Articles: critical-care.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Sep 1996
Review[Mucociliary clearance function and medicamentous modification].
Mucociliary clearance represents a complex self-cleaning mechanism of the lung and is based on the functional unity of ciliated columnar cells and the special viscoelastic properties of the secretion produced in the tracheobronchial system. It has been known for a long time that intubation and mechanical ventilation can impair mucous transport and lead to morphological damage to the tracheobronchial mucosa. Recent studies made it clear, however, that mechanical ventilation during anaesthesia using an appropriate anaesthesiological technique has no deleterious effect on mucus transport in patients with healthy lungs. ⋯ In these patients a number of factors combine to form a formidable potential insult to the mucociliary transport mechanism. Numerous drugs can affect mucociliary transport. Beta-mimetics and theophylline, in particular, have a favourable effect on mucociliary transport, whereas the effect of mucolytic agents is controversial.
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In this paper we have studied cortical dynamics as assessed using graphical methods during deep anaesthesia. Graphical analysis was carried out by autocorrelation functions and return maps with different lags. During moderate and deep anaesthesia, the electroencephalogram (EEG) shows a burst suppression pattern, consisting of abruptly-occurring high amplitude bursts alternating with periods of relative silence. ⋯ The graphical methods used revealed differences in dynamics and topology of bursts as evoked by different stimuli. Spontaneous bursts clearly had different dynamics from evoked burst; which could not be seen directly from the raw EEG data. This study suggests that graphical analysis is a useful tool to obtain information about the dynamics of neuronal processes behind cortical responses during deep anaesthesia.
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Anaesth Intensive Care · Aug 1996
Continuous renal replacement therapy in critically ill patients: monitoring circuit function.
There is currently no universally accepted method to monitor circuit function or guidelines for circuit replacement during continuous renal replacement therapies (CRRT). The objectives of this study were to diagnose the causes of circuit failure, identify factors responsible for circuit clotting and determine a predictive monitor of circuit function. The CRRT technique used in this study was continuous venovenous haemodialysis (CVVHD). ⋯ In any circuit an increase of 26 mmHg or more in the transfilter pressure gradient accurately predicted circuit failure due to clotting and imminent cessation of function. Increases in platelet count, haematocrit, and low circuit flows are important determinants of haemofilter life. The measurement of transfilter pressure gradient across the haemofilter is an accurate bedside monitor of circuit function.
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The prognostic value of serial measurements of serum albumin concentration during the first 72 h after admission to a general adult intensive care unit was retrospectively reviewed in 348 consecutive critically ill patients over a one year period. The accuracy of the admission APACHE II (Acute Physiology And Chronic Health Evaluation) score in correctly predicting patient outcome was compared with the serum albumin concentration measured at different times after intensive care unit admission. Multiple logistical regression analyses were performed to evaluate whether combining APACHE II and serum albumin into a unified risk index improved prognostic accuracy. ⋯ However, serum albumin measured after 24 h was as accurate as the admission APACHE II score in correctly classifying patients according to outcome. There was a good correlation between the admission APACHE II score and serum albumin measured after 24 h but not between the admission APACHE II and the admission serum albumin. Combining the APACHE II score and serial albumin concentrations into a unified risk of death equation did not improve the accuracy of outcome prediction.