Intensive care medicine
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Intensive care medicine · Apr 1995
ReviewThe pathogenesis of ventilator-associated pneumonia: I. Mechanisms of bacterial transcolonization and airway inoculation.
Ventilator-associated pneumonia (VAP) is an infection of the lung parenchyma developing in patients on mechanical ventilation for more than 48 h. VAP is associated with a remarkably constant spectrum of pathogenic bacteria, most of which are aerobic Gram-negative bacilli (AGNB) and, to a lesser extent Staphyloccus aureus. Most authorities agree that VAP develops as a result of aspiration of secretions contaminated with pathogenic organisms, which appear to be endogenously acquired. ⋯ Amorphic particulate deposits containing AGNB form along the endotracheal tube and are capable of being propelled into the distal airways by ventilator-generated airflow or by tubing manipulation. Bacteria embedded within this type of amorphous matrix are particularly difficult for the host to clear. If host defenses fail to clear the inoculum, then bacterial proliferation occurs, and the host inflammatory response progresses to bronchopneumonia.(ABSTRACT TRUNCATED AT 400 WORDS)
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Intensive care medicine · Apr 1995
Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: incidence, morbidities and outcomes in surgical ICU patients.
To determine the incidence of systemic inflammatory response syndrome (SIRS), sepsis and severe sepsis in surgical ICU patients and define patient characteristics associated with their acquisition and outcome. ⋯ Almost everyone in the SICU had SIRS. Therefore, because of its poor specificity, SIRS was not helpful predicting severe sepsis and septic shock. Patients who developed sepsis or severe sepsis had higher crude mortality and length of stay than those who did not. Studies designed to identify those who develop complications of SIRS would be very useful.
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Intensive care medicine · Apr 1995
Thyroid and thymic endocrine function and survival in severely traumatized patients with or without head injury.
Functional links among the brain, endocrine and immune system have been described previously. An impairment of both immunological defence mechanisms and thyroid hormone turnover was present in trauma conditions. An investigation on the relevance of thymulin and thyroid hormones in multiple trauma patients with or without head injury has been performed. The role of these hormones as predictive factors for patients outcome was also evaluated. ⋯ Thymulin is markedly reduced in multiple trauma patients with head injury and it represents a predictive factor for the outcome better than the one deriving from the single measurements restricted to thyroid hormones.
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Intensive care medicine · Apr 1995
Smoke inhalation causes a delayed increase in airway blood flow to primarily uninjured lung areas.
Single lung inhalation injury causes tissue damage to the contralateral lung. We therefore examined airway blood flow after smoke inhalation in chronic instrumented sheep to get further information about the underlying pathophysiology. ⋯ Damage to one lung can lead to pathophysiologic changes in the contralateral lung. This response appears to be mediated by hematogenous factors.