Acta anaesthesiologica Scandinavica. Supplementum
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Extracorporeal membrane oxygenation (ECMO), originally developed as an artificial replacement for respiratory assistance, is decreasingly used in neonates with respiratory failure. Nevertheless, there is a constant need for this invasive and expensive neonatal treatment modality. ⋯ ECMO remains an important tool in neonatal and pediatric intensive care. However, the number of ECMO therapies was reduced due to respiratory therapeutic progress, but indications and ECMO technology have changed.
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Unlike normal thermoregulatory control, which is largely neuronally mediated, fever is activated by circulating pyrogens. Pyrogens are triggered by either infectious or non-infectious etiologies, all of which may be present in patients undergoing ambulatory surgery. Fever is a regulated elevation in the setpoint temperature for all thermoregulatory responses (warm and cold defenses). ⋯ Wound infections are responsible for many such fevers, although numerous other etiologies contribute. Initial diagnosis should thus focus on determining the etiology of fever. Once that is established, treatment can focus on the specific cause.
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Acta Anaesthesiol Scand Suppl · Jan 1997
Review Comparative StudyEnteral or parenteral nutrition? Pro-enteral.
There is a convincing evidence for the superiority of enteral nutrition as compared with parenteral In critically ill and injured patients. The general objectives of providing nutritional support in the critically ill is to persevere body functions that are functioning normally and to facilitate recovery of those that are failing. The specific objective for enteral nutrition is, however, preservation and restoration of the gastrointestinal structure and function. ⋯ Early enteral nutrition can be successfully carried out in virtually all critically ill patients also after major abdominal surgery and in acute pancreatitis. There are very few contraindications for using enteral nutrition and severe complications are rare. Parenteral nutrition, on the other hand, is associated with increased incidence of infectious complications and is rarely indicated in critically ill patients.
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Diminished availability of oxygen at the cellular level might account for organ dysfunction in sepsis. Although the classical forms of tissue hypoxia due to hypoxemia, anemia, or inadequate perfusion all might be important under some conditions, it seems increasingly likely that a fourth mechanism, namely cytopathic hypoxia, might play a role as well. ⋯ At least in theory, cytopathic hypoxia could be a consequence of several different (but mutually compatible) pathogenic mechanisms, including diminished delivery of a key substrate (e.g., pyruvate) into the mitochondrial tricarboxylic acid (TCA) cycle, inhibition of key mitochondrial enzymes involved in either the TCA cycle or the electron transport chain, activation of the enzyme, poly-(ADP)-ribosylpolymerase (PARP), or collapse of the protonic gradient across the inner mitochondrial membrane leading to uncoupling of oxidation (of NADH and FADH) from phosphorylation of ADP to form ATP. Tantalizing, but limited, data support the view that cytopathic hypoxia occurs in both animals and patients with sepsis or endotoxemia.