Intensive care medicine
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Intensive care medicine · Nov 2002
Acute lung injury and acute respiratory distress syndrome at the intensive care unit of a general university hospital in Brazil. An epidemiological study using the American-European Consensus Criteria.
To determine: (1) the frequency of acute lung injury (ALI)/acute respiratory distress syndrome (ARDS); (2) the mortality associated with these syndromes and (3) the influence of risk factors, comorbidities and organ system dysfunction in the mortality of ALI patients. ⋯ (1) The frequency of ALI was 3.8%, of which the frequency of ARDS was 2.3% and of ALI/non-ARDS 1.5%; (2) The ICU and hospital mortality of ALI patients was 44.0% and 48.0%, respectively; mortality rates of ARDS and ALI/non-ARDS did not differ significantly; (3) Renal and hematological dysfunction were associated with mortality in ALI patients.
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Intensive care medicine · Nov 2002
Multicenter StudyPyrexia in head-injured patients admitted to intensive care.
(a) To quantify the occurrence of pyrexia during the first week after head injury; (b) to elucidate the relationships between pyrexia and neurological severity, length of stay in the ICU, intracranial hypertension, and cerebral perfusion pressure (CPP); and (c) to describe the effects of antipyretic therapy on temperature, intracranial pressure (ICP) and CPP. ⋯ Pyrexia is extremely frequent in the acute phase after head injury. Its incidence is higher in more severe cases and is correlated with a longer ICU stay. It may affect ICP, but its contribution is difficult to assess when other major causes of increased intracranial volume are present. Antipyretic therapy is poorly effective for controlling body temperature and may be deleterious for CPP.
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Intensive care medicine · Nov 2002
Pulmonary gas exchange response to weaning with pressure-support ventilation in exacerbated chronic obstructive pulmonary disease patients.
To assess if pressure-support ventilation (PSV) can improve ventilation-perfusion (V(A)/Q) imbalance observed during the transition from positive-pressure ventilation to spontaneous breathing in intubated chronic obstructive pulmonary disease (COPD) patients during weaning. ⋯ In COPD patients during weaning, PSV avoided V(A)/Q worsening during the transition from positive-pressure ventilation to spontaneous breathing. Hemodynamics, blood gases or V(A)/Q mismatch were no different between ACV and PSV when both modalities provided similar levels of ventilatory assistance.
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Intensive care medicine · Nov 2002
Comparative StudyComparison of the effects of heat and moisture exchangers and heated humidifiers on ventilation and gas exchange during non-invasive ventilation.
To compare the short-term effects of a heat and moisture exchanger (HME) and a heated humidifier (HH) during non-invasive ventilation (NIV). ⋯ During NIV the increased dead space of a HME can negatively affect ventilatory function and gas exchange. The effect of HME dead space may decrease efficiency of NIV in patients with ARF.
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Intensive care medicine · Nov 2002
Clearance of vancomycin during high-volume haemofiltration: impact of pre-dilution.
To measure the sieving coefficient (SC) and clearance of vancomycin during high-volume haemofiltration (HVHF) and to evaluate the impact of different pre-dilution regimens on these variables. ⋯ HVHF achieves high vancomycin clearances, which despite some deterioration in SC increase with the proportion of replacement fluid given post-filter. Clinicians applying HVHF need to be aware of such clearances to avoid inadequate vancomycin dosing and to adjust therapy according to variations in HVHF technique.