Intensive care medicine
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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)
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Intensive care medicine · Jan 1988
Extracorporeal CO2-removal with a heparin coated artificial lung.
Treatment of severe acute respiratory failure with extracorporeal gas exchange necessitating near complete systemic anticoagulation requires a delicate balance to be maintained between disseminated intravascular coagulation and hemorrhagic complications. The present study describes our first experience using a heparin coated extracorporeal artificial lung and circuitry during clinical extracorporeal CO2 removal. ⋯ Scanning electron microscopy of the heparin coated hollow fiber gas exchanger demonstrated only minor deposits on the surface. Use of a heparin coated artificial lung may enhance the margin of safety of extracorporeal gas exchange and ultimately broaden its indications.
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Intensive care medicine · Jan 1988
The microbiologic risk of invasive haemodynamic monitoring in open-heart patients requiring prolonged ICU treatment.
The microbiologic risk of invasive haemodynamic monitoring and support was prospectively studied in 48 patients undergoing open-heart surgery under antibiotic prophylaxis and requiring intensive care for longer than 4 days. A total of 420 catheter tips were cultured of which 12 (2.9%) were positive. The incidence of positive catheter tip cultures was as follows: intravenous 1.8%, central venous 1.2%, arterial 1.8%, pulmonary arterial 5.9%, direct right atrial 2.4%, direct left atrial 0% and intra-aortic balloon pump catheters 7.7%. ⋯ Complicated surgical procedures, a cardiopulmonary bypass time longer than 3.5 h, mechanical ventilation for more than 7 days, intensive care stay longer than 10 days, positive blood cultures and the use of more than 20 catheters were all individually associated with a significantly higher incidence of patients with positive tip cultures. Nevertheless, no patient developed endocarditis nor major morbidity related to the positive catheter tip cultures. Invasive haemodynamic monitoring does not seem to be an important microbiologic risk in open-heart patients requiring intensive care for longer than 4 days.
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Intensive care medicine · Jan 1988
Case ReportsPulmonary edema due to partial upper airway obstruction in a child.
The case of an 8-year-old boy is reported, who developed acute pulmonary edema associated with acute subglottic swelling and subsequent partial upper airway obstruction after extubation and recovery from anaesthesia. The main factors responsible for the formation of pulmonary edema presumably are a large subatmospheric transpulmonary pressure gradient and hypoxia leading to translocation of circulating blood volume into the pulmonary vasculature and fluid shift across the alveolar-capillary membrane. Application of oxygen and CPAP or PEEP plus diuretic therapy will promote rapid clearance of the pulmonary edema.
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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.