Intensive care medicine
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Intensive care medicine · Aug 2002
ReviewPulmonary and cardiac sequelae of subarachnoid haemorrhage: time for active management?
Cardiac injury and pulmonary oedema occurring after acute neurological injury have been recognised for more than a century. Catecholamines, released in massive quantities due to hypothalamic stress from subarachnoid haemorrhage (SAH), result in specific myocardial lesions and hydrostatic pressure injury to the pulmonary capillaries causing neurogenic pulmonary oedema (NPO). The acute, reversible cardiac injury ranges from hypokinesis with a normal cardiac index, to low output cardiac failure. ⋯ An active approach to investigation and organ support could provide a window of opportunity to intervene before significant hypoxia and hypotension develop, potentially reducing adverse consequences for the long-term neurological status of the patient. Indeed, there is an argument for all SAH patients to have echocardiography and continuous monitoring of respiratory rate, pulse oximetry, blood pressure and electrocardiogram. In the event of cardio-respiratory compromise developing i.e. cardiogenic shock and/or NPO, full investigation, attentive monitoring and appropriate intervention are required immediately to optimise cardiorespiratory function and allow subsequent definitive management of the SAH.
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Intensive care medicine · Aug 2002
Comparative StudyBench testing of pressure support ventilation with three different generations of ventilators.
The new generations of intensive care ventilators tend to be more innovative and sophisticated than previous ones, but little is known about their respective performance for delivering pressure support ventilation (PSV) and how they compare to previous generations. ⋯ Regarding PSV and trigger performance, the new generation ventilators - but also some piston and turbine-based ventilators - outperform most of previous generation ventilators.
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Intensive care medicine · Aug 2002
Comparative StudyChanges in intensive care from 1987 to 1997 - has outcome improved? A single centre study.
To study changes in a single intensive care unit (ICU) over a 10 year period and to investigate possible concomitant changes in outcome. ⋯ This study indicates that the increased intensive care activity over the 10 year period was associated with a prolonged severity-adjusted survival. QOL was still reduced 3 and 13 years after ICU, compared to population scores.
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Intensive care medicine · Aug 2002
Comparative StudyShort-term cardiovascular effects of plasmapheresis in norepinephrine-refractory septic shock.
To examine the short-term cardiovascular effects of plasmapheresis in seven patients (six surgical, one medical) with norepinephrine-refractory septic shock. ⋯ In patients with norepinephrine-refractory septic shock no directional changes in measured variables were found in the first 24 h after a plasmapheresis. Thus, regarding the cost (ca. 1000 euros per separation) and possible risks the procedure needs rigorous evaluation even as "rescue therapy" in patients with septic shock.