Intensive care medicine
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Intensive care medicine · Jan 1988
Case ReportsCorynebacterium JK: surgical infections in non-immunosuppressed patients.
Infection caused by Corynebacterium JK (CJK) has been recently described in immunocompromised patients. To evaluate the frequency of CJK infection among surgical and trauma intensive care patients, all patients with CJK isolations at clinical sites were reviewed. ⋯ Eight patients were studied; 3 of them were considered infected, while 5 were judged only colonized. It is concluded that CJK infections can be a clinical problem in surgical trauma patients.
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Intensive care medicine · Jan 1988
Sepsis associated with central vein catheters in critically ill patients.
In 440 critically ill patients, the association between different central vein catheter insertion sites, the duration of catheter insertion and catheter-associated sepsis was examined. Of 780 catheter tips studied, 19% were colonized by microorganisms. The incidence of colonization varied with the different insertion sites. ⋯ Catheter colonization was closely related to the development of bacteraemia and was associated with approximately 10% of colonized catheters. Our results suggest that the subclavian site is associated with the lowest infective complication rate. To minimize catheter associated sepsis, catheters at all insertion sites should be used with parsimony and only kept in place for the minimum amount of time that their continuing use is necessary.
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Intensive care medicine · Jan 1988
Midazolam infusion for basal sedation in intensive care: absence of accumulation.
This study was designed to: (1) determine plasma midazolam concentrations producing adequate sedation in ICU patients; (2) establish an intravenous regimen to provide continuous sedation and rapid recovery after discontinuation of infusion. Initially, 13 ICU patients were given midazolam as a bolus injection, 0.20 mg.kg-1 over 30 s in order to define the midazolam plasma concentration corresponding to an adequate level of sedation. The optimal level was reached in a mean time of 61 +/- 26 min and the mean corresponding midazolam plasma concentration was 163 +/- 62 ng.ml-1. ⋯ The mean midazolam plasma concentration during infusion was 215 +/- 61 ng.ml-1, and the mean midazolam plasma concentration at the end of infusion was 199 +/- 93 ng.ml-1. The level of sedation was considered as optimal in most patients throughout the study. After discontinuation of infusion, the mean time for normalization of the mental state was 97 min.
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Intensive care medicine · Jan 1988
Review Retracted PublicationRight ventricular function and cardiac surgery.
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Intensive care medicine · Jan 1987
Comparative StudyRelation of oxygen transport patterns to the pathophysiology and therapy of shock states.
Descriptions of the sequence of hemodynamic and oxygen transport events have characterized the various types of shock syndromes and have shown that reduced VO2 is the earliest pathophysiologic event; it precedes the initial hypotensive crisis. Reduced or inadequate VO2, produced by low flow, by maldistribution of flow, and by increased metabolic demand is the primary pathogenic event that produces the shock state as well as the regulatory mechanism that stimulates compensatory reactions including increases in heart rate, myocardial contractility, cardiac output and minute ventilation. Sequential hemodynamic and oxygen transport patterns are related to the degree of the shock state and its outcome; the patterns of survivors and nonsurvivors can be predicted from these patterns by multivariate analyses. ⋯ This approach emphasizes aggressive fluid management in tacit acknowledgement that unrecognizes hypovolemia, delay in treatment of hypovolemia or inadequate volume therapy all lead to low VO2 which is the primary precipitating event in most patients with postoperative, hemorrhagic, traumatic and septic shock. The essence of this plan is to maintain prophylactically the patient in an optimal hemodynamic state that does not allow him to develop tissue hypoxia from blood volume, hemodynamic and oxygen transport deficits. However, episodes of reduced CI, DO2 and VO2 often occur intraoperatively with little or no hypotension or with hypotension which is treated by administration of ephedrine or other vasopressors.