Intensive care medicine
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Intensive care medicine · Jan 1989
The effect of tidal volume and intravascular volume state on systolic pressure variation in ventilated dogs.
Both tidal volume and effective blood volume may affect the variation in the arterial pressure waveform during mechanical ventilation. The systolic pressure variation (SPV), which is the difference between the maximal and minimal systolic pressure values following one positive pressure breath was analyzed in 10 anesthetized and ventilated dogs, during ventilation with tidal volumes of 15 and 25 ml/kg. The dogs were studied during normovolemia, hypovolemia (after bleeding of 30% of estimated blood volume) and hypervolemia (after retransfusion of shed blood with additional 50 ml/kg of plasma expander). ⋯ Unlike all other hemodynamic parameters it was also affected by the tidal volume and significantly increased at higher tidal volumes during each volume state. We conclude that the SPV and its components are useful parameters in evaluating the intravascular volume state. They also reflect the magnitude of the tidal volume employed.
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Intensive care medicine · Jan 1989
ReviewInfluence of architectural design on nosocomial infections in intensive care units--a prospective 2-year analysis.
Nosocomial infection rates in an old intensive care ward constructed in 1924 were compared with those in a new one constructed in 1986. The nosocomial infection rate in the old unit was 34.2% and that in the new unit 31.9%, with an average of 33%. ⋯ After transfer of the intensive care unit (ICU) the incidence and profile of nosocomial infections remained the same. These findings suggest that the influence of architectural design has little impact on the incidence of nosocomial infections.
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Cardiac transplantation is now an accepted therapeutic option for patients with end-stage myocardial failure. Provided donor and recipient are appropriately selected and adequately matched, expected survival rates at one and five years are 85% and 65%, respectively. Two major challenges are encountered in clinical heart transplantation. ⋯ The second challenge is accelerated coronary disease, which has emerged as the major factor limiting long-term survival. It is usually clinically silent and often presents with sudden death, acute myocardial infarction, or progressive unexplained graft failure. Coronary arteriography is currently the only method for premorbid diagnosis, and retransplantation the only effective therapy.