Intensive care medicine
-
Intensive care medicine · Jan 2002
Case ReportsRemoval of propylene glycol and correction of increased osmolar gap by hemodialysis in a patient on high dose lorazepam infusion therapy.
We report a case of successful treatment of propylene glycol toxicity by discontinuation of propylene glycol administration and hemodialysis therapy. A critically ill woman receiving high dose intravenous lorazepam therapy is described. ⋯ Hemodialysis efficiently lowers propylene glycol serum concentrations in a manner analogous to extracorporeal therapy for other small molecular weight alcohol intoxications. Therefore, hemodialysis may be a useful component of therapy for critically ill patients exhibiting propylene glycol toxicity in the context of multiple organ dysfunction.
-
Intensive care medicine · Jan 2002
Intracranial pressure, brain PCO2, PO2, and pH during hypo- and hyperventilation at constant mean airway pressure in pigs.
To evaluate in healthy, non-brain-traumatized animals the effects of hypo- and hyperventilation on intracranial pressure (ICP) and brain carbon dioxide, oxygen, and pH during the use of a ventilatory mode at constant mean airway pressure (MAwP). ⋯ Controlled hypo- and hyperventilation at constant MAwP in non-brain-traumatized pigs appears to induce changes in ICP and cerebral perfusion pressure which, however, do not necessarily lead to cerebral ischemia. To achieve adequate cerebral perfusion at an increased ICP level due to hypoventilation one must maintain sufficient arterial blood pressure. Hypercapnia resulted in a significant increase in brain oxygenation; however, this does not necessarily mean that permissive hypercapnia is neuroprotective.
-
Intensive care medicine · Dec 2001
The impact of delirium in the intensive care unit on hospital length of stay.
To determine the relationship between delirium in the intensive care unit (ICU) and outcomes including length of stay in the hospital. ⋯ In this patient cohort, the majority of patients developed delirium in the ICU, and delirium was the strongest independent determinant of length of stay in the hospital. Further study and monitoring of delirium in the ICU and the risk factors for its development are warranted.
-
Intensive care medicine · Dec 2001
Comparative StudyActivation of the fibrinolytic system and utilization of the coagulation inhibitors in sepsis: comparison with severe sepsis and septic shock.
To determine whether the fibrinolytic system is activated and coagulation inhibitors are utilized in sepsis, to compare the findings detected in sepsis with those found in severe sepsis and septic shock, and to compare the role played by different infectious pathogens on fibrinolysis and coagulation inhibitors. ⋯ Fibrinolysis is strongly activated and ATIII is utilized in sepsis. These findings are further enhanced in severe sepsis and septic shock. In sepsis only ATIII is decreased. In contrast, in severe sepsis and mainly in septic shock plasminogen and the main coagulation inhibitors (i.e., ATIII, PrC) are depleted, indicating exhaustion of fibrinolysis and coagulation inhibitors. Finally, Gram-positive, Gram-negative and other micro-organisms produce identical impairment.