Intensive care medicine
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Intensive care medicine · May 1996
Multicenter StudyModification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group.
To assess the frequency of and the reasons for changing empiric antibiotics during the treatment of pneumonia acquired in the intensive care unit (ICU). ⋯ A high percentage of patients (43.7%) required modification of empiric antibiotic treatment for pneumonia acquired in the ICU. In 62.1% of cases the main reason for changing antibiotic treatment was inadequate antibiotic coverage of microorganisms. Attributable mortality was significantly higher in patients with inappropriate initial antibiotic therapy. Rapid and accurate diagnostic methods are needed to initiate appropriate antibiotic treatment as soon as pneumonia is suspected.
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Intensive care medicine · May 1996
Clinical TrialUse of capnography to detect hypercapnic episodes during weaning from mechanical ventilation.
To evaluate the relationship between PaCO2 and end-tidal CO2 tension (PetCO2) before weaning and during a weaning trial and to determine the ability of PetCO2 to identify clinically relevant episodes of hypercapnia. ⋯ Capnography provided good assessment of hypercapnic episodes during weaning, although the high number of false positives may result in arterial blood sampling in patients who do not present with ventilation failure.
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Intensive care medicine · May 1996
Relationship of changes in cardiac output to changes in heart rate in medical ICU patients.
To determine whether changes in cardiac output are correlated with changes in other commonly measured covariables (heart rate, respiratory rate, mean arterial pressure, mean pulmonary artery pressure, pulmonary artery occlusion pressure, and temperature). ⋯ Changes in cardiac output were best correlated with changes in heart rate. Changes in pulmonary artery occlusion pressure were not correlated with changes in cardiac output in this population of medical ICU patients. A change in any of the covariables (alone or in combination) cannot be reliably used to indicate a simultaneous change in cardiac output.
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Intensive care medicine · May 1996
Case ReportsLong-term follow-up of coronary artery dissection due to blunt chest trauma with spontaneous healing in a young woman.
We report a previously healthy 17-year-old woman who experienced coronary artery dissection with an acute transmural anterior myocardial infarction and myocardial contusion following blunt chest trauma in a motorcycle accident. A chest roentgenogram on admission was normal, and an electrocardiogram showed an acute transmural anterior myocardial infarction with complete right-bundle-branch block. A 2D echocardiogram revealed an akinesis of the anterior wall and a hypokinesis of the posterior wall in the left ventricle. ⋯ Technetium-99m pyrophosphate myocardia scintigraphy demonstrated diffuse tracer uptake in the left ventricular wall. Follow-up coronary angiography performed 1 year after the accident showed a minor stenosis without any filling defects. We describe long-term follow-up of the coronary artery dissection following blunt chest trauma with spontaneous healing.