Intensive care medicine
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Intensive care medicine · Jan 1990
European attitudes towards ethical problems in intensive care medicine: results of an ethical questionnaire.
A questionnaire was sent to the 590 members of the European Society of Intensive Care Medicine to define both the current practices and the opinions of these specialists on various ethical issues. The answers from 242 (41%) European members were collected and analysed. The first part of the questionnaire was designed to define the criteria for admission to Intensive Care throughout Europe. ⋯ Only 24 (10%) of the respondents stated that they always delivered complete information to their patients and only 31 (13%) thought they should do so. When an iatrogenic incident occurred, only 39 (16%) claimed to relate exactly what had happened, to the patient or their relatives but 121 (50%) thought they should. Informed consent was usually required for surgery or gastroscopy and the administration of a new medication.
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Intensive care medicine · Jan 1990
Case ReportsSurvival in adults after cardiac arrest due to drowning.
Some remarkable cases of full neurological recovery after cardiac arrest following immersion incidents have been intermittently reported in the journals over the years. These have largely been in children or teenagers who have fallen into extremely cold water. We report here two older adults who recovered completely after a period of cardiac arrest in cold water. Certainly, death should not be pronounced in cold water drowning, without a thermometer reading and ECG.
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Intensive care medicine · Jan 1990
Case ReportsAccidental hypothermia with cardiac arrest: complete recovery after prolonged resuscitation and rewarming by extracorporeal circulation.
A 51-year-old male remained immersed in sea water (6 degrees C) for 40 min. Brought ashore, the ECG showed asystole. Advanced life support was immediately commenced. ⋯ After 60 min of re-perfusion the patient was be weaned from bypass supported by a high-dose vasopressor infusion and nitroglycerine. He was discharged after 13 days with no evidence of any permanent organ damage. Given the advantage of providing circulatory support, extracorporeal circulation may be useful when rewarming hypothermic victims with cardiac arrest.
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Intensive care medicine · Jan 1990
Case ReportsPositive end expiratory pressure and critical oxygenation during transport in ventilated patients.
Transportation of patients critically dependent on positive end expiratory pressure (PEEP) can be problematic, as a patient of ours with adult respiratory distress syndrome (ARDS) and bilateral broncho-pleural fistulae demonstrated. He required intermittent positive pressure ventilation (IPPV) (Siemens 900C) with 100% O2 and PEEP of 2 kPa to maintain his arterial O2 saturation (SaO2) greater than 90%. Severe hypoxemia (SaO2 less than 75%) occurred on change to a portable ventilator (Oxylog, Dräger) with a PEEP value (Ambu 20) at its expiratory port, despite adjusting the valve to 2 kPa, continuing use of 100% O2, and varying the ventilatory pattern. ⋯ A small leak was introduced from the lung resulting in a decrease in PIP, VT, and PEEP. Adjustment of ventilator minute volume to restore PIP to 5 kPa failed to restore PEEP, airway pressure continuing to fall throughout the expiratory pause. PEEP was restored by providing a compensatory flow of O2 of 5 l/min to the system between the Oxylog non-rebreathing valve and the lung.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1990
Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome.
Many animal studies have shown that high peak inspiratory pressures (PIP) during mechanical ventilation can induce acute lung injury with hyaline membranes. Since 1984 we have limited PIP in patients with ARDS by reducing tidal volume, allowing spontaneous breathing with SIMV and disregarding hypercapnia. Since 1987 50 patients with severe ARDS with a "lung injury score" greater than or equal to 2.5 and a mean PaO2/FiO2 ratio of 94 were managed in this manner. ⋯ Only 2 died, neither from respiratory failure. There was no significant difference in lung injury score, ventilator score, PaO2/FiO2 or maximum PaCO2 between survivors and non-survivors. We suggest that this ventilatory management may substantially reduce mortality in ARDS, particularly from respiratory failure.