Intensive care medicine
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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.
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Intensive care medicine · Jan 1992
Test of 20 similar intensive care ventilators in daily use conditions--evaluation of accuracy and performances.
Infrequent control, aging of components, may compromise the accuracy of ICU ventilators. In order to assess the reliability of ventilators during their clinical use, we bench tested a group of 20 CPU1 ventilators (Ohmeda) sampled at random in several ICU units. We found major leaks in 5 ventilators, attributable to the disposable tubings used in these systems. ⋯ The valve opening pressure threshold was correlated to the inspiratory flow (r = 0.81) contrary to the valve opening delay (average 138 +/- 40 ms). These two parameters did not correlate with the age of the ventilator. Our study addresses the need for periodic control of ventilator performance in order to minimize the risks of errors and malfunctions.
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Intensive care medicine · Jan 1992
Round table conference on ventilatory failure, Brussels, Belgium, March 16-18, 1991.
It was possible to reach agreement on several important issues relating to VF. First, the phenomenon of CO2 retention may have both pathophysiologic and compensatory components. There is increased awareness of the nature, intensity, and significance of the cross-talk between the ventilatory control center and the pump itself, as expressed in breathing pattern and indices of ventilatory drive. ⋯ In the acute setting, measures to limit alveolar distention, such as controlling airway pressure, revising blood gas targets, and/or using adjunctive methods for blood gas exchange may avoid barotraumatic edema and rupture. The potential for non-invasive ventilation to avert intubation, facilitate ventilator withdrawal, and help patients with chronic VF to achieve compensation without machine dependence is now being actively investigated. This two day conference proved a stimulating forum for interchange of ideas regarding the state of the field, and allowed many opportunities for scientific interaction, both during outside the formal program.(ABSTRACT TRUNCATED AT 250 WORDS)
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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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Measurement of arterial oxygen saturation by pulse oximetry was performed in two patients with acute and chronic anaemia (haemoglobin concentrations: 2.9 mmol/l (4.7 g/dl) and 1.9 mmol/l (3.0 g/dl), respectively) using a Radiometer OXI and a Nellcor N-200 pulse oximeter. The two oximeters read alternating different values in the two patients. In conclusion, pulse oximeters are able to give a value for oxygen saturation even at extreme anaemia, and when a high value is given, it possibly reflects arterial oxygen saturation. The value of pulse oximetry in severe anaemia is discussed.