Lijec̆nic̆ki vjesnik
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Lijec̆nic̆ki vjesnik · Jun 1995
[Causes of disorders of consciousness in internal medicine intensive care units].
The present study on 5330 patients admitted to the internal intensive care unit over the five year period (1990-1994) indicated that consciousness disorders are most frequently associated with poisoning. On admission, the state of consciousness of 665 of these 5330 patients was retrospectively evaluated. Poisoning by drugs was most common among intoxications (93 patients of 154 cases of poisoning). ⋯ Glycemia disorders, including hypoglycemia, hyperglycemia as well as hyperosmotic state, did not result in lethal outcome, regardless of GCS on admission. The highest death rate was registered in patients with cardiopulmonary arrest and lowest GCS on admission. Patients with cardiogenic shock, despite high GCS on admission, had high death rate.
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Lijec̆nic̆ki vjesnik · Jun 1995
Randomized Controlled Trial Clinical TrialThe importance of glucose-insulin-potassium with cardiopulmonary bypass prior to cardioplegic arrest in open-heart surgery.
The benefit of a high dose glucose-insulin-potassium (33% glucose, 80 mmol KCl, 120 units of insulin - 1 mL/kg) (GIK) with cardiopulmonary bypass support (CPB) prior to cardioplegic arrest in open-heart surgery has been evaluated in this article. Twenty non-diabetic patients (PTS) were selected upon their preoperatively impaired left ventricular ejection fraction (LVEF < 45%) and were divided into two groups. Group 1 was given GIK and 20 minutes of CPB prior to cardioplegic arrest; Group 2 was the control group with no GIK and no CPB support. ⋯ At 30 minutes and 24 hours postoperatively there was no significant difference, but clinical difference was observed, probably due to necessary inotropic stimulation in Group 2. There was neither clinical nor statistical difference in right ventricular stroke work index (RVSWI) throughout the whole measurement. The authors emphasise the importance of GIK with CPB in myocardial protection in patients undergoing open-heart surgery.
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Hemodynamic and oxygen transport variables were evaluated in 34 patients with septic shock during fluid repletion and infusion of vasoconstricting and inotropic catecholamines (dopamine, dobutamine). Hypovolemia, increased cardiac output (CO), low pulmonary and systemic vascular resistance dominated in initial hypotensive status. Oxygen consumption (VO2) decreased despite increased oxygen delivery (DO2). Hypotension and hypovolemia were successfully corrected by therapeutic intervention and significantly higher values of CO and DO2 were obtained. However, VO2 remained low and oxygen extraction index declined from the initial level. ⋯ The underlying pathophysiological defect in septic shock is not altered hemodynamics or low DO2 but impaired tissue oxygen extraction. The usual hemodynamic resuscitation does not improve tissue oxygen utilization and the results in the treatment of septic shock remain poor.
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ECMO is the process of prolonged extracorporeal circulation in the treatment of respiratory and cardiovascular failure not responding to conventional therapy in neonates and children. Basic principles and techniques are discussed. After training ECMO on dogs ECMO was successfully introduced in clinical practice in Slovenia in 1994.
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Monitoring of vital functions is one of the most important and essential tools in the management of critically ill patients in the ICU. Today it is possible to detect and analyze a great variety of physiological signals by various noninvasive and invasive techniques. ⋯ It enables monitoring of pressures, flow and saturation, pressures in the systemic and pulmonary circulation, estimation of cardiac performance and judgment of the adequacy of the cardiocirculatory system. Carefully and correctly obtained information are basis for proper hemodynamic assessment which usually effects the therapeutic decisions.