Intensive care medicine
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Intensive care medicine · Apr 1999
Comparative Study Clinical TrialComparison of five sedation scoring systems by means of auditory evoked potentials.
To review five sedation scoring systems and to determine their correlation with an objective method for assessing the level of sedation by means of auditory evoked potentials (AEP) in critically ill patients. ⋯ For the assessment of sedation, several scoring systems have been introduced into clinical practice, but the differentiation of deeper sedation levels, especially, remains poor. In this study we compared auditory evoked potentials, as an objective method with which to assess the level of sedation, with five different sedation scoring systems. In comparison with changes in latency of the midlatency component N(b), Ramsay's sedation score showed the closest correlation. Objective electrophysiological monitoring is desirable during long-term sedation.
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Intensive care medicine · Apr 1999
Medication errors at the administration stage in an intensive care unit.
To assess the type, frequency and potential clinical significance of medication-administration errors. ⋯ According to this first observation-based study of medication administration errors in a European ICU, these errors were due to deficiencies in the overall organisation of the hospital medication track, in patient follow-up and in staff training.
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Intensive care medicine · Apr 1999
Case ReportsRight-to-left interatrial shunt in ARDS: dramatic improvement in prone position.
The mechanisms leading to shunting through a patent foramen ovale include high right-sided cardiac pressures and respiratory factors due to mechanical ventilation and also anatomical changes in the right atrium as described in the platypnea-orthodeoxia syndrome. We report a patient with the adult respiratory distress syndrome (ARDS) who had a right-to-left atrial shunt which decreased in the prone position, after which oxygenation improved. The patient was admitted to the intensive care unit because of ARDS due to an invasive fungal infection. ⋯ Blood gas values improved dramatically (arterial oxygen tension/fractional inspired oxygen ratio increasing from 59 to 278 torr). Transcranial Doppler sonography was performed with bubble study, which confirmed a massive right-to-left shunt in the supine position and which instantaneously decreased in the prone position. This case suggests that a decrease in right-to-left shunt in patients who have a patent foramen ovale could partly explain the improvement in hypoxemia in the prone position.
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To examine the correlation between the clinical diagnosis and autopsy findings in adult patients who died in an intensive care unit (ICU). To determine the rate of agreement of the basic and terminal causes of death and the types of errors in order to improve quality control of future care. ⋯ The rate of recognition of the basic cause was 66.7%, which is consistent with the literature, but the Class I error rate was higher than that reported in the literature.
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Intensive care medicine · Apr 1999
Case ReportsDifferential lung physiotherapy using a double lumen tube in flail chest and refractory lung atelectasis.
The management of refractory lung atelectasis in a patient with flail chest can be difficult. Treatment of lung atelectasis is complicated by practical problems with the application of chest physiotherapy, postural drainage and incentive spirometry. Although double lumen endotracheal tubes have been used in such cases for the purpose of differential lung ventilation, the use of differential lung physiotherapy has not been reported before. This report describes the successful application of this technique in a patient with flail chest and refractory lung atelectasis.