Intensive care medicine
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Intensive care medicine · Apr 1999
Comparative Study Clinical TrialThe comet-tail artifact: an ultrasound sign ruling out pneumothorax.
Ultrasound artifacts arising from the lung-wall interface are either vertical (comet-tail artifacts) or horizontal. The significance of these artifacts for the diagnosis of pneumothorax was assessed. ⋯ Ultrasound detection of the "comet-tail artifact" at the anterior chest wall allows complete pneumothorax to be discounted.
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Intensive care medicine · Apr 1999
Randomized Controlled Trial Clinical TrialFatty acid composition of platelet membrane lipids after administration of two different fat emulsions in critically ill patients.
To determine the effects on platelet membrane fatty acid composition following administration of two different fat emulsions. ⋯ The observed changes in fatty acid composition are in agreement with the lipid composition of the fat emulsions used. Because the C18:2n-6/C18:3n-3 ratio in both emulsions is close (approximately 9.0), the observed changes in the fatty acid composition of platelets may not be relevant for platelet function.
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Intensive care medicine · Apr 1999
Multicenter StudyApplication of SOFA score to trauma patients. Sequential Organ Failure Assessment.
To assess the ability of the SOFA score (Sequential Organ Failure Assessment) to describe the evolution of organ dysfunction/failure in trauma patients over time in intensive care units (ICU). ⋯ The SOFA score can reliably describe organ dysfunction/ failure in trauma patients. Regular and repeated scoring may be helpful for identifying categories of patients at major risk of prolonged ICU stay or death.
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Intensive care medicine · Apr 1999
Comparative Study Clinical TrialComparison of five sedation scoring systems by means of auditory evoked potentials.
To review five sedation scoring systems and to determine their correlation with an objective method for assessing the level of sedation by means of auditory evoked potentials (AEP) in critically ill patients. ⋯ For the assessment of sedation, several scoring systems have been introduced into clinical practice, but the differentiation of deeper sedation levels, especially, remains poor. In this study we compared auditory evoked potentials, as an objective method with which to assess the level of sedation, with five different sedation scoring systems. In comparison with changes in latency of the midlatency component N(b), Ramsay's sedation score showed the closest correlation. Objective electrophysiological monitoring is desirable during long-term sedation.
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Intensive care medicine · Apr 1999
Case ReportsRight-to-left interatrial shunt in ARDS: dramatic improvement in prone position.
The mechanisms leading to shunting through a patent foramen ovale include high right-sided cardiac pressures and respiratory factors due to mechanical ventilation and also anatomical changes in the right atrium as described in the platypnea-orthodeoxia syndrome. We report a patient with the adult respiratory distress syndrome (ARDS) who had a right-to-left atrial shunt which decreased in the prone position, after which oxygenation improved. The patient was admitted to the intensive care unit because of ARDS due to an invasive fungal infection. ⋯ Blood gas values improved dramatically (arterial oxygen tension/fractional inspired oxygen ratio increasing from 59 to 278 torr). Transcranial Doppler sonography was performed with bubble study, which confirmed a massive right-to-left shunt in the supine position and which instantaneously decreased in the prone position. This case suggests that a decrease in right-to-left shunt in patients who have a patent foramen ovale could partly explain the improvement in hypoxemia in the prone position.