Intensive care medicine
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Intensive care medicine · Oct 2000
Esophageal motility disorders in critically ill patients: a 24-hour manometric study.
Impaired tubular esophageal motility is involved in the pathogenesis of gastroesophageal reflux disease, which, in turn, has been shown to cause nosocomial pneumonia in critically ill patients. As multiple factors are involved, this pilot study was undertaken to evaluate whether, similarly, impaired esophageal motility may contribute to nosocomial infections by determining esophageal motility in critically ill patients undergoing mechanical ventilation and sedation in comparison to that of a healthy control group. ⋯ Irrespective of the underlying disease, propulsive motility of the esophageal body is significantly reduced during any kind of sedation in critically ill patients. Possibly central as well peripheral drug-related effects are involved in such a depression. Twenty-four hour motility recordings appear to be a valuable and feasible method to quantify and analyze esophageal motor disorders in critically ill patients.
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Intensive care medicine · Oct 2000
Do we need new indications for ECMO in neonates pretreated with high-frequency ventilation and/or inhaled nitric oxide?
High-frequency ventilation (HFV) and/or inhaled nitric oxide (iNO) has reduced ECMO in neonates. But, frequently, improvement with HFV/iNO is temporary and only prolongs lung injury without preventing ECMO. We tried to identify a threshold oxygenation index (OI) that predicts temporary or persistent improvement with HFV/iNO in neonatal ECMO candidates as early as possible. ⋯ For neonates pretreated with HFV/iNO, an OI > 40 is an inadequate ECMO indication. Based on our data we hypothesize that an OI > or = 25 after 72 h of HFV/ iNO is a better ECMO indication that avoids prolonged barotrauma.
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Intensive care medicine · Oct 2000
Prevalence of tracheostomy in ICU patients. A nation-wide survey in Switzerland.
To assess the frequency, timing and technique of tracheostomy and its variation between different intensive care units (ICUs) in Switzerland. ⋯ Despite its frequency, tracheostomy in Swiss ICUs is far from being standardized with regard to indication, timing and choice of technique.
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Intensive care medicine · Oct 2000
Respiratory depression under long-term sedation with sufentanil, midazolam and clonidine has no clinical significance.
Assessment of respiratory depression caused by long-term sedation with sufentanil, midazolam and clonidine. ⋯ Patients under continuous sedation with sufentanil exhibit a statistically significant rise in arterial PCO2, however this respiratory depression is only slight and has no clinical significance. Mechanically assisted spontaneous ventilation modes can safely be used under continuous sedation with sufentanil, midazolam or clonidine.
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Intensive care medicine · Oct 2000
Hepatic O2 exchange and liver energy metabolism in hyperdynamic porcine endotoxemia: effects of iloprost.
To compare the effects of a 12 h continuous infusion of iloprost, a stable prostacyclin analogue, on hepatic blood flow (Qliv), O2 exchange, and energy metabolism during a 24 h hyperdynamic, porcine endotoxemia with volume resuscitation alone. ⋯ Thus, in a clinically relevant model of human sepsis, iloprost did not produce potential adverse effects but rather ameliorated hepatic metabolic disturbances and, thereby, hepatic energy balance.