Intensive care medicine
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Intensive care medicine · Dec 1995
Multicenter StudyContribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism.
To verify whether the determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat inclusions is a useful diagnostic tool of posttraumatic pulmonary fat embolism. ⋯ Lipid inclusions in alveolar cells are common during traumatic and non-traumatic respiratory failure. Determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat droplets may contribute to the diagnosis of the fat embolism syndrome in mechanically-ventilated trauma patients with respiratory failure provided that the significant threshold would be 30%.
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Intensive care medicine · Dec 1995
Clinical TrialShort-term effects of methylene blue on hemodynamics and gas exchange in humans with septic shock.
The aim of this study was to investigate the acute effects of methylene blue (MB), an inhibitor of the L-arginine nitric oxide pathway, in patients with septic shock. ⋯ MB induces systemic and pulmonary vasoconstriction in patients with septic shock, without significant decrease in cardiac index. The worsening of arterial oxygenation following MB injection may limit its use in patients with the adult respiratory distress syndrome. Larger studies are required to determine whether MB improves the outcome of patients with septic shock.
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Intensive care medicine · Dec 1995
Clinical TrialPharmacokinetics and pharmacodynamics of propofol/alfentanil infusions for sedation in ICU patients.
Population pharmacokinetic analysis and pharmacodynamic profile of propofol/alfentanil infusions for sedation and analgesia of intensive care unit patients for up to 24 h. ⋯ The population pharmacokinetic analysis of propofol/alfentanil for ICU sedation therapy revealed increased volumes of drug distribution and decreased elimination characteristics as compared to pharmacokinetic data from short-term infusions in surgical patients. This can be attributed in part to altered distribution/redistribution processes and/or drug elimination under the condition of ICU therapy. No significant drug accumulation was observed. For future long-term sedation and analgesia of ICU patients with propofol/alfentanil, this altered pharmacokinetic behaviour should be taken into consideration to allow a more individualized and safer dosing of this drug combination.
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Intensive care medicine · Dec 1995
Case ReportsPostobstructive pulmonary edema induced by endotracheal tube occlusion.
Pulmonary edema is a well-described complication of upper airway obstruction, most commonly caused in adults by postanesthetic laryngospasm. The mechanism initiating the formation of postobstructive pulmonary edema is believed to be the markedly negative intrapleural pressure generated by a forceful inspiratory effort against an obstructed extrathoracic airway. We herein describe a young, male patient who developed pulmonary edema postoperatively, upon emergence from anesthesia, after performing repeated, forceful inspiratory maneuvers directed against an endotracheal tube on which he had bitten down, thereby occluding it. To our knowledge, such an etiology of postobstructive pulmonary edema has not previously been described.
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Intensive care medicine · Dec 1995
Editorial CommentDown side up--a prone and partial liquid asset.