Clinical intensive care : international journal of critical & coronary care medicine
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Clin Intensive Care · Jan 1995
ReviewThe aetiology, consequences and prevention of barotrauma: a critical review of the literature.
To review critically the literature on pulmonary barotrauma in mechanically ventilated patients. ⋯ Pulmonary barotrauma is a clinically important phenomenon that may delay the healing of injured lungs and lead to the development, or the exacerbation, of ARDS. Risk factors for barotrauma include high peak airway pressures, large tidal volumes and acute lung injury. Resolution of the role for pressure-limited ventilation in ARDS prevention and treatment requires a large-scale randomised clinical trial.
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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 1994
ReviewA multi-disciplinary approach to families of brain dead children.
To relate our multi-disciplinary approach to families of brain dead children. ⋯ Our multi-disciplinary approach may assist clinicians and other health care providers in successfully dealing with families of brain dead children.
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Chest tubes are placed to empty the pleural space of air or fluid which prohibits full lung expansion. The function of these tubes is dependent on adequate placement, effective drainage and frequent re-evaluation of the patient and the chest drainage system. Knowledge of the principles of chest tube drainage is important to evaluate adequately the function of a tube thoracostomy.
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Clin Intensive Care · Jan 1994
ReviewNew horizons in ICU sedation: exploring non-sedative effects of ICU sedation.
Sedative drugs are widely used in intensive care, primarily in ventilated patients. The common actions and side-effects of these agents are widely recognised. However, recent evidence suggests that opiates and other sedative agents that are used in this situation also have important, but not widely appreciated, effects on metabolism, physiological signalling and disease mechanisms. ⋯ First, they provide explanations for some phenomena observed during their use. Second, some of the undesirable side-effects may be avoided by judicious use of drugs in certain clinical situations. Finally, there is the prospect that we may be able to harness some actions for novel therapeutic purposes.