Intensive care medicine
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Intensive care medicine · Oct 2001
Randomized Controlled Trial Comparative Study Clinical TrialSalbutamol delivery during non-invasive mechanical ventilation in patients with chronic obstructive pulmonary disease: a randomized, controlled study.
We investigated the clinical response to equivalent doses of salbutamol delivered, via metered dose inhaler (MDI) during non-invasive mechanical ventilation (NIMV-MDI), during spontaneous breathing using a spacer (MDI-Spacer), and also during intermittent positive pressure breathing (IPPB). ⋯ We show that delivery of bronchodilators via MDI with a spacer chamber during NIMV is feasible and induces a significant bronchodilator effect compared to placebo, even though it may be slightly less effective than the classical delivery system (MDI-Spacer).
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Intensive care medicine · Oct 2001
Comparative StudyAccuracy of pulse oximetry in the intensive care unit.
Pulse oximetry (SpO2) is a standard monitoring device in intensive care units (ICUs), currently used to guide therapeutic interventions. Few studies have evaluated the accuracy of SpO2 in critically ill patients. Our objective was to compare pulse oximetry with arterial oxygen saturation (SaO2) in such patients, and to examine the effect of several factors on this relationship. ⋯ Large SpO2 to SaO2 differences may occur in critically ill patients with poor reproducibility of SpO2. A SpO2 above 94% appears necessary to ensure a SaO2 of 90%.
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Intensive care medicine · Oct 2001
Changes in the profile of paediatric intensive care associated with centralisation.
To compare intensive care admissions from a defined population of children in 1991 and 1999, during a period of organisational change and centralisation of paediatric intensive care. ⋯ Centralisation by expansion of the lead centre was associated with a large increase in the numbers of children receiving intensive care consistent with an unmet need for paediatric intensive care in 1991, which may still exist. Centralisation of paediatric intensive care may have contributed to the fall in child mortality over this time period.
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Intensive care medicine · Oct 2001
Case ReportsMassive pulmonary embolism with large floating thrombus in the truncus of the pulmonary artery.
A conservative strategy with anticoagulation led to spontaneous dissolution of a large floating thrombus (7.0x0.5 cm) in the truncus of the pulmonary artery in a 51-year-old woman with massive pulmonary embolism (pulmonary emboli in both lungs down to the level of the segmental arteries). Interventional therapy such as thrombolysis or pulmonary thrombectomy was not considered to be appropriate for this patient because of the risk of disrupture and embolization of parts of this large central thrombus. We believe that in certain cases with massive pulmonary embolism and large floating central thrombi a conservative strategy with anticoagulation may be appropriate. Such cases may be observed more often in the future using the technique of spiral computed tomographic angiography.
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Intensive care medicine · Oct 2001
Inter-hospital transportation of patients with severe acute respiratory failure on extracorporeal membrane oxygenation--national and international experience.
To evaluate the experiences and results from inter-hospital transportation of patients with acute respiratory failure on extracorporeal membrane oxygenation (ECMO). ⋯ Tertiary intensive care units and ECMO centers require a dedicated transport team. ECMO transports can be performed safely for all age groups for long distances, probably throughout most of Europe.