Lijec̆nic̆ki vjesnik
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238 patients with multiple trauma hospitalized in the Intensive Care Unit of the Zagreb General Hospital during 1993 and 1994 were analyzed. They were grouped with respect to the type of their injury. The first group was composed of patients with isolated head injury. ⋯ Assisted ventilation over 24 hours needed 180 patients (average of 11,4 days). The most common complications were respiratory: pneumonia developed 60 and ARDS five patients. The rate of mortality was 35,9% (65 patients died.
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Lijec̆nic̆ki vjesnik · Jun 1995
Case Reports[Accidental hypothermia with cardiorespiratory arrest. Case report].
A case of an effective cardiopulmonary resuscitation in a 71-year-old woman following drowning in a cold water and cardiopulmonary arrest for at least 20 minutes is presented. Intubation, ventilation with 100% oxygen, external cardiac massage and administration of adrenaline, 1 mg intravenously, were implemented. Ventricular fibrillation, which occurred after adrenaline therapy, responded to electrical defibrillation with 200 J and converted into a sinus rhythm. ⋯ The patient became gradually conscious, and she was weaned from mechanical respiration after 12 hours. Subsequently, the patient was extubated. There were no neurological deficits.
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An extraordinary advance in basic sciences and technology did not reduce high lethality rate of the septic shock patients. The lethality rate of those patients was and still is around 50%. ⋯ A clinical experiences are disappointing, at first because of our still poor knowledge about various cytokines cascade, feedback mechanisms, cellular protective mechanisms, etc. The new chapter on the treatment of that highly lethal syndrome is open, though a final achievement of that approach is not clear till now.
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A significant improvement has been noticed over the last 20 years in children in whom shock syndrome has developed. This has been attained through the application of technological advances in respiratory, cardiovascular, renal, nutritional support and improved antibacterial and antifungal therapy, but mostly through a better understanding of the physiology of shock. Newer concepts of the pathophysiology of sepsis and septic shock are presented, with clinical definitions referring to the pediatric patient. Innovative therapeutic modalities designed to modulate the systemic inflammatory response triggered by bacterial infection are discussed.