Articles: critical-care.
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Anaesthesiol Reanim · Jan 1997
Review[Ventilation modes and strategies in intensive care medicine].
Advances in ventilator technology and recent findings in pathophysiological mechanisms have resulted in a remarkable decrease in classical volume controlled and pressure controlled ventilation modes as treatment for severe acute respiratory insufficiency. New modes of ventilatory support enabling and encouraging patients' spontaneous breathing, such as Biphasic Positive Airway Pressure (BIPAP) and Airway Pressure Release Ventilation (APRV), make it possible to adapt ventilatory support better and more easily to suit patients' needs than conventional modes of controlled ventilation. Preservation and support of patients' spontaneous breathing improves pulmonary gas exchange and reduces stress imposed by mechanical ventilation. ⋯ Through this, the need for sedation and analgesia is considerably reduced and this may minimize systemic side-effects and complications from analgo-sedation and mechanical ventilation. The drugs should be administered in an adequate, individually adapted manner. Routinely-ordered and fixed combinations of drugs administered continuously are not adequate adequate as they further carry the risk of overdosing a different single drug with the corresponding side-effects (depression of respiratory drive, gut motility, etc.).
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Ann Fr Anesth Reanim · Jan 1997
Review[Treatment of intracranial hypertension in the case of severe craniocerebral injuries].
More than 50% of severely head-injured patients develop increased intracranial pressure, risking exacerbating ischaemic insults to the already injured brain. In approximately 10% of these cases, intracranial pressure may become unresponsive to medical or surgical treatment, with a resulting mortality of over 90%. ⋯ Recently, an algorithm for treating intracranial hypertension under three different therapeutic situations has been suggested, based on the successive application of effective agents with increasing associated risks. Therapeutic modalities of this protocol are discussed.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Comparative Study[Effective costs of intensive care: TISS and TISS-28 for the evaluation of an intensive care unit].
In 1996, Miranda published the TISS-28, a simplified version of the well-known Therapeutic Intervention Scoring System (TISS) for the evaluation of intensive care. A prospective observational study in 939 patients compared both scores, and the TISS-28 was found to show less interobserver variation. A cost analysis based on 1995 data revealed a value of 68.70 DM per TISS-28 point, which can be used to calculate the average costs for groups of patients, e.g., 1410 DM for 1 day postoperative surveillance in the ICU.