Articles: critical-care.
-
Burn treatment is a complex therapeutic regimen, enclosing immediate resuscitation, burn would care and the complete spectrum of surgical intensive care as well as plastic surgical reconstruction. The pathophysiology of a severe burn injury resembles a maximal trauma response by activating a wide variety of mediators, resulting in a generalized tissue edema (capillary leak). ⋯ Sepsis is still the major mortality factor (75%). Besides established methods like skin culturing, future efforts are directed towards the generation of composite skin grafts and an immunological approach to influence or prevent the course of a burn sepsis.
-
Intensive care medicine · Jan 1993
Comparative StudyIntensive use of general ultrasound in the intensive care unit. Prospective study of 150 consecutive patients.
To assess the impact of systematic ultrasound (US) examination in patients admitted to the ICU. ⋯ Routine US examination may alter therapeutic plans in up to 1/4 of critically ill patients admitted to the ICU. US examination should be liberally performed on such patients.
-
The clinical syndrome sepsis has been redefined recently, and the SIRS (systemic inflammatory response syndrome) concept has been developed. In the initial phase of sepsis, different mediator systems are activated finally resulting in a generalized endothelial inflammatory reaction. This reaction may lead to a vicious circle with subsequent multiple organ failure. ⋯ Replacement of antithrombin III, continuous venovenous hemofiltration, application of high doses of immunoglobulins and of low doses of hydrocortisone have been used. A monoclonal antibody against endotoxin (Centoxin) was taken from the German market in January 1993. Experimental aspects of treatment include the administration of C1 esterase inhibitor, pharmacological inhibition of nitric oxide (NO), plasmapheresis, the application of non-steroidal anti-inflammatory agents and of high-dose naloxone as well as manipulation of cytokines.
-
Because of the need for rapid diagnosis and management of patients acutely stricken by either injury or illness, critical care delivery cannot be limited to intensive care units. Instead, it must span the continuum from the scene of injury or illness to the patient's eventual arrival at the intensive care unit. University Hospital in Ghent, Belgium, has developed a comprehensive system that involves prehospital and in-hospital critical care, as well as a rapid and efficient interhospital and intrahospital transportation system. ⋯ The emergency department and its staff are available 24 hours a day to ensure uninterrupted delivery of critical care, including when patients are transported between various hospital departments. In addition, critical care specialists with at least 2 years' intensive care experience are available 24 hours a day. They also serve as coordinators for disaster planning for the hospital and the city of Ghent and its province.
-
The so-called percutaneous dilatational tracheostomy-essentially a minimally invasive puncture method-inserting the tracheal cannula by a modified Seldinger-technique is an alternative method to the conventional operative tracheostomy. The percutaneous dilatational tracheostomy was evaluated in a prospective trial (June 92-January 93) on 50 consecutive surgical (n = 36), medical (n = 10), and neurological-neurosurgical (n = 4) critically ill patients (29 m, 21 f; age 14-87 years) with need for prolonged mechanical ventilation. After an average duration of endotracheal intubation of 6 (0-22) days, the procedure was endoscopically guided and controlled via the endotracheal tube. ⋯ Infection of stoma site, misplacement of cannula, rupture of the tube cuff, and pneumothorax were not noticed. On 13 decannulated patients stenosis of the trachea was not found in a period of 6-8 weeks following the tracheostomy. As a bedside procedure the percutaneous dilatational tracheostomy is safe and quick and should therefore be the method of choice for critically ill patients who require a tracheostomy.