Intensive care medicine
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Intensive care medicine · May 2002
Lung recruitment maneuver in patients with cerebral injury: effects on intracranial pressure and cerebral metabolism.
To investigate the effects of a lung recruitment maneuver on intracranial pressure (ICP) and cerebral metabolism in patients with acute cerebral injury and respiratory failure. ⋯ Our VRM reduced cerebral hemodynamics and metabolism. We conclude that our VRM with high peak pressure effects only a marginal improvement in oxygenation but causes deterioration of cerebral hemodynamics. We therefore cannot recommend this technique for the ventilatory management of brain-injured patients.
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Intensive care medicine · May 2002
Effects of acid-base abnormalities on blood capacity of transporting CO2: adverse effect of metabolic acidosis.
Objective. To investigate the effects of some acid-base abnormalities on blood capacity of transporting CO2. Design. ⋯ Conclusions. Our findings suggest that acid-base abnormalities, particularly metabolic acidosis, markedly affect blood capacity of transporting CO2 and may worsen tissue hypercarbia associated with hypoperfusion. However, because of possible errors due to small measurements and the assumptions of the method, in the future definitive clarification will require the construction of original CO2 dissociation curves for each acid-base abnormality.
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To document the effect of neurocritical care, delivered by specialist staff and based on protocol-driven therapy aimed at intracranial pressure (ICP) and cerebral perfusion pressure (CPP) targets, on outcome in acute head injury. ⋯ Specialist neurocritical care with protocol-driven therapy is associated with a significant improvement in outcome for all patients with severe head injury. Such management may also benefit patients requiring no surgical therapy, some of whom may need complex therapeutic interventions. We found it impossible to predict need for such interventions from clinical features at presentation. These data suggest that specialist critical care with ICP/CPP guided therapy may benefit patients with severe head injury.
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Intensive care medicine · May 2002
Super high flux hemofiltration: a new technique for cytokine removal.
To test whether hemofiltration using a hemofilter with large pores (super high flux hemofiltration) achieves effective cytokine removal. ⋯ High volume ultrafiltration using a super high flux filter achieved cytokine clearances comparable to, or greater than, those currently achieved for urea during standard continuous renal replacement therapy.
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Intensive care medicine · May 2002
Psychiatric adjustment following meningococcal disease treated on a PICU.
To describe the psychiatric status of child survivors of meningococcal disease and their mothers. ⋯ A significant proportion of children surviving meningococcal disease and their parents are likely to suffer psychological stress symptoms to a degree that warrants attention.