Intensive care medicine
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Intensive care medicine · Sep 2000
Cortical arousal in critically ill patients: an evoked response study.
Assessing the level of sedation in critically ill patients remains a challenge for the intensivist in order to avoid over or under-sedation. Clinical scoring systems may fail in patients with concomitant neurological disorders or requiring muscle relaxants. We evaluated auditory (AER) and median nerve somatosensory evoked responses (MnSSER) in critically ill patients sedated with sufentanil and propofol, in order to quantify the level of sedation during therapeutic interventions. ⋯ Changes of AER or MnSSER waves indicated cortical arousal in ICU patients during nursing care and physiotherapy. Further studies with evoked responses are recommended to evaluate whether bolus injections of sedatives and/or analgesics reduce cortical arousal and thereby minimise the patient's stress during nursing care.
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Intensive care medicine · Sep 2000
Comparative StudyThe use of the arterial line as a source for blood cultures.
To determine the reliability of blood cultures obtained through indwelling arterial lines as compared to that of blood cultures obtained by venipuncture. ⋯ The results of blood cultures taken from the arterial line are frequently equivalent to those taken from venipuncture. When discordant, the growth of gram-positive bacteria almost certainly reflects contamination or arterial line colonization, whereas the growth of gram-negative bacteria may have to be considered as reflecting bacteremia.
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Intensive care medicine · Sep 2000
Early signs of critical illness polyneuropathy in ICU patients with systemic inflammatory response syndrome or sepsis.
To evaluate with electromyography the incidence and the time of appearance of neuromuscular abnormality in patients with systemic inflammatory response syndrome (SIRS) and/or sepsis. ⋯ Because neuromuscular abnormalities seem to develop earlier than previously reported, electroneuromyography should be used more frequently as a diagnostic test.
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Intensive care medicine · Sep 2000
Randomized Controlled Trial Comparative Study Clinical TrialAssessment of hemodynamic and gastric mucosal acidosis with modified fluid versus 6% hydroxyethyl starch: a prospective, randomized study.
To investigate the effect of 4 % succinylated modified fluid gelatin (MFG) versus mean weight, highly substituted 6% hydroxyethyl starch (HES) on hemodynamic and gastric mucosal acidosis variables, in septic hypovolemic patients. ⋯ Although MFG and 6% HES have the same hemodynamic effects, their physicochemical properties induce different responses on gastric mucosal acidosis in septic, hypovolemic and ventilated patients. These effects of MFG and HES on gastric mucosa need to be considered in patient management.
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Intensive care medicine · Sep 2000
Randomized Controlled Trial Clinical TrialPre-operative tonometry is predictive for mortality and morbidity in high-risk surgical patients.
To determine whether a) pre-operative measurement of gastric intramucosal pHi is predictive for mortality and morbidity in high-risk surgical patients and b) peri-operative improvement of global oxygen delivery (DO2) with fluids and dopexamine leads to increased gastric pHi and c) either improved global perfusion or improved splanchnic perfusion is related to the prevention of multiple organ failure (MOF). ⋯ In high-risk surgical patients pre-operative measurement of pHi was predictive for mortality. The peri-operative response of pHi to dopexamine seemed to be dependent on pre-operative gastric pHi.