Intensive care medicine
-
The need for reintubation within 24-72 h of planned extubation is a common event, occurring in 2-25% of extubated patients. Risk factors for extubation failure include being a medical, multidisciplinary or paediatric patient; age >70 years; a longer duration of mechanical ventilation; use of continuous intravenous sedation; and anaemia (haemoglobin <10 g/dl or haematocrit <30%) at the time of extubation. The pathophysiology of extubation failure can be distinct from that seen with weaning failure and includes upper airway obstruction, inadequate cough, excess respiratory secretions, encephalopathy, and cardiac dysfunction. ⋯ Tests designed to assess for upper airway obstruction, secretion volume, and the effectiveness of cough seem most promising for improving the decision to extubate. Mortality increases with delays in reintubation for patients failing extubation. Timely identification of patients at elevated risk of extubation failure followed by rapid re-establishment of ventilatory support can improve outcome.
-
Intensive care medicine · May 2002
Randomized Controlled Trial Clinical TrialHydroxyethyl starch and modified fluid gelatin maintain plasma volume in a porcine model of septic shock with capillary leakage.
To compare the effects of different volume replacement therapies on maintenance of plasma volume in septic shock and capillary leakage syndrome. ⋯ In this porcine septic shock model with concomitant capillary leakage syndrome, confirmed by an increased albumin escape rate, the artificial colloids HES, MFG4%, and MFG8% maintained plasma volume and colloid osmotic pressure. These results suggest the intravascular persistency of artificial colloids in the presence of albumin leakage. An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-002-1283-9)
-
Intensive care medicine · May 2002
A prospective survey of early 12-h prone positioning effects in patients with the acute respiratory distress syndrome.
To evaluate of the oxygenation effects of 12-h prone positioning (PP) in ARDS patients and to assess the safety of such a procedure. ⋯ Twelve-hour PP is a safe procedure and allows a continuous oxygenation improvement throughout the entire session.
-
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.
-
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.