Intensive care medicine
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Intensive care medicine · Dec 1996
Editorial Comment ReviewAspergillosis in the ICU: the glass half-empty?
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To assess the outcome of intensive care treatment in invasive aspergillosis. ⋯ In patients with highly suspected or proven invasive aspergillosis, admission to an ICU and mechanical ventilation should be considered in cases of localized infection and obvious signs of hematologic recovery. In most other circumstances ICU admission for mechanical ventilation does not seem to improve survival.
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Intensive care medicine · Dec 1996
Comparative Study Clinical Trial Controlled Clinical TrialSplanchnic blood flow is greater in septic shock treated with norepinephrine than in severe sepsis.
To assess global and splanchnic blood flow and oxygen transport in patients with sepsis with and without norepinephrine treatment. ⋯ These data confirm a redistribution of blood flow to the splanchnic region in sepsis that is even more pronounced in patients with septic shock requiring norepinephrine. However, subnormal gastric mucosal pH suggested inadequate oxygenation in parts of the splanchnic region due to factors other than splanchnic hypoperfusion. Progress in this area will depend on techniques that address not only total splanchnic blood flow, but also inter-organ flow distribution, intra-organ distribution, and other microcirculatory or metabolic malfunctions.
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Intensive care medicine · Dec 1996
Clinical Trial Controlled Clinical TrialEffect of hemofiltration on hemodynamics and systemic concentrations of anaphylatoxins and cytokines in human sepsis.
To determine whether hemofiltration (HF) can eliminate cytokines and complement components and alter systemic hemodynamics in patients with severe sepsis. ⋯ HF effectively eliminated the anaphylatoxins C3adesArg and C5adesArg during sepsis. There was also a significant rise in SVR and MAP during high volume HF. Therefore, HF may represent a new modality for removal of anaphylatoxins and may, thereby, deserve clinical testing in patients with severe sepsis.
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Intensive care medicine · Dec 1996
New aspects of pulmonary mechanics: "slowly" distensible compartments of the respiratory system, identified by a PEEP step maneuver.
The aims of the present study were 1) to evaluate a method for identification of "slowly" distensible compartments of the respiratory system (rs), which are characterized by long mechanical time constants (RC) and 2) to identify "slowly" distensible rs-compartments in mechanically ventilated patients. ⋯ The gas distribution properties of the respiratory system can be easily studied by a PEEP-step maneuver. The relative contribution of the "slow" units to the total increase of lung volume following a PEEP step could be adequately assessed. "Slowly" distensible rs-compartments could be detected in patients with severe and mild lung injury, however significantly more ARDS patients revealed "slow" rs-compartments in PEEP-decreasing steps. The influence of "slowly" distensible rs-compartments on pulmonary gas exchange is unknown and has yet to be studied.