. Patients with this variant of eosinophilic lung disease develop acute hypoxemic respiratory failure with a rapid response to treatment with corticosteroids, The characteristic feature of this syndrome is a predominance of eosinophils found in bronchoalveolar lavage fluid and lung biopsy. Despite the increasing number of reported cases, to our knowledge, distributive shock has not been reported as a feature of AEP. We report a unique case of AEP associated with shock and review the pertinent literature.
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To implement and retrospectively evaluate a therapeutic algorithm for the treatment of refractory status epilepticus with midazolam coma. ⋯ Midazolam infusion, as per our described algorithm, is effective in terminating refractory status epilepticus. This treatment is not associated with cardiovascular instability, even at doses resulting in burst suppression. In the majority of cases, cessation of seizures occur before burst suppression is achieved on EEG.
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Critical care medicine · Sep 1999
Cannulation of the internal jugular vein: is postprocedural chest radiography always necessary?
To determine whether clinical features can be used in a decision rule to prospectively identify a subgroup of internal jugular catheter placements that are correctly positioned and free from mechanical complications, thus obviating the need for routine postprocedural chest radiographs in selected patients. ⋯ In experienced hands, internal jugular venous catheterization is a safe procedure. However, the incidence of axillary vein or right atrial catheter malposition is 14%, and clinical factors alone will not reliably identify malpositioned catheters. Chest radiographs are necessary to ensure correct internal jugular catheter position.
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Critical care medicine · Sep 1999
Perfluorocarbon priming and surfactant: physiologic and pathologic effects.
To test the hypothesis that perfluorocarbon (PFC) priming before surfactant administration improves gas exchange and lung compliance, and also decreases lung injury, more than surfactant alone. ⋯ Priming the lung with PFC neither improved the physiologic effects of exogenous surfactant nor improved lung pathology in this animal model.
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Critical care medicine · Sep 1999
Mortality and the increase in length of stay attributable to the acquisition of Acinetobacter in critically ill patients.
To determine the impact of Acinetobacter baumannii (AB) acquisition in intensive care unit (ICU) patients on mortality and length of stay (LOS). ⋯ AB acquisition involved an excess LOS in ICU patients and increased risk of death, but the latter could be found only in patients with proven infection.