Intensive care medicine
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Intensive care medicine · Sep 2002
ReviewOpening the microcirculation: can vasodilators be useful in sepsis?
A prominent feature of sepsis is dysfunction of the microcirculation, with impaired perfusion and regional tissue oxygenation causing a deficit in oxygen extraction. If shunting of oxygen transport past closed hypoxic microcirculatory beds is responsible for this, vasodilator therapy, which raises the driving pressure of the microcirculation and thereby promotes flow, could recruit such shunted microcirculatory units and improve tissue oxygenation. ⋯ Prostacyclin and nitric oxide donors are the best studied vasodilating agents in experimental sepsis and have shown improved tissue perfusion and oxygen extraction. In several clinical studies prostacyclin has also been shown to have such beneficial effects. Recent studies using orthogonal polarization spectral imaging have shown microcirculatory recruitment by nitric oxide donors in hemodynamically resuscitated septic patients. Whether such therapeutic modalities aimed at recruitment of the microcirculation improve outcome, however, still has to be determined.
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Intensive care medicine · Sep 2002
Case ReportsLife-threatening hyperkalaemia following therapeutic barbiturate coma.
To report the occurrence of life-threatening hyperkalaemia following treatment with therapeutic thiopentone coma. ⋯ Severe hypokalaemia refractory to potassium therapy may occur during therapeutic thiopentone coma. Severe rebound hyperkalaemia may occur after cessation of thiopentone infusion. Protocols for the management of patients with therapeutic barbiturate coma should recognise this potentially serious complication.
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Intensive care medicine · Sep 2002
Randomized Controlled Trial Comparative Study Clinical TrialSingle-dilator percutaneous tracheostomy: a comparison of PercuTwist and Ciaglia Blue Rhino techniques.
To compare two single-dilator percutaneous tracheostomy techniques, Ciaglia Blue Rhino and the new PercuTwist technique. ⋯ So far the new PercuTwist technique represents an alternative to the established Blue Rhino technique. Nonetheless, the two cases of posterior tracheal wall injury should not be underestimated, on the one hand, but, on the other, may be attributed to a learning curve with a new technique. The new PercuTwist technique should be performed by various teams and in a considerably larger numbers of patients before an ultimate rating can be made.
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Intensive care medicine · Sep 2002
Randomized Controlled Trial Comparative Study Clinical TrialShort-term treatment of severe hypertension of pregnancy: prospective comparison of nicardipine and labetalol.
To assess the efficacy and safety of nicardipine in comparison to labetalol in the initial management of severe hypertension in pregnancy. DESIGN. Randomized prospective study. ⋯ Nicardipine and labetalol are effective and safe in the initial treatment of severe hypertension of pregnancy.