Intensive care medicine
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Intensive care medicine · Jan 1990
Case ReportsPositive end expiratory pressure and critical oxygenation during transport in ventilated patients.
Transportation of patients critically dependent on positive end expiratory pressure (PEEP) can be problematic, as a patient of ours with adult respiratory distress syndrome (ARDS) and bilateral broncho-pleural fistulae demonstrated. He required intermittent positive pressure ventilation (IPPV) (Siemens 900C) with 100% O2 and PEEP of 2 kPa to maintain his arterial O2 saturation (SaO2) greater than 90%. Severe hypoxemia (SaO2 less than 75%) occurred on change to a portable ventilator (Oxylog, Dräger) with a PEEP value (Ambu 20) at its expiratory port, despite adjusting the valve to 2 kPa, continuing use of 100% O2, and varying the ventilatory pattern. ⋯ A small leak was introduced from the lung resulting in a decrease in PIP, VT, and PEEP. Adjustment of ventilator minute volume to restore PIP to 5 kPa failed to restore PEEP, airway pressure continuing to fall throughout the expiratory pause. PEEP was restored by providing a compensatory flow of O2 of 5 l/min to the system between the Oxylog non-rebreathing valve and the lung.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1990
Case ReportsAccidental hypothermia with cardiac arrest: complete recovery after prolonged resuscitation and rewarming by extracorporeal circulation.
A 51-year-old male remained immersed in sea water (6 degrees C) for 40 min. Brought ashore, the ECG showed asystole. Advanced life support was immediately commenced. ⋯ After 60 min of re-perfusion the patient was be weaned from bypass supported by a high-dose vasopressor infusion and nitroglycerine. He was discharged after 13 days with no evidence of any permanent organ damage. Given the advantage of providing circulatory support, extracorporeal circulation may be useful when rewarming hypothermic victims with cardiac arrest.
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Multiple Organ Failure (MOF) has largely been attributed to bacterial sepsis, though conclusive evidence of an essential role for bacteria and/or their endotoxins is still lacking. On the other hand, MOF and the clinical syndrome of sepsis may be aseptically induced in germ-free animals. This paper reviews the evidence that excessive activation of endogenous humoral mediators and inflammatory cells may cause this highly lethal syndrome.
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Intensive care medicine · Jan 1990
ReviewPractical points in the application of oxygen transport principles.
Application of the principles of oxygen transport in the management of critically ill patients can influence the frequency of organ failure and outcome. Adequate tissue oxygen consumption in these patients may depend on a supranormal level of oxygen delivery. ⋯ The methods used to perform the measurements are reviewed. Widespread acceptance and use of oxygen transport protocols in treatment is only possible if the measurements on which they are based are accurate and properly interpreted.
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Intensive care medicine · Jan 1990
ReviewVentilatory management of ARDS: can it affect the outcome?
Animal studies have demonstrated that mechanical ventilation with high peak inspiratory pressure (PIP) results in acute lung injury characterised by hyaline membranes, granulocyte infiltration and increased pulmonary and systemic vascular permeability. This can result in progressive respiratory failure and death. In surfactant deficient lungs this occurs with tidal volumes (Vt) as low as 12 ml/kg, and PIP as low as 25 cm H2O, values which are frequently used clinically. ⋯ It can be prevented or reduced in severity in some animal models by the use of PEEP. It is suggested that the use of high PIP in some patients may result in progressive deterioration of their ARDS, possibly contributing to mortality both from respiratory failure and other causes. It may be very important to limit PIP by reducing Vt even if this results in hypercapnia and a deterioration of oxygenation in the short term.