Intensive care medicine
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Intensive care medicine · Jan 1989
Multicenter Study Clinical TrialDescription of various types of intensive and intermediate care units in France. French Multicentric Group of ICU Research.
The types of intensive care are multiple. The aim of this multicentric study was to describe activity of different ICUs using the same methods. 38 ICU were chosen by cooption, not randomization. Collected data concerned input (age, previous health status (HS), Simplified Acute Physiology Score or SAPS, Intensive Care Group (ICG), processes (TISS points), percentage of ventilated patients and pulmonary arterial lines and outcome (ICU death rate). ⋯ Surgical patients had better previous health status, were younger and scheduled for 40%. TISS points were higher, mainly by a higher rate of ventilated patients and patients with pulmonary artery lines on the first day. Specialized units characteristics depended mainly on the ICG.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1989
Comparative StudyComparison of pressure support ventilation and assist control ventilation in patients with acute respiratory failure.
We compared the effects of pressure support ventilation (PSV) with those of assist control ventilation (ACV) on the breathing pattern, work of breathing and blood gas exchange in 8 patients with acute respiratory failure. During ACV, the tidal volume was set at 10 ml/kg, and the inspiratory flow was set at 50 to 70 l/min. During PSV, the pressure support level selected was 27 +/- 5 cm H2O to make the breathing pattern regular. ⋯ The oxygen cost of breathing, an estimate based on the inspiratory work added by a ventilator and the oxygen consumption, did not change significantly. PaO2 was significantly higher during PSV than during ACV. We conclude that PSV using high levels of pressure support can improve the breathing pattern and oxygenation and fully sustain the patient's ventilation while matching his inspiratory efforts.
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Intensive care medicine · Jan 1989
A model: systems management of life threatening injuries in children for the state of Maryland, USA.
In the past two years several guidelines for suggested components of emergency medical systems for children have been suggested, and for the first time, specific standards of pediatric trauma care have also been formulated. The American Academy of Pediatrics new Provisional Committee on Emergency Medicine has been charged with the responsibility of developing national standards of emergency care for children and are currently at work on such a landmark document. ⋯ The evolution, organization, and current status of the Maryland system is described in this report. Hopefully it may serve as one successful model which could be modified for use in other regions of the country.
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We monitored the response to intensive care of 480 patients by calculating the difference in their organ failure score on the day of admission and that on the day of discharge, and related the response to hospital outcome. The patients were classified into: A) those who benefited (33%), B) those who might have benefited (28%), C) those who would never or would no longer have benefited (18%) and D) those who did not require intensive care management (21%). ⋯ Group C patients used up 26.8% of the total intensive care unit bed days, while group D patients occupied 3.7%. We concluded that an acute terminal care unit to care for group C patients who have no hope of survival is more appropriate to the needs of our hospital than an intermediate care unit for overnight monitoring of uncomplicated postoperative and non-operative patients (group D).
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Intensive care medicine · Jan 1989
Reflection of differential pulmonary perfusion in polytrauma patients on differential lung ventilation (DLV). A comparison of two CO2-derived methods.
Seventeen polytrauma patients with asymmetric pulmonary contusion were treated with differential lung ventilation (DLV). The ratios of differential values of end-tidal CO2 concentration (ETCO2) and CO2 excretion ml/min (VCO2) were compared as indirect parameters for differential pulmonary perfusion. Both CO2-derived methods indicated asymmetry after starting DLV suggesting asymmetric pulmonary perfusion as a consequence of contusion. ⋯ In two patients with very severe contusion who underwent bilobectomies a marked difference between the ratios of ETCO2 and VCO2 was observed. It is concluded that differential measurement of CO2-derived variables may be useful in indicating differential perfusion in clinical practice on DLV. In very severe asymmetric contusion ETCO2 ratios may underestimate the differential perfusion ratio.