Intensive care medicine
-
Intensive care medicine · Jan 1997
Case ReportsLiver inflammation and acute respiratory distress syndrome in a patient receiving hepatitis B vaccine: a possible relationship?
We describe a patient in whom clinical evidence of liver and lung dysfunction developed after he received the second dose of recombinant hepatitis B vaccine, despite no serologic evidence of viral hepatitis. However, liver biopsy specimens demonstrated both surface antigens and core antigens, possibly indicating silent hepatitis B virus infection. A search for an infective etiology for the patient's subsequent clinical deterioration in lung function did not yield pathogens: postmortem examination revealed evidence of immune complex-mediated organ injury in the liver, lungs, and kidneys.
-
Intensive care medicine · Jan 1997
Randomized Controlled Trial Clinical TrialA cost analysis of a treatment policy of a deliberate perioperative increase in oxygen delivery in high risk surgical patients.
To investigate the cost implications of a treatment policy of a deliberate perioperative increase of oxygen delivery in high risk surgical patients. ⋯ Perioperative increase of oxygen delivery in high risk surgical patients not only improves survival, but also provides an actual and relative cost saving. This may have important implications for the management of these patients and the funding of intensive care.
-
Intensive care medicine · Jan 1997
Case ReportsSerotonin syndrome due to an overdose of moclobemide and clomipramine. A potentially life-threatening association.
The serotonin syndrome is frequently characterized by minor neurologic manifestations that regress rapidly (such as confusion, tremor, ...). Many medications including tricyclic antidepressants, serotonin reuptake inhibitors, tryptophan and the association of monoamine oxidase inhibitors together with a serotoninergic agent have been implicated in this syndrome. In certain cases, and for poorly understood reasons, clinical manifestations can include circulatory collapse, malignant hyperthermia, convulsions and rhabdomyolysis. ⋯ Treatment, other than the withdrawal of the offending drug, is symptomatic. Dialysis may be of value in withdrawing the drug from the circulatory system. We report a patient with the serotonin syndrome of favorable outcome due to an overdose of moclobemide and clomipramine.
-
Intensive care medicine · Jan 1997
Comparative StudyAccuracy of infrared ear thermometry in adult patients.
To assess (1) the agreement between infrared ear thermometry and core reference temperature (in the pulmonary artery). (2) the agreement between measurements in the right and left ears, and (3) the screening validity of infrared tympanic thermometry in detecting rectal fever. ⋯ Both rectal and esophageal thermistor measurements showed better agreement with pulmonary artery temperature than single ear themometry. Using the mean of two ear measurements improves the agreement and screening validity for detecting fever by rectal temperature. If temperature measurements are critical, esophageal measurements achieve excellent agreement with pulmonary artery temperatures.