Intensive care medicine
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Intensive care medicine · Jun 1996
Comparative StudyPrognostic factors and treatment of severe ethylene glycol intoxication.
Analysis of prognostic factors and treatment of a large epidemic of ethylene glycol intoxication. ⋯ In patients with severe ethylene glycol intoxication, severe acidosis, hyperkalemia, seizures, and coma at admission carry a dismal prognosis. We believe very large amounts of intravenous HCO3 should be used immediately for rapid correction of the metabolic acidosis. Intravenous ethanol and hemodialysis should be started early and continued until acidosis is corrected.
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Intensive care medicine · Jun 1996
Multicenter Study Comparative StudyApplication of the APACHE III prognostic system in Brazilian intensive care units: a prospective multicenter study.
To compare patients and their outcomes at ten Brazilian intensive care units (ICUs) with those reported from the United States. ⋯ The APACHE III prognostic system was a good discriminator of hospital mortality for ICU admissions at 10 Brazilian ICUs. There was substantial and significant variation, however, in SMRs among the Brazilian ICUs, which suggests that further evaluations of international differences in intensive care using a common risk assessment system should be performed and factors associated with variations in risk-adjusted mortality scrutinized.
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Intensive care medicine · Jun 1996
Randomized Controlled Trial Comparative Study Clinical TrialClinical evaluation of diminished early expiratory flow (DEEF) ventilation in mechanically ventilated COPD patients.
To evaluate the cardiopulmonary effects, especially the end-expiratory lung volume (EEV) and ventilation inhomogeneity during diminished early expiratory flow ventilation (DEEF), which resembles pursed-lips breathing, with the conventional intermittent positive pressure ventilation (IPPV) in postoperative mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). ⋯ There was no improvement in pulmonary and hemodynamic parameters during the DEEF mode in comparison to the IPPV mode. The small increase in EEV during DEEF was probably caused by the slightly higher mean expiratory pressures as in the PEEP mode. However, this had no effect on the hemodynamic parameters. As we could not observe any improvement with the DEEF ventilation in our optimally pretreated postoperative COPD patients, we do not advise applying this therapy in this group of patients, since this mode of ventilation may cause barotrauma if not monitored adequately.
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Intensive care medicine · Jun 1996
Case ReportsSurfactant replacement therapy in acute respiratory distress syndrome from viral pneumonia.
A modified natural surfactant was administered to a patient with life-threatening adult respiratory distress syndrome caused by viral pneumonia. Subsequently, there was a marked improvement in gas exchange. ⋯ Quantitative analysis of the scans taken before and after surfactant administration indicates that improvement in gas exchange was largely due to the expansion of underinflated and collapsed lung areas. Although this is a single case report, it provides insight into the possible beneficial effect of instilled surfactant in severe respiratory distress from viral pneumonia.
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Intensive care medicine · Jun 1996
Comparative StudyOutcome prediction for patients with cirrhosis of the liver in a medical ICU: a comparison of the APACHE scores and liver-specific scoringsystems.
To find the most adequate prognostic scoring system for predicting ICU-outcome in patients with decompensated liver cirrhosis in a medical intensive care unit (ICU). ⋯ To predict the outcome for patients with decompensated cirrhosis of the liver admitted to a medical ICU liver failure alone is not decisive. Liver-specific scoring systems (Mayo Risk Score, CCLI) are adequate, but the APACHE II and III proved to be more powerful, because they include additional physiologic parameters and therefore also take into account additional complications associated with this liver disorder.