Intensive care medicine
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Intensive care medicine · Jan 1993
Comparative StudyProspective evaluation of self-extubations in a medical intensive care unit.
To evaluate the incidence, associated factors and gravity of self-extubations. ⋯ Self-extubation is a frequent and serious complication of mechanical ventilation. Deliberate self-extubation, the most frequent type of incident could possibly be reduced by better sedation of agitated patients and accidental self-extubation by better training of the nursing staff.
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Intensive care medicine · Jan 1993
Comparative StudyIntrinsic PEEP determined by static pressure-volume curves--application of a novel automated occlusion method.
Evaluation of new computer-controlled occlusion procedure for determination of intrinsic PEEP in mechanically ventilated patients and comparison with the standard end-expiratory occlusion method. ⋯ Since no significant difference between PEEPi values measured by the inspiratory and expiratory occlusion method (SCASS) was seen, this indicates that no alveolar recruitment occurred during the respiratory cycle. This study demonstrates that the automated occlusion method for measuring Cstat system can also be used with high accuracy for determination of intrinsic PEEP in mechanically ventilated patients.
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Intensive care medicine · Jan 1993
Epidemiological impact of prolonged systematic use of topical SDD on bacterial colonization of the tracheobronchial tree and antibiotic resistance. A three year study.
to evaluate the effect of the prolonged systematic use of topical SDD (tobramycin 80 mg, polymyxin E 100 mg, amphotericin B 500 mg) on ICU ecology as expressed by changes in tracheal colonization and bacterial resistances. ⋯ Our data suggest that the prolonged use of SDD is associated with dramatic changes in ICU ecology: the incidence of Gram negative colonization is significantly diminished by SDD whereas Gram positive tend to increase. Pseudomonas developed an increasing resistance towards tobramycin one of the components of the SDD formula we used.
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Intensive care medicine · Jan 1993
Influence of constant sustained positive airway pressure on right ventricular performance.
The detrimental effect of positive airway pressure on right ventricular (RV) performance is controversial and the aim of this study was to determine the effects of constant positive airway pressure without ventilatory fluctuation on RV performance with the aid of a pulmonary arterial catheter equipped with a rapid response thermistor for measuring RV ejection fraction (RVEF) and RV end-diastolic volume index (RVEDVI). ⋯ In most patients, the changes in RVEF, SVI, and RVEDVI did not occur under constant positive airway pressure, therefore the changes reported in mechanically ventilated patients may not attributable to the extent of positive airway pressure but rather to abrupt increases in airway pressure. These appears, however, to be patients whose RV function is so disturbed that they cannot cope with increased afterloads.
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Intensive care medicine · Jan 1993
Comparative StudyAngiotensin-converting enzyme activity in serum and bronchoalveolar lavage fluid after damage to the alveolo-capillary barrier in the human lung.
Angiotensin-converting enzyme (ACE) is considered as a possible marker for endothelial cell damage in serum or bronchoalveolar lavage fluid. This hypothesis was tested during cardiac surgery and during the adult respiratory distress syndrome. ⋯ Angiotensin-converting enzyme activity in serum or bronchoalveolar lavage fluid does not reflect damage of endothelial cells or damage of alveolocapillary integrity in acute pulmonary disease.