Intensive care medicine
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Intensive care medicine · Apr 2001
ReviewComputerised tomography scan imaging in acute respiratory distress syndrome.
Computerised tomography (CT) is being used with increasing frequency in acute respiratory distress syndrome (ARDS) patients. This brief review will discuss some of the clinical insights that a CT scan can offer. A large number of CT scan studies have provided new insights into the pathophysiology of ARDS and of mechanical ventilation, and are particularly focused on the recruitment-derecruitment phenomenon. To this end, newer fast CT scan technology promises a dynamic, rather than a static view of lung ventilation.
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Intensive care medicine · Apr 2001
Randomized Controlled Trial Clinical TrialClosed system endotracheal suctioning maintains lung volume during volume-controlled mechanical ventilation.
A closed suction system (CS) maintains connection with the mechanical ventilator during tracheal suctioning and is claimed to limit loss in lung volume and oxygenation. We compared changes in lung volume, oxygenation, airway pressure and hemodynamics during endotracheal suctioning performed with CS and with an open suction system (OS). ⋯ Avoiding suction-related lung volume loss can be helpful in patients with an increased tendency to alveolar collapse; CS allows suctioning while avoiding dramatic drops in lung volumes and seems to be safe during the VC ventilation setting that we used.
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Intensive care medicine · Apr 2001
Randomized Controlled Trial Clinical TrialEqual aspiration rates in gastrically and transpylorically fed critically ill patients.
To determine the difference in aspiration rates between gastrically and transpylorically fed patients in the intensive care unit. ⋯ There was no difference in aspiration rates between gastrically and transpylorically fed critically ill patients.
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Intensive care medicine · Apr 2001
Randomized Controlled Trial Comparative Study Clinical TrialHirudin versus heparin for anticoagulation in continuous renal replacement therapy.
To compare the efficacy and safety of hirudin and heparin for anticoagulation during continuous renal replacement therapy (CRRT) in critically ill patients. ⋯ Hirudin can be used efficiently for anticoagulation in CRRT. Late bleeding complications may have been caused by possible hirudin accumulation, but this was not evident from hirudin plasma and ECT levels. Since bleeding complications were observed only in the presence of documented coagulation disorders, not only adequate drug monitoring but also the plasmatic and cellular coagulation status of the patient should be taken into consideration for adjusting hirudin dosage.
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Intensive care medicine · Apr 2001
Comparative StudyValidity of applying TRISS analysis to paediatric blunt trauma patients managed in a French paediatric level I trauma centre.
Using a weighted combination of the Revised Trauma Score (RTS), the Injury Severity Score (ISS), the type of injury (blunt or penetrating) and patient age, the TRISS method is used to calculate the probability of survival (ps) in trauma patients. The goal of this study was to compare the ability of the American Major Trauma Outcome Study (MTOS) norm for adult blunt trauma patients (ADULT) and the specific norm for paediatric patients (PED) to estimate the ps of injured children using TRISS methodology. ⋯ Both adult and paediatric norms were equally good predictors of the probability of survival of injured children, provided that Ws and Zs are used when there is a disparity in the severity match between the study group and the MTOS group.