Intensive care medicine
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Intensive care medicine · Sep 1996
Randomized Controlled Trial Clinical TrialN-acetylcysteine pretreatment of cardiac surgery patients influences plasma neutrophil elastase and neutrophil influx in bronchoalveolar lavage fluid.
Study of leukocyte activation and release of toxic mediators during extracorporeal circulation (ECC). ECC can be used to study the potential protective effect of a pharmacon against neutrophil-mediated lung injury. Clinical studies have indicated that N-acetylcysteine (NAC) may improve systemic oxygenation and reduce the need for ventilatory support when given to patients with acute lung injury. ⋯ Pretreatment with NAC may prevent lung injury by diminishing elastase activity. Since the release of mediators, especially MPO, is not affected, this diminished activity of elastase may be achieved by enhanced inactivation by antiproteases after initial treatment.
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To determine survival and changes in quality of life (QOL) after hospital discharge in patients who had stayed in an intensive care unit (ICU). ⋯ After hospital discharge, the survival of ICU-admitted patients is comparable to that of the general population and not related to ICU treatments. Most patients maintain their physical activity and social status at the preadmission level. Any worsening, if present, is slight and does not influence perceived QOL.
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Intensive care medicine · Sep 1996
Critical illness polyneuropathy in multiple organ dysfunction syndrome and weaning from the ventilator.
Acute axonal polyneuropathy has been found in patients with multiple organ dysfunction syndrome. This 'critical illness polyneuropathy' (CIP) has been associated with difficult weaning from the ventilator in retrospective studies. ⋯ Axonal polyneuropathy is related to the severity of multiple-organ-dysfunction syndrome. Its presence does not necessarily implicate difficult weaning from artificial ventilation.
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Intensive care medicine · Sep 1996
Infection control practices in intensive care units of 14 European countries. The EURO.NIS Study Group.
To evaluate compliance with recommended patient-care practices for the prevention of hospital-acquired infections (HAI) in the intensive care unit (ICU). ⋯ Interpretation of data is made difficult by the lack of consensus among experts with respect to some of the practices investigated. Nevertheless, the implementation of standard practices for preventing HAIs is far from satisfactory in the hospitals surveyed, even in a high priority hospital area such as intensive care. Documented European guidelines could be worth-while in increasing awareness of the ICU staff. The availability of at least one infection control nurse in each hospital should be strongly advocated.
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Intensive care medicine · Sep 1996
Postal survey on the long-term use of neuromuscular block in the intensive care.
To assess the long-term use of neuromuscular blocking (NMB) agents in intensive care, especially with reference to the potential problems of the long-term use of NMB drugs in the intensive care unit (ICU). ⋯ Most responders agreed that while neuromuscular block in the ICU population may provide advantages, it cannot be considered benign. Indeed, a great majority consider that NMB agents should be used only as a last option and -for as short a period as possible.