Intensive care medicine
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Intensive care medicine · Apr 1997
Relation of echocardiographic preload indices to stroke volume in critically ill patients with normal and low cardiac index.
To examine the usefulness of preload indices obtained by transoesophageal echocardiography (TOE) for estimating stroke volume at various levels of cardiac index. ⋯ Stability of the relation between echocardiographic preload indices and stroke volume emphasize the potential of TOE for continuous preload monitoring in the critically ill.
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Altered platelet function plays a role in the pathophysiology of multiple organ failure in sepsis. The purpose of the present study was to evaluate various aspects of platelet adhesive function in septic patients and its putative relevance for prognosis. ⋯ In septic patients platelets become activated and are hyperadhesive to other vascular cells including neutrophils and endothelium. This may induce sequestration of platelets and microcirculatory arrest, thus the development of MODS.
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Intensive care medicine · Apr 1997
Case ReportsPneumothorax following nasogastric feeding tube insertion in a tracheostomized patient after bilateral lung transplantation.
We report the case of a pneumothorax caused by the improper placement of a nasogastric feeding tube in a tracheostomized patient after bilateral lung transplantation. We discuss the contribution of low-pressure cuffed tracheostomy tubes to the inadvertent respiratory tract misplacement of a nasogastric feeding tube, as well as the problems of nasogastric feeding tube insertion in the sedated patient, why the previously installed closed-tube thoracostomy did not prevent the pneumothorax and possible pitfalls in confirming the proper position of the nasogastric feeding tube. In conclusions, we stress that in high risk patients a nasogastric feeding tube should only be inserted under direct vision and that a subsequent routine X-ray is mandatory for confirming proper positioning.
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Intensive care medicine · Apr 1997
Randomized Controlled Trial Clinical TrialUse of 2% propofol to produce diurnal sedation in critically ill patients.
The assessment of propofol to produce diurnal sedation in critically ill patients. ⋯ Propofol can safely provide diurnal sedation in the critically ill when titrated against the Ramsay score. Sedation levels cannot be manipulated in some severely ill patients.
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Intensive care medicine · Apr 1997
Randomized Controlled Trial Clinical TrialUnfavorable mechanical effects of heat and moisture exchangers in ventilated patients.
To investigate the mechanical effects of artificial noses. ⋯ The artificial noses cause unfavorable mechanical effects by increasing inspiratory resistance, ventilation requirements, and dynamic intrinsic PEEP. Clinicians should consider these effects when setting mechanical ventilation and when assessing patients' ability to breathe spontaneously.