Intensive care medicine
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Intensive care medicine · Jan 1992
Comparative StudyThe influence of different levels of PEEP on peripheral tissue perfusion measured by subcutaneous and transcutaneous oxygen tension.
To compare subcutaneous (PscO2) and transcutaneous (PtcO2) oxygen tension measurements in relation to hemodynamic variables at different levels of PEEP, and to evaluate the usefulness of these measurements as monitors of peripheral tissue perfusion. ⋯ PscO2 is a sensitive indicator of subcutaneous tissue perfusion, which can be used to identify the PEEP level, with optimum peripheral perfusion. PscO2 seems to be a more reliable indicator of tissue perfusion than PtcO2.
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Intensive care medicine · Jan 1992
Cardiopulmonary resuscitation in paediatric intensive care patients.
To identify the success of cardiopulmonary resuscitation in the paediatric ICU patient we undertook a retrospective study in an 11-bed medical and a 14-bed surgical paediatric ICU over a 32-month period. Thirty-four patients suffered an arrest in the ICU. Only 4 patients could be resuscitated successfully; 1 died after 24 h. ⋯ All but 3 patients had PSI scores greater than 8. The decision to resuscitate or to withhold therapy in individual patients who are deteriorating in the course of a critical, preceding illness should not be based on the risk index of these scoring systems. Both medical and ethical considerations should be guidelines in the process of decision-making.
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Intensive care medicine · Jan 1992
Case ReportsMethylene blue increases systemic vascular resistance in human septic shock. Preliminary observations.
We report the hemodynamic improvements induced by intravenous methylene blue (MB), a guanylate cyclase inhibitor, in 2 patients with hyperdynamic septic shock treated with norepinephrine (NE) infusion, mechanical ventilation and hemodialysis. MB injection augmented the low vascular resistance, mean arterial pressure and induced a slight decrease of cardiac index, without any change of heart rate and pulmonary artery wedge pressure. ⋯ These data suggest that in patients, severe sepsis-induced loss of vascular responsiveness to NE involves activation of soluble guanylate cyclase, possibly stimulated by enhanced nitric oxide production. Furthermore, these observations support the concept that pharmacological blockade of guanylate cyclase may improve hemodynamics but not survival rates.
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Intensive care medicine · Jan 1992
Case ReportsBrain death: timing of apnea testing in primary brain stem lesion.
In a 73-year-old patient complete areflexia of the cerebral and peripheral nerves following the rupture of an aneurysm of the basilar artery was diagnosed. During apnea testing the spectral analysis of electroencephalography (EEG) revealed an irreversible shift of peak from 6 to 3 Hz within the low-frequency bands. These findings suggest that apnea testing in patients with primary lesion of the brain stem should be carried out only after an isoelectric EEG.
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Intensive care medicine · Jan 1992
Comparative StudyAn experimental randomized study of five different ventilatory modes in a piglet model of severe respiratory distress.
To characterize different modes of pressure- or volume-controlled mechanical ventilation with respect to their short-term effects on oxygen delivery (DO2). Furthermore to investigate whether such differences are caused by differences in pulmonary gas exchange or by airway-pressure-mediated effects on the central hemodynamics. ⋯ In this model, as far as oxygenation is concerned, it does not matter in which specific way the airway pressures are produced. As far as oxygen transport is concerned, i.e. aiming at increasing DO2, we conclude that optimizing the circulatory status must take into account the circulatory influence of different modes of positive pressure ventilation.