Intensive care medicine
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Intensive care medicine · May 2000
Clinical TrialEffects of periodic lung recruitment maneuvers on gas exchange and respiratory mechanics in mechanically ventilated acute respiratory distress syndrome (ARDS) patients.
We wished to investigate whether volume recruitment maneuvers (VRMs) could improve alveolar recruitment and oxygenation in acute respiratory distress syndrome (ARDS) patients, ventilated at relatively low positive end-expiratory pressure (PEEP). ⋯ VRMs can improve oxygenation and alveolar recruitment during CPPV at relatively low PEEP, but are relatively less effective than a continuous high PEEP level.
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Intensive care medicine · May 2000
Multicenter Study Clinical TrialThe impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation.
Primarily, to determine if respiratory variables, assessed on a daily basis on days 1-6 after ICU admission, were associated with mortality in non-ARDS and ARDS patients with respiratory failure requiring mechanical ventilation. Secondarily, to determine non-respiratory factors associated with mortality in ARDS and non-ARDS patients. ⋯ No independent significant association was seen between 90-day mortality and degree of hypoxaemia, PEEP, MAP or BE for the first full week of ICU care in either ARDS or non-ARDS. In a sub-group of non-ARDS a lower PaO2/FIO2 and MAP tended to influence mortality where a significant association was seen for 3 of 7 study days. Age, gender, APS, presence of a chronic disease and a pulmonary/non-pulmonary reason for the respiratory failure were associated with mortality in non-ARDS, while only age and APS showed a similar association in ARDS.
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Intensive care medicine · May 2000
Comparative StudyEndotoxaemia in patients with severe sepsis or septic shock.
To examine the incidence and the bacteriological and clinical significance of endotoxaemia in ICU patients with severe sepsis or septic shock. ⋯ Early detection of endotoxaemia appeared to be associated with GNB infection only in cases of bacteraemic GNB infection. Early endotoxaemia correlated neither to occurrence of organ dysfunction nor mortality in patients with severe sepsis or septic shock. This study suggests that the use of endotoxaemia as a diagnostic or a prognostic marker in daily practice remains difficult.
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Intensive care medicine · May 2000
Case ReportsDialysis disequilibrium syndrome: an unusual cause of respiratory failure in the medical intensive care unit.
We describe a case of the dialysis disequilibrium syndrome (DDS) that was marked by the rapid onset of cerebral edema and the subsequent development of acute respiratory failure. The patient was treated successfully with a combination of mechanical hyperventilation and mannitol. The clinical presentation, pathogenesis, prevention and treatment of the entity are discussed.