Intensive care medicine
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Intensive care medicine · Jan 1992
Fat emulsions containing medium chain triglycerides in patients with sepsis syndrome: effects on pulmonary hemodynamics and gas exchange.
Fat emulsions containing medium chain triglycerides (MCT) have recently been introduced into clinical practice as a component of total parenteral nutrition. Since several authors reported increased pulmonary artery pressure and impaired gas exchange during intravenous (i.v.) fat use, in particular in septic patients, we studied the pulmonary hemodynamic and gas exchange effects of i.v. fat containing MCT and long chain triglycerides (LCT) in patients with sepsis syndrome. ⋯ We conclude that fat emulsions containing MCT induce little alterations in pulmonary hemodynamics and gas exchange. This result is probably due to reduced prostaglandin formation because fat emulsions containing MCT provide less prostaglandin precursors than pure LCT emulsions.
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Intensive care medicine · Jan 1992
Randomized Controlled Trial Clinical Trial Retracted PublicationPhosphodiesterase-inhibitors enoximone and piroximone in cardiac surgery: influence on platelet count and function.
Some phosphodiesterase (PDE)-inhibitors are believed to alter platelet count and function due to changes in intracellular cAMP. Whether newly developed (specific) PDE-inhibitors negatively influence platelet function in cardiac surgery should be investigated in a randomized study. ⋯ It is concluded that enoximone and the new PDE-III-inhibitor piroximone do not affect platelet function and can be used before CPB without risking platelet-related bleeding in cardiosurgical patients in the perioperative period.
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Intensive care medicine · Jan 1992
Randomized Controlled Trial Comparative Study Clinical TrialComparison of hydrophobic heat and moisture exchangers with heated humidifier during prolonged mechanical ventilation.
Inspired gases must be warmed and humidified during mechanical ventilation. In a prospective randomized study we compared the performance of a heated humidifier (HH) (Draegger Aquaport) and a heat and moisture exchanger (HME) (Pall Filter BB 2215). A total of 116 patients requiring mechanical ventilation (Servo 900 C Siemens) were enrolled into the study and were randomly assigned to 2 groups. ⋯ This purely physical property is linked to the magnitude of the thermic gradient between the expired gases and the ambiant temperature. Performance impairment of PF in our study might be due to high ambiant temperature in the intensive care unit (usually around 28 degrees C) which reduces thermic gradient and water exchanges. We conclude that efficiency of PF may be weak in some conditions of ambiant temperature.
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Intensive care medicine · Jan 1992
ReviewPrevention of pneumonia by selective decontamination of the digestive tract (SDD).
Prevention of respiratory tract infections is only possible when the pathogenesis is known. Three types of infection can be distinguished: primary endogenous infections, caused by pathogens carried in the throat at the commencement of mechanical ventilation, generally develop early and can only be prevented by intravenous antibiotics. Secondary endogeneous infections, caused by hospital-acquired pathogens, generally develop later and can be prevented by selective decontamination of the digestive tract (SDD). ⋯ However, gastric colonization is reduced rather than eliminated and sucralfate has almost no effect on oropharyngeal or tracheal colonization. Whether sucralfate is significantly better than a placebo remains to be established. SDD is superior to sucralfate in preventing both colonization and infection.