Intensive care medicine
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Intensive care medicine · Apr 2002
Review Randomized Controlled Trial Clinical TrialRelationship between ventilatory settings and barotrauma in the acute respiratory distress syndrome.
High pressures or volumes may increase the risk of barotrauma in the acute respiratory distress syndrome (ARDS). ⋯ Clinical studies maintaining P(plat) lower than 35 cmH(2)O found no apparent relationship between ventilatory parameters and pneumothorax. Analysis of the literature suggests a correlation when patients receive mechanical ventilation with P(plat) levels exceeding 35 cmH(2)O.
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Intensive care medicine · Apr 2002
Multicenter StudyCustomized prediction models based on APACHE II and SAPS II scores in patients with prolonged length of stay in the ICU.
To study customized APACHE II and SAPS II models in predicting hospital death in patients with a prolonged length of stay in the ICU. ⋯ Despite customization, the predictive models may not support clinical decision-making in those patients who require a high share of resources. More relevant instruments are needed for the prediction of outcome of patient groups who consume the major part of ICU resources.
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Intensive care medicine · Apr 2002
Randomized Controlled Trial Clinical TrialSelective decontamination of subglottic area in mechanically ventilated patients with multiple trauma.
To determine whether selective decontamination locally in the subglottic area (SDSA) reduces tracheal colonization and prevents ventilator-associated pneumonia (VAP) in patients with multiple trauma. ⋯ The SDSA is an effective and safe type of chemoprophylaxis against tracheal colonization and can significantly reduce the incidence of VAP in mechanically ventilated patients with multiple trauma.
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Intensive care medicine · Apr 2002
Comparative StudyCardiac output measurement by pulse dye densitometry: a comparison with the Fick's principle and thermodilution method.
To evaluate the agreement between cardiac output (CO) measurements obtained by a new dye dilution technique using pulse dye densitometry (PDD) and thermodilution (TD) and the direct Fick method (F). ⋯ Comparison between PDD and TD showed good agreement for the normal to high CO range. However, agreement was poor in patients with low CO. In the latter patient group PDD showed relevant underestimation of CO compared to TD and F. Due to these limitations PDD cannot entirely replace the pulmonary artery catheter for CO determination.
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Intensive care medicine · Apr 2002
Comparative StudyComparison of different methods for measuring intra-abdominal pressure.
Intra-abdominal pressure (IAP) can be measured in different ways but is usually measured indirectly via the urinary bladder. The aim of the study was to: 1) compare urinary bladder pressure, femoral vein pressure, and inferior caval vein pressure with IAP at different levels of IAP; and 2) try to find an optimal amount of fluid to be instilled into the urinary bladder before measurement of the bladder pressure, and to compare changes in blood flow in the femoral vein with that in the caval vein at different pressure levels. ⋯ In our porcine model, and increasing the IAP by means of instillation of Ringer's solution, a reliable estimation of the IAP was obtained by measuring the pressure in the urinary bladder, the femoral vein or the inferior caval vein. The IAP estimated indirectly as the urinary bladder pressure is affected by the amount of fluid in the bladder, which should not exceed 10-15 ml. The decrease in femoral vein blood flow reflects the changes in inferior caval vein flow during increased IAP.