Intensive care medicine
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Intensive care medicine · Jan 1990
Comment Letter Case ReportsRewarming by extracorporeal circulation.
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Of 347 victims of out-of-hospital cardiac arrest 196 (56.5%) died before and 109 (31.4%) after admission to hospital, while 42 patients (12.1%) were discharged alive. The 37 patients (10.7%) discharged without severe hypoxic brain damage were assigned to the group with "good", the remaining 310 patients to the group with "poor outcome". ⋯ Evaluation of the score revealed a specificity of 100% (0.95 confidence interval: 80%-100%) and predictive value of 100% (0.95 confidence interval: 95%-100%). A predictive score for specific identification of victims with poor prognosis can contribute to decision making in out-of-hospital cardiac arrest.
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We studied five patients in the intensive care unit (ICU) with acute polyneuropathy. All had previously presented severe infectious processes, accompanied by diverse organ failure accompanied by the Adult Respiratory Distress Syndrome (ARDS) in all cases. Two patients died and the three survivors suffered severe motor deficiencies. ⋯ The common causes of polyneuropathy were excluded, but in all cases a nutritional disorder was detected, based on laboratory values of proteins, serum albumin and transferrin. We conclude that polyneuropathy is relatively frequent among critically ill patients and must be closely monitored because of diagnostic difficulties and the repercussions on the progress of these patients. In spite of uncertainties about its cause, it appears to be related to severe infectious processes, ARDS, and nutritional disorders.
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Successful organ transplantation offers patients with end stage organ failure the chance of a normal life. The recognition of brain death allowed the use of beating heart donors and this has enabled multiple organ procurement from a single donor. Suitable patients with severe brain injury resulting in brain death, who may be potential organ donors, are to be found on both neurosurgical and general intensive care units. ⋯ The management of brain injury before death often results in abnormalities of fluid balance, due to fluid restriction and diuretic therapy. Other problems such as acute endocrine failure and the impact of their correction on ultimate organ function remains to be elucidated. Good donor maintenance in the intensive care unit and operating theatre is essential if optimal function of the transplanted organ is to occur.