Intensive care medicine
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Intensive care medicine · Nov 1997
Case ReportsVenobronchial fistula: an unusual early complication after central venous catheterization.
Venobronchial fistula is a rare complication of long-term central venous catheterization. We present the uncommon occurrence of a venobronchial fistula as an acute complication of central venous catheterization during open heart surgery. The factors responsible for this unusual complication and the methods to prevent it are discussed.
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Intensive care medicine · Nov 1997
Comparative StudyIntensive care 1980-1995: change in patient characteristics, nursing workload and outcome.
To assess temporal changes in patient characteristics, nursing workload and outcome of the patients and to compare the actual amount of available nursing staff with the estimated needs in a medical-surgical ICU. ⋯ During the last 16 years, there has been a marked increase in workload at this medical-surgical ICU. Despite an increase in the number of severely sick patients (as defined by the nursing grading system) and patient age, ICU mortality and LOS declined from 1980 to 1995. This may be ascribed to improved patient treatment or care. Whether an increasingly liberal discharge policy (transfer to newly opened intermediate care units, transfer of patients expected to die to the ward) or a more rigorous triage (denying admission to patients with a very poor prognosis) are confounding factors cannot be answered by this investigation. The present data provide support for the tenet that there is a trend toward more complex therapies in increasingly older patients in tertiary care ICUs. Calculations for the number or nurses needed in an ICU should take into acount the increased turnover of patients and the changing patient characteristics.
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Intensive care medicine · Nov 1997
Clinical TrialQuantification and predictors of plasma volume expansion from mannitol treatment.
To determine the effects of acute hypertonic mannitol infusion on intravascular volume expansion and to identify potential predictors of hypervolemia. ⋯ Therapeutic doses of hypertonic mannitol cause substantial plasma volume expansion, resulting in increased blood pressure. Plasma volume expansion is related to mannitol serum concentrations and mannitol clearance determines the time required to restore normovolemia. ADH and ANP are potentially aggravating factors of mannitol-induced hyponatremia.
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Intensive care medicine · Nov 1997
Comparative StudyInterpretation of the pulmonary artery occlusion pressure in mechanically ventilated patients with large respiratory excursions in intrathoracic pressure.
To assess the reliability of the pulmonary artery occlusion pressure (Ppao) when respiratory excursions in intrathoracic pressure are prominent. ⋯ In mechanically ventilated patients whose respiratory muscles produce large excursions in the Ppao, the end-expiratory Ppao is often much higher than the Ppao measured after muscle relaxation. The pre-relaxation mid-point Ppao and the relaxed Ppao are usually similar, but this may not be true in individual patients. In this setting, the Ppao measured after muscle relaxation probably provides the most clinically reliable estimate of left heart filling pressure.