Intensive care medicine
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Intensive care medicine · Nov 1999
Changing a hydrophobic heat and moisture exchanger after 48 hours rather than 24 hours: a clinical and microbiological evaluation.
Complications following ventilation with dry and cold gases may be prevented by the use of artificial noses or heat and moisture exchangers, which are a solution to both the problems of humidification and heat preservation. The aim of the present study was to determine whether changing hydrophobic heat and moisture exchangers (HMEs) every 48 h rather than 24 h would affect their efficacy to preserve the heat and moisture of inspiratory gases. The impact of a prolonged use of the HME on its microbial colonization was also assessed. ⋯ Changing the hydrophobic HME after 48 h rather than 24 h did not affect its technical performance in terms of heat and water preservation of ventilatory gases. There is also some indirect evidence of very little, if any, change in HME resistance. No bacterial colonization of the ventilator sides of the HMEs was observed after 48 h of use. However, other large clinical trials should be undertaken to confirm the safety of extending the time between HME changes.
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Intensive care medicine · Nov 1999
Plasma levels of the three endothelial-specific proteins von Willebrand factor, tissue factor pathway inhibitor, and thrombomodulin do not predict the development of acute respiratory distress syndrome.
To determine if the plasma levels of three endothelial-specific proteins, von Willebrand factor (vWF), tissue factor pathway inhibitor (TFPI) and thrombomodulin (TM) may be useful in predicting the development of acute respiratory distress syndrome (ARDS). ⋯ Plasma levels of vWF, TFPI and TM did not appear to serve as useful markers for predicting ARDS in patients at risk.
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Intensive care medicine · Nov 1999
Septic shock without documented infection: an uncommon entity with a high mortality.
To determine whether patients with clinically identified infection have the same outcome as patients with apparent sepsis but no identified infectious source. ⋯ A small number of patients presenting with septic shock have no clinically identified infection. These patients have a higher mortality rate than patients in whom an infection is identified.
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Intensive care medicine · Nov 1999
Alteration of anion gap during almost total plasma replacement with synthetic colloids in piglets.
In ten piglets (body weight 8.2-11.6 kg), acid base, electrolyte and anion gap changes were investigated during almost total plasma replacement with hydroxyethyl starch (HES) and modified fluid gelatin (GEL) in saline solution using a cell saver autotransfusion technique. During the study, there were only moderate acid base changes, but marked disturbances in anion balance. ⋯ It is concluded that plasma replacement with electroneutral HES, but not with negatively charged GEL, can lower the anion gap irrespective of the underlying disease. This can be misleading when the anion gap is used for differential diagnosis of metabolic acidosis in patients after large volume infusion of synthetic colloids.