Intensive care medicine
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Intensive care medicine · Apr 2002
What is the optimal duration of ventilation in the prone position in acute lung injury and acute respiratory distress syndrome?
To evaluate the effects of prone ventilation on respiratory parameters and extravascular lung water (EVLW) in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in order to characterise the optimal duration of ventilation in the prone position. ⋯ Over the 18 h period studied there was progressive improvement in gas exchange, pulmonary shunt and EVLW. Although it is not possible to exclude that improvement over this period was unrelated to prone positioning, these findings suggests that ventilation in the prone position for more prolonged periods may be required for optimal improvement and warrants further study.
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Intensive care medicine · Apr 2002
Tracheal gas insufflation during late exhalation efficiently reduces PaCO(2) in experimental acute lung injury.
Tracheal gas insufflation (TGI) reduces PaCO(2) by flushing the tracheal and mechanical deadspace, and may have its maximum benefit when TGI gas is unopposed by significant expiratory gas flow. Thus, limiting TGI to the late expiratory period may diminish tracheal exposure to TGI gas while preserving the efficacy of TGI. This study examined the gas exchange consequences of such late-expiratory TGI. ⋯ Under these conditions confining TGI to the final 60% of expiration achieved effective PaCO(2) reduction, not significantly different from panexpiratory TGI, while limiting exposure of the trachea to TGI gas, and reducing the potential for TGI-induced hyperinflation. These findings suggest that TGI is most effectively applied in a phasic manner in late expiration, with its duration titrated to effect.
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Intensive care medicine · Apr 2002
Letter Case ReportsFull recovery after 45 min accidental submersion.
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Intensive care medicine · Apr 2002
Comparative Study Retracted PublicationDoes coagulation differ between elderly and younger patients undergoing cardiac surgery?
Multiple improvements allow cardiac surgery in an increasingly older population. It is still unclear whether perioperative hemostasis differs between elderly and younger patients. ⋯ Elderly cardiac surgery patients already showed moderately altered coagulation prior to surgery. Thus elderly patients may be at risk of developing postoperative alterations in hemostasis on the ICU. The exact reasons for the impaired coagulation in the elderly remains to be determined.