Intensive care medicine
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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 1987
Suppression of spontaneous breathing during high-frequency jet ventilation. Separate effects of lung volume and jet frequency.
The effect of ventilatory frequency of high-frequency jet ventilation (HFJV) from 1 to 5 Hz, apart from changes in thoracic volume, on spontaneous breathing activity was studied in Yorkshire piglets under pentobarbital anesthesia. The highest PaCO2 at which the animals did not breathe against the ventilator (apnea point) was established either by changing minute volume of ventilation or by adding CO2 to the respiratory gas. The higher the apnea point, the higher the suppression of spontaneous breathing activity was assumed to be. ⋯ When thoracic volume was kept constant in this way a constant tidal volume at increasing jet frequencies resulted in only a slight increase in suppression of spontaneous breathing. We conclude that the increase in lung volume is a major factor in suppressing central respiratory activity during HFJV. Jet frequency by itself might be an additional suppressive factor.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1987
Case ReportsPost lobectomy atelectasis: the use of a Servo 900 B as a high-frequency ventilator.
High-frequency ventilation (HFV) has been used with good results in a variety of clinical situations where conventional ventilation has proved ineffective. However, all of the reports so far have involved the use of a specially purchased specifically designed ventilator which tends to be unfamiliar to most medical and nursing staff responsible for its use. A case where HFV was used in combination with differential lung ventilation in the treatment of unilateral pulmonary atelectasis is described using a Servo 900B as the high-frequency ventilator. It serves to demonstrate that the Servo 900B can be used as an occasional high-frequency ventilator as required, thus avoiding the expense of purchasing a specialized ventilator.
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Intensive care medicine · Jan 1987
Comparative StudyEvaluation of pediatric intensive care in Europe. A collaborative study by the European Club of Pediatric Intensive Care.
There are no reports analyzing the results of pediatric intensive care in Europe. We evaluated quantitatively the severity of illness and the amount of care required for 714 consecutively admitted patients. We used simultaneously the Clinical Classification System (CCS) the Acute Physiology Score (APS) and the Therapeutic Intervention Scoring System (TISS). ⋯ Among these 3 groups the highest mortality was observed in cardio-vascular patients (p less than 0.01 v.s. respiratory, p less than 0.05 v.s. neurologic). The death rate was 22% among the 264 neonates, 9.7% among the 247 infants (p less than 0.01) and 12.6% among the 198 children. APS and TISS scores increased significantly with the CCS classes.(ABSTRACT TRUNCATED AT 250 WORDS)
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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.