Intensive care medicine
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Intensive care medicine · Jan 1993
ReviewEnteral nutrition in the critically ill patient: a critical review of the evidence.
To examine the relationship between enteral nutrition (EN) and infection in the critically ill. ⋯ Evidence from experimental data in critically ill patients suggests that enteral nutrition may have a favourable impact on gastrointestinal immunological function and infectious morbidity.
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Intensive care medicine · Jan 1993
Randomized Controlled Trial Comparative Study Clinical TrialRespiratory response to salbutamol (albuterol) in ventilator-dependent infants with chronic lung disease: pressurized aerosol delivery versus intravenous injection.
To compare the effects of intravenously injected with inhaled salbutamol in ventilator dependent infants with chronic lung disease (CLD). ⋯ Inhaled and intravenous salbutamol improves pulmonary mechanics to the same extent with comparable side effects, and may therefore be used to facilitate weaning from respirators.
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Intensive care medicine · Jan 1993
Review Case ReportsTrends from the United States with end of life decisions in the intensive care unit.
To describe the changes that have occurred in the United States since medicine has moved away from a paternalistic model to one that promotes patient autonomy and self-determination. To discuss the implications for cardiopulmonary resuscitation (CPR) and the increasing use of when not to perform CPR and other life-sustaining therapies. To describe the various interpretations of the ritual term Do-Not-Resuscitate (DNR) and to introduce the concept of futility in the context of non-beneficial over-treatment and discriminatory under-treatment. ⋯ Although Health Proxy in its current formulation has been disappointing, there is a clear trend for wider application of DNR and for more active discussions about withholding or forgoing other life-sustaining therapies. DNR has a different interpretation late into the ICU course (> 72 h) than when applied at or shortly after ICU admission. Late in the ICU course, it has been decided by the medical team and family or surrogate decision maker/Health Proxy that the patient has failed or is in the process of failing aggressive ICU therapy. Early use of DNR may be related to limitations based on pre-existing chronic or subacute disease burden or an unwillingness to proceed with a full ICU course of therapy. It is unclear how Ethics Committees, risk management and hospital administrators, national practice guidelines, governmental sponsored health care reform will interface with the highly complex individual patient--physician--family--Health Proxy interface as practiced in the United States. Dialogue between the Society of Critical Care Medicine and the European Society of Critical Care Medicine and among interested physicians could provide a format for a multi-cultural context to discuss end of life issues in the ICU setting.
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Intensive care medicine · Jan 1993
Review Case ReportsSudden death revealing Chiari type 1 malformation in two children.
We report the first two fatal cases of sudden unprovoked cardiorespiratory arrest in children with previously undiagnosed Arnold-Chiari type 1 malformation. This diagnosis should be considered in children with unexplained cardiorespiratory arrest. The risk of sudden death in Arnold-Chiari type 1 malformation reinforces the indication for early neurosurgical procedure.
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Intensive care medicine · Jan 1993
Randomized Controlled Trial Clinical TrialEffects of extrinsic positive end-expiratory pressure on mechanically ventilated patients with chronic obstructive pulmonary disease and dynamic hyperinflation.
To examine the circulatory and respiratory effects of extrinsic positive end-expiratory pressure (PEEPe) in patients with chronic obstructive pulmonary disease (COPD) and dynamic hyperinflation during controlled mechanical ventilation. ⋯ The effects of PEEPe on iso-volume flow and hence on lung mechanics and hemodynamics, depend on many factors, such as airways resistances, lung volumes and airway characteristics, making the patient response to PEEPe unpredictable.