Intensive care medicine
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Intensive care medicine · Jan 1987
Randomized Controlled Trial Comparative Study Clinical Trial Retracted PublicationInfluence of nimodipine and nifedipine on intrapulmonary shunting--a comparison to other vasoactive drugs.
This study was assigned to investigate the influence of calcium channel blockers (nimodipine and nifedipine) in comparison to other vasoactive drugs (nitroglycerin, dopamine) on pulmonary shunting (Qs/Qt). Fifty anesthetised patients scheduled for aortocoronary bypass operation were randomly allocated to 5 groups receiving one of the following drugs: nimodipine 1.0 microgram X kg-1 X min-1; nifedipine 0.7 microgram X kg-1 X min-1; nitroglycerin (TNG) 0.5 microgram X kg-1 X min-1; dopamine; micrograms X kg-1 X min-1; placebo (0.9% NaCl). ⋯ In contrast, the increase in cardiac output induced by dopamine (+27%) was accompanied by a significant increase in shunting (+34%). TNG application did not alter Qs/Qt, but pulmonary artery pressure (PAP) decreased markedly (-19%).
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Intensive care medicine · Jan 1986
Case ReportsRhabdomyolysis and acute renal failure in a patient with thermal injury.
We report a case of rhabdomyolysis with acute renal failure during recovery from thermal burn injury. The late occurrence of this unusual complication is emphasized and possible etiological factors are discussed.
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Intensive care medicine · Jan 1986
Case ReportsHypophosphatemia and acute respiratory failure in a diabetic patient.
A previously healthy 48-year-old male developed diabetic ketoacidosis and severe hypophosphatemia. Within a few hours, acute respiratory insufficiency developed with a marked discrepancy between the pulmonary pathology and the very poor oxygenation seen. We argue that this was due to the effect of hypophosphatemia on respiratory muscle- and heart function and P50, leading to impaired oxygen delivery.
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Mortality occurs from a burn injury because of infections which result from the metabolic and bacterial consequences of a large open wound, depression of the host's resistance, and both protein and total caloric malnutrition. Systemic antibiotics, topical wound therapy, and gentle wound debridement constitute traditional burn therapy. The systemic antibiotics and topical wound therapy do not solve problems presented by large open wounds and the related protein and caloric deprivation. ⋯ As long as devitalized, burned tissue remains present in the setting of depressed host resistance, cross infection tends to colonize those remaining devitalized burn wounds with more virulent organisms than those that were already present. Bacterial controlled nursing units (BCNU) provide strict protection against that cross infection. Though inevitably a catabolic response occurs with massive injury, intensive nutritional support provides the calories necessary for the response to injury to avoid a prolongation of that negative nitrogen balance.