Intensive care medicine
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The development of methods for the analysis of gene structure and function, referred to as recombinant DNA (deoxyribonucleic acid) technology, has created unprecedented opportunities for significantly improving the prevention or treatment of human diseases. Both practitioners working in this field and interested observers cannot fail to recognize that the remarkable progress in understanding disease pathogenesis has placed us on the threshold of a new, revolutionary era of clinical practice. In this context, molecular medicine--that is, the application of molecular biology to elucidating the causes and potential cures of disease, has become a major thrust of research at virtually all medical schools. Incorporating the techniques of molecular biology into the research arsenal of the physician should provide new opportunities to dissect out and define the reversible and irreversible intracellular processes giving rise to acute respiratory distress syndrome, sepsis, septic shock, or multiple system organ failure, the major causes of mortality in most intensive care units.
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Intensive care medicine · Jul 1999
Randomized Controlled Trial Clinical TrialPatient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger.
Air leaks around the mask are very likely to occur during noninvasive ventilation, in particular when prolonged ventilatory treatment is required. It has been suggested that leaks from the mask may impair the expiratory trigger cycling mechanism when inspiratory pressure support ventilation (PSV) is used. The aim of this study was to compare the short-term effect of two different expiratory cycling mechanisms (time-cycled vs flow-cycled) during noninvasive inspiratory pressure support ventilation (NIPSV) on patient-ventilator synchronisation in severe hypoxemic respiratory failure. ⋯ In the presence of air leaks a time-cycled expiratory trigger provides a better patient-machine interaction than a flow-cycled expiratory trigger during NIPSV.
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Intensive care medicine · Jul 1999
Multicenter StudyThe use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM.
To evaluate the performance of total maximum sequential organ failure assessment (SOFA) score and a derived measure, delta SOFA (total maximum SOFA score minus admission total SOFA) as a descriptor of multiple organ dysfunction/failure in intensive care. ⋯ The results show that total maximum SOFA score and delta SOFA can be used to quantify the degree of dysfunction/failure already present on ICU admission, the degree of dysfunction/failure that appears during the ICU stay and the cumulative insult suffered by the patient. These properties make it a good instrument to be used in the evaluation of organ dysfunction/failure.
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Intensive care medicine · Jul 1999
Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment.
Many survivors of critical illness and intensive care unit (ICU) treatment have traumatic memories such as nightmares, panic or pain which can be associated with the development of posttraumatic stress disorder (PTSD). In order to simplify the rapid and early detection of PTSD in such patients, we modified an existing questionnaire for diagnosis of PTSD and validated the instrument in a cohort of ARDS patients after long-term ICU therapy. ⋯ The questionnaire was found to be a responsive, valid and reliable instrument to screen survivors of intensive care for PTSD.