Clinical intensive care : international journal of critical & coronary care medicine
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Despite more than 25 years of extensive research the mortality of ARDS patients remains high. Besides the often deleterious course of the underlying disease, another reason for this high mortality lies in the aggressive ventilatory regimen which is required to maintain arterial blood gases in a more or less normal range. Therapeutic methods which are used to reduce iatrogenic damage to the lungs are pressure controlled ventilation with permissive hypercapnia, differential lung ventilation, positioning therapy, dehydration, and extracorporeal gas exchange with membrane lungs. ⋯ Therefore, the need remains to develop new therapeutic strategies and to investigate their influence on the morbidity and mortality of this life-threatening disease. First experiences with nitric oxide (NO) inhalation, intravenous application of antioxidants, intratracheal instillation of surfactant, tracheal gas insufflation and combined fluid/gas ventilation with perfluorocarbon are presented. All these new methods have proved their efficacy, at least in animal studies, however, they should still be regarded as experimental.
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Clin Intensive Care · Jan 1995
Clinical TrialPilot clinical trial of an anti-TNF alpha monoclonal antibody for the treatment of septic shock.
To determine the safety and pharmacokinetics of an anti-tumour necrosis factor (TNF alpha) monoclonal antibody in the treatment of septic shock, and to evaluate the biological evolution of cytokine response. ⋯ No side effects were noted during treatment regardless of the dose used; however, further studies are needed to determine the clinical efficacy of this agent in septic shock.
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Clin Intensive Care · Jan 1994
Impaired glucose and lipid metabolism seen in intensive care patients is related to severity of illness and survival.
To relate glucose and lipid metabolism to the severity of illness and survival in critically ill patients. ⋯ In a sample of unselected critically ill patients indices of both glucose and lipid metabolism were found to be related to the severity of illness as well as to the occurrence of sepsis and survival.
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Clin Intensive Care · Jan 1994
Case ReportsProviding psychological support for patients after critical illness.
The majority of patients have little or no memory of their stay in ICU or remember only pain, suctioning or lack of sleep. Dreams and nightmares while in the intensive care unit (ICU) and after discharge home have also been reported. The few studies investigating the longer-term psychological problems of critical illness point to a picture of social isolation with patients avoiding company and showing less affection to their partners. ⋯ Two case histories give an illustration of the type of problems ICU patients experience during their recovery and how an informal support group can help. In addition to possible benefits to the patients, support groups can also give ICU staff a chance to understand the process of recovery from critical illness and to examine the effects on patients of their own practice. However, they must also have enough insight to know when a patient needs professional help; for example, a patient displaying symptoms of post-traumatic stress disorder should be referred, with their agreement, to a clinical psychologist.