Swiss medical weekly
-
Swiss medical weekly · Nov 1991
Review[Mechanical ventilation and weaning of patients with obstructive bronchopneumopathy].
Mechanical ventilation of chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure poses certain problems specific to the pathophysiology of this condition. These difficulties arise during the mechanical ventilation phase as well as during weaning. A thorough knowledge of the mechanisms involved and of the means of minimizing complications allows the vast majority of these patients to be weaned successfully. This article reviews some of these problems and possible solutions.
-
Swiss medical weekly · Oct 1991
Review[Non-respiratory therapy of adult respiratory distress syndrome].
Several approaches to non-respiratory management of adult respiratory distress syndrome (ARDS) are discussed. (1) Diagnosis and therapy of the underlying disease is a primary goal in order to avoid the ongoing process of lung injury. (2) Specific pharmacologic therapy for primary lung injury is not available even after 25 years of immunologic research, because no specific mediator has yet been identified as a primary pathogenic factor in ARDS, which is a heterogenous clinical syndrome. (3) Supportive therapy (i.e. improving right ventricular dysfunction and treating pulmonary arterial hypertension) should be emphasized. (4) The most important approach is to optimize prophylactic management to avoid nosocomial infection by eliminating unnecessary invasive techniques, changing the patients' positioning and conserving organ function. So far the latter approach seems to be the only way to improve survival in respiratory failure.
-
In a retrospective study (1984-1989) we analyzed 281 consecutive patients undergoing surgery for rectal cancer. We were interested in the relationship between operative mortality rate and type of operation as well as age and sex of the patient. We stress that "death within 30 days of the last operation" best reflects the true operative deaths. ⋯ In men a trend towards a higher mortality rate can be shown, but not to a significant degree. In our series the 30-day operative mortality was 1.4%, and the in-hospital mortality rate 3.9%. We recommended that death within 30 days of surgery should be the standard definition for operative mortality rate, since it offers the best yardstick for peri- and postoperative management.
-
Swiss medical weekly · Jul 1991
[Accidental hypothermia in Switzerland (1980-1987)--case reports and prognostic factors].
This retrospective study comprises 234 cases of accidental hypothermia (core temperature less than 35 degrees C) hospitalized in 95 Swiss clinics between 1980 and 1987. The most frequent accidents were alpine (n = 78) in origin, followed by cold exposure after injuries (n = 63) and suicide attempts (n = 43). Hypothermia was induced by cold air in 129 cases and by water in 47 cases. ⋯ Results are expressed with ODD's ratios (OR). The negative survival factors are asphyxia (OR 30), invasive rewarming methods (OR 20), slow rate of cooling (OR 10), asystole on arrival (OR 9), pulmonary edema or ARDS during hospitalization (OR 8), elevated serum potassium (OR 2/mmol/l) and age (OR 1.03/year). The positive survival factors are rapid cooling rate (OR 10), presence of ventricular fibrillation in cardiac arrest patients (OR 9) and presence of narcotics and/or alcohol during hypothermia (OR 5).(ABSTRACT TRUNCATED AT 250 WORDS)
-
We present a retrospective study of 30 cases of delayed intracranial hematoma, of which 28 were intracerebral, 5 epidural and 2 subdural. Follow-up of the neurologic and radiologic evolution aimed at determining the risk factors capable of predicting the occurrence of delayed intracranial hematoma. 14 patients had a Glasgow score of 15 on admission. 11 patients were neurologically entirely normal and did not undergo an initial CT-scan. In the 19 cases where it was performed the initial CT-scan showed contusion in 9 cases, edema in 6 and epidural hematoma in 7. ⋯ Of the 14 patients who had a score of 15, 7 made good recoveries, 4 had a minor handicap, 1 a severe handicap and 2 died. Delayed intracerebral hematomas are highly unpredictable and can occur in any age group, in patients who are fully conscious on admission, and in patients with a normal CT-scan, with or without fracture. Our current policy is the following: no concussion but normal neurological findings: discharge home; concussion but normal neurological findings on admission: plain skull films; if fracture, 24 hours' hospital supervision; if no fracture, discharge home; abnormal neurological findings on admission: CT-scan; repeat CT if there is secondary neurological deterioration, secondary rise in intracranial pressure, or lack of improvement after 24 hours, and in all sedated and hyperventilated patients after 24 hours.