Intensive care medicine
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Intensive care medicine · Jan 1988
Central mixed and splanchnic venous oxygen saturation monitoring.
Central mixed venous oxygen saturation (SvO2) monitoring in critically ill patients to estimate adequacy of peripheral perfusion is gaining increasing popularity. However, a number of unexpected responses, one of which is marked depression of regional (splanchnic) venous oxygen saturation which may coexist with normal or high SvO2, makes interpretation of this parameter difficult. The SvO2 and hepatic venous oxygen saturation levels in seven injured (postoperative) and 15 septic patients were measured. ⋯ This reduced oxygen saturation was noted to arise from an increased regional metabolic rate rather than reduced perfusion. Nevertheless, we conclude that a flow limited regional oxygen consumption may potentially exist despite the presence of a normal SvO2 in certain patient subgroups such as septic subjects. Therefore, a normal SvO2 should not be considered as sole criteria to insure optimal oxygen delivery in critically ill patients.
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Intensive care medicine · Jan 1988
Case ReportsPostpartum headache, seizures and bloodstained C.S.F.: a possible complication of dural puncture?
A 32-year-old parturient developed severe headache with subsequent convulsions on the third day after the delivery under epidural anesthesia. Neuroradiological investigations were negative. All complaints disappeared promptly after the performance of an epidural blood patch.
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Intensive care medicine · Jan 1988
Audit of intensive care: a 30 month experience using the Apache II severity of disease classification system.
608 patients admitted to a general Intensive Care Unit (ICU) over a 30 month period were analyzed according to the Apache II Severity of Disease Classification System on day one of admission. Hospital outcome details were available on 583 patients in the series. ⋯ Our higher than predicted mortality (mortality ratio 1.2) in comparison with centres in the United States of America (US) may be partly explained by the high proportion of our population from these unfavourable groups, by our use of the best Glasgow Coma Scale in the first 24 h following admission, and the major differences between our patient population and that of the US upon which the Apache II was based. The presence of these large unfavourable groups indicates a change in our admission policy is warranted.
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Intensive care medicine · Jan 1988
Case ReportsMiliary tuberculosis presenting as adult respiratory distress syndrome.
We report the history of a 27-year-old Caucasian girl who died of adult respiratory distress syndrome secondary to miliary tuberculosis (MTB), after treatment with antibiotics to which the organism was sensitive, and a long period of ventilation. This case emphasises the importance of considering MTB as the cause of respiratory failure when another aetiology is not apparent.