Articles: critical-care.
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Acute respiratory failure is still one the main problems in surgical intensive care. Unknown pathophysiological mechanisms permit only symptomatic therapy. Today ventilatory strategies by using PEEP und IRV are established to improve gas exchange and FRC by recruiting collapsed alveoli, decreasing intrapulmonary shunting and returning V/Q matching to normal. ⋯ Posture changing depends on blood gas analysis, specifically on decreasing PaO2 after previous increment. Patients remained in prone and supine position at a mean of 6.3 (4.5-20) h and posture changing was proceeded over a period of 15.4 (7-32) days. No problems recording to blood pressure or mechanical ventilation appeared during prone position. 11 of 16 patients survived (68.8%), 5 died of cardiac (2) and multi organic failure (3) in connection with sepsis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Rev Med Univ Navarra · Oct 1992
[Cardiorespiratory arrest as a reason for admission to the ICU: clinical course and prognostic factors].
The cardiac arrest is a situation associated with a abrupt and unexpected interruption of the spontaneous breath and circulation. It's a frequent cause to admit people in hospital. There the patients are admitted to the intensive care unit in order to care for them after cardiac arrest. ⋯ We encountered a higher mortality the longer the time of arrest, the higher the score on the Apache scale, on the lower the score on the Glasgow coma scale. Another point is if we aren't sure about the cause of the cardiac arrest or it's cerebrovascular accidents or upper airway failure, the prognostic is worse. Finally, if the ECG at the moment of the admission is asystole the death rate is 100%.
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J Neurosurg Anesthesiol · Oct 1992
End-tidal carbon dioxide as an indicator of arterial carbon dioxide in neurointensive care patients.
The relationship between the arterial partial pressure of carbon dioxide (Paco2) and the end-tidal carbon dioxide partial pressure (PEtco2) was evaluated in 11 critically ill adult neurointensive care patients during mechanical ventilation. It was hypothesized that the Paco2 to PEtco2 gradient, or P(a-Et)co2, was maintained and that PEtco2 can be used to determine Paco2 accurately in these patients. After approval by the Clinical Investigations Committee, when clinically indicated arterial blood gases (with Paco2) were measured, the PEtco2 was determined from the capnograph (Hewlett Packard 78520A infrared capnometer). ⋯ The direction of Paco2 change was inaccurately predicted by PEtco2 changes in 31.9% of measurements. PEtco2 does not provide a stable reflection of Paco2 in all neurointensive care patients. Arterial blood gases cannot be eliminated when monitoring respiratory acid-base balance in mechanically ventilated neurointensive care patients.