Intensive care medicine
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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
Sepsis associated with central vein catheters in critically ill patients.
In 440 critically ill patients, the association between different central vein catheter insertion sites, the duration of catheter insertion and catheter-associated sepsis was examined. Of 780 catheter tips studied, 19% were colonized by microorganisms. The incidence of colonization varied with the different insertion sites. ⋯ Catheter colonization was closely related to the development of bacteraemia and was associated with approximately 10% of colonized catheters. Our results suggest that the subclavian site is associated with the lowest infective complication rate. To minimize catheter associated sepsis, catheters at all insertion sites should be used with parsimony and only kept in place for the minimum amount of time that their continuing use is necessary.
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Intensive care medicine · Jan 1988
Midazolam infusion for basal sedation in intensive care: absence of accumulation.
This study was designed to: (1) determine plasma midazolam concentrations producing adequate sedation in ICU patients; (2) establish an intravenous regimen to provide continuous sedation and rapid recovery after discontinuation of infusion. Initially, 13 ICU patients were given midazolam as a bolus injection, 0.20 mg.kg-1 over 30 s in order to define the midazolam plasma concentration corresponding to an adequate level of sedation. The optimal level was reached in a mean time of 61 +/- 26 min and the mean corresponding midazolam plasma concentration was 163 +/- 62 ng.ml-1. ⋯ The mean midazolam plasma concentration during infusion was 215 +/- 61 ng.ml-1, and the mean midazolam plasma concentration at the end of infusion was 199 +/- 93 ng.ml-1. The level of sedation was considered as optimal in most patients throughout the study. After discontinuation of infusion, the mean time for normalization of the mental state was 97 min.
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Intensive care medicine · Jan 1988
Mortality and quality of life after intensive care for critical illness.
Early and late mortality of 313 ICU patients and the quality of life of 118 long term ICU survivors was studied to assess the effectiveness of intensive care for critically ill patients. The survival rate at discharge from the ICU was 76%, falling to 61% at 6 months and to 58% at 1 year. A simplified acute physiology score (SAPS) was recorded on ICU admission, as well as age, length of ICU-stay and the number of complications during intensive care. ⋯ In 21% of the patients a deteriorated physical condition was found, 77% remained unchanged and 2% were improved 2 years after ICU discharge, compared to their condition prior to the acute illness. Major functional impairment was found in 38% of the patients. Although the longterm physical condition and functional status correlated with SAPS and age on ICU admission, the best indicator for quality of life after intensive care proved to be the health status prior to the acute illness.
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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)