Intensive care medicine
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Intensive care medicine · Jan 1985
Case ReportsIndomethacin treatment in a patient with lithium-induced polyuria.
Lithium intoxication causes polyuria, central nervous system manifestations, and ultimately stupor progressing to coma. Moreover, polyuria leading to hypernatraemia itself can progress to convulsions and coma. We present a patient with lithium intoxication who remained polyuric, hypernatraemic and somnolent despite normal serum lithium concentrations. After institution of indomethacin orally, polyuria and hypernatraemia disappeared and patient regained consciousness.
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Intensive care medicine · Jan 1985
Decelerating inspiratory flow waveform improves lung mechanics and gas exchange in patients on intermittent positive-pressure ventilation.
The effects of two inspiratory flow waveforms (WFs), decelerating and constant have been studied in 14 patients undergoing intermittent positive-pressure ventilation (IPPV). With tidal volume (VT), inspiratory time, inspiratory-expiratory (I/E) ratio and frequency being kept constant, the decelerating waveform produced statistically significant reduction of peak pressure, total respiratory resistance, work of inspiration, ratio of dead space to tidal volume (VD/VT) and alveolar-arterial gradient for oxygen (A-a)PO2. There was significant increase in total static and kinetic compliances and PaO2, with no significant changes in PaCO2, in cardiac output (CO) and in other haemodynamic measurements.
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Intensive care medicine · Jan 1985
Comparative StudyThe acute effects of prostaglandin E1 on the pulmonary circulation and oxygen delivery in patients with the adult respiratory distress syndrome.
Prostaglandin E1 was administered intravenously to 10 patients who had the adult respiratory distress syndrome associated with severe infection in order to investigate its hemodynamic effects. Infusion of PGE1 significantly decreased the mean pulmonary arterial pressure, mean systemic arterial pressure, pulmonary vascular resistance and systemic vascular resistance, and increased the cardiac index, oxygen delivery and oxygen consumption. No significant difference was noted in the intrapulmonary shunt fraction. These results indicate that administration of PGE1 improves pulmonary hemodynamics and tissue oxygenation in patients with acute respiratory distress syndrome, by reducing right ventricular afterload and increasing the cardiac index.
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Intensive care medicine · Jan 1984
Variations of regional lung function in acute respiratory failure and during anaesthesia.
Acute respiratory failure and anaesthesia impede ventilation of dependent lung units and perfusion of non-dependent ones, creating considerable ventilation-perfusion (V/Q) mismatch. General PEEP can improve V/Q but it cannot restore it to normal. To improve matching, ventilation must be distributed in proportion to regional blood flow. ⋯ Using this ventilator setting as a rule of thumb in patients with acute, severe, bilateral lung disease, arterial oxygen tension was improved by an average of 45% compared with that during general PEEP, with no reduction in cardiac output. It is concluded that differential ventilation with selective PEEP can offer considerable improvement in gas exchange in acute, bilateral lung disease. However, long-term studies are required before a final evaluation can be made.