Intensive care medicine
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Intensive care medicine · Dec 2000
Clinical Trial Controlled Clinical TrialDifferent dosages of dobutamine in septic shock patients: determining oxygen consumption with a metabolic monitor integrated in a ventilator.
Oxygen consumption (VO2) obtained from respiratory gases by indirect calorimetry (VO2,IC) with a metabolic monitor integrated in a ventilator were to be compared to VO2 obtained by the Fick principle (VO2,Fick) in septic patients following an increase in oxygen delivery (DO2) induced by positive inotropic support. ⋯ With a metabolic monitor integrated in a ventilator it was possible to carry out continuous monitoring of calorimetric data under clinical conditions. In contrast to previous studies using indirect calorimetry, this study showed a moderate correlation between VO2 and DO2 in septic patients using either method. The clinical relevance of this finding requires further investigation. Different factors (e. g. injectant temperature, pulmonary VO2) produced substantial differences between VO2,IC and VO2,Fick as previously shown.
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Intensive care medicine · Dec 2000
ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy.
To determine if having a night-time nurse-to-patient ratio (NNPR) of one nurse caring for one or two patients (> 1:2) versus one nurse caring for three or more patients (< 1:2) in the intensive care unit (ICU) is associated with clinical and economic outcomes following esophageal resection. ⋯ A nurse caring for more than two ICU patients at night increases the risk of several postoperative pulmonary and infectious complications and was associated with increased resource use in patients undergoing esophageal resection.
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Intensive care medicine · Dec 2000
Predictive factors of death in primary lung cancer patients on admission to the intensive care unit.
To assess the lung cancer patient's prognosis in the intensive care unit with early predictive factors of death. ⋯ We confirmed the high mortality rate of lung cancer patients admitted to the MICU. Two predictive factors of death in MICU were identified: performance status < 70 and acute pulmonary disease.
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Intensive care medicine · Dec 2000
Clinical Trial Controlled Clinical TrialPlasma cortisol levels before and during "low-dose" hydrocortisone therapy and their relationship to hemodynamic improvement in patients with septic shock.
To compare cortisol levels during "low-dose" hydrocortisone therapy to basal and ACTH-stimulated endogenous levels and to assess whether clinical course and the need for catecholamines depend on cortisol levels and/or pretreatment adrenocortical responsiveness. ⋯ (a) During proposed regimens of "low-dose" hydrocortisone therapy, initially achieved plasma cortisol concentrations considerably exceed basal and ACTH stimulated levels. (b) Cortisol concentrations decline subsequently, despite continuous application of a constant dose. (c) "Inadequate" endogenous steroid production appears to sensitize patients to the hemodynamic effects of a "therapeutic rise" in plasma cortisol levels.
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Intensive care medicine · Dec 2000
Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance.
To determine the morbidity and mortality of percutaneous dilational tracheostomy with bronchoscopic guidance when performed by medical intensivists. ⋯ Percutaneous dilational tracheostomy with bronchoscopic guidance is a safe procedure when performed by experienced medical intensive care personnel in tertiary care institutions. Bronchoscopy helps to reduce the risk of major complications and aids in the management of minor complications.