Intensive care medicine
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Intensive care medicine · Jan 1991
Comparative StudyThe cost of an intensive care unit: a prospective study.
The cost of intensive care for patients admitted to the ICU were estimated. Patients suffering from severe combined acute respiratory and renal failure who required mechanical ventilation and renal replacement therapy (SCARRF-D) cost per day significantly more than non-renal patients (pounds 938 compared to pounds 653 per patient respectively) and their average length of stay in hospital is nearly 4 times as long (28.8 compared to 7.6 days respectively). Approximately 44% of the total cost was staff related (28% for the provision of nurses and 16% for the rest). Retrieving information related to cost was difficult, time consuming and labour intensive.
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Intensive care medicine · Jan 1991
Prognostic significance of early intracranial and cerebral perfusion pressures in post-cardiac arrest anoxic coma.
The prognosis of prolonged cardiac arrests is generally related to brain damage due to the cerebral anoxia. A neurological worsening leading to irreversibility is sometimes associated with an increase in intracranial pressure. We studied for 5 years the early intracranial and cerebral perfusion pressures in 84 patients with deep anoxic coma after cardiac arrest. ⋯ Moreover, none of the patients showing intracranial peak pressures over 25 mmHg survived without after-effects. It is clear that many patients suffer early periods of high intracranial pressures and low cerebral perfusion pressures leading to a bad neurological prognosis. Intracranial pressure monitoring may allow assessment of patients' neurological status and prognosis after cardiac resuscitation.
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Intensive care medicine · Jan 1991
Injurious sleep behavior disorders (parasomnias) affecting patients on intensive care units.
There are no previous reports on parasomnias (sleep behavior disorders) affecting patients on intensive care units (ICUs). During 8 years of clinical practice, we evaluated over 200 adults with complaints of injurious, sleep-related behaviors, 20 of whom had ICU admissions while their parasomnias had been active and generally undiagnosed/untreated. Mean age during ICU confinement was 62.8 (+/- SD 13.1) years; 85.0% (17/20) were males. ⋯ The polysomnographic studies were diagnostic for the REM sleep behavior disorder (vigorous dream-enactment during rapid eye movement [REM] sleep) in 85.0% (17/20) of patients, and for night terrors/sleepwalking in 15.0% (3/20). Three groups of parasomnia-ICU relationships were identified: i) Parasomnias originating in ICUs, stroke-induced (n = 3); ii) Admission to ICUs resulting from parasomnia-induced injuries: C2 odontoid process fracture and C3 spinous process fracture with severe concussion (n = 2); iii) Parasomnias in patients admitted to ICUs for various other medical problems (n = 15). Physicians should be thus alerted about the possibility of injurious, but usually treatable, parasomnias in ICU patients.
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Intensive care medicine · Jan 1991
Case Reports Clinical TrialCombined use of mask CPAP and minitracheotomy as an alternative to endotracheal intubation. Preliminary observation.
We describe the combined use of mask CPAP (continuous positive airway pressure) and minitracheotomy as an alternative to conventional endotracheal intubation in 3 patients requiring CPAP, secretion removal and diagnostic procedures such as bronchoalveolar lavage and bronchial cultures. These requirements were fulfilled with the combined technique approach, thus preserving glottic function and avoiding the disadvantages of endotracheal intubation of tracheotomy. This approach seems particularly suitable in the treatment of immunocompromised patients because of its reduced invasiveness.
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Intensive care medicine · Jan 1991
Acute carbon monoxide intoxication and hyperbaric oxygen in pregnancy.
Modalities of oxygen therapy for pregnant women intoxicated with carbon monoxide (CO) are ill defined. Hyperbaric oxygen (HBO) is presumed to be hazardous to the pregnancy. On the other hand CO entails anoxic injuries in the mother and fetus. ⋯ Finally 1 elected to undergo abortion for reasons unrelated to the intoxication and 1 gave birth to a baby with Down's syndrome. There is no evidence that HBO was involved with either abortion of our study. We conclude that HBO may be carried out in pregnant women acutely intoxicated with carbon monoxide.