Articles: critical-care.
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Anaesthesiol Reanim · Jan 1991
[A computer-controlled closed circle system for ventilation during anesthesia and intensive care and its possibilities for patient monitoring].
A computer feed back controlled anaesthesia- and intensive care ventilator has been developed with on-line and separate lung function measurement. The system design is built on the principle of a totally closed circuit (closed rebreathing respirometer) and an inspiratory "high flow", the gas being rotated through the closed circuit unidirectionally by a blower with 70 l/min. Ventilation is performed by metal membranes freely movable in membrane chambers with an internal part included into the closed circuit and an external part connected to pressurized air controlling inspiratory valves expiratory valves. ⋯ Ergonometric aspects led to the triangular from of the new anaesthesia and intensive care ventilator with the controlling service screen turnable to all three sides of the ventilator (high flexibility of the user) and all necessary equipment and material included into the "Anaesthesia workstation". All measured and present parameters are continuously displayed on the service (computer) screen and entered into the computer-memory in minute cycles with a memory capacity of 75 h anaesthesia. At any desired moment the memorized values can be transferred to IBM-compatible disc systems for storage or into the respective data management systems, thus at the end of anaesthesia, at the end of the working day or at the end of the week.
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We investigated retrospectively 761 acute head trauma patients, who were admitted to our intensive care unit from 1983 to 1989. The objective of our study was to investigate the influence of pre-hospital acute care and intensive care protocols on mortality and outcome. We showed that the introduction of organized pre-hospital emergency care and well organized interdisciplinary patient management in the hospital and in the intensive care unit had a significant effect on outcome.
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Allocation of scarce and vital medical resources in intensive care units (ICUs) is one of the most actual and controversial questions within the context of medical ethics. How shall doctors decide which patients shall benefit from scarce resources such as ICU beds, ventilators, incubators, etc.? Which criteria are more acceptable from the ethical viewpoint in these triage situations: The rights of the patients? The expected benefits? The will of the patients or of their relatives? And how can medical responsibility be envisaged within this context? These are some of the questions discussed in this article having in mind the present framework of ethical and legal obligations pending upon doctors practicing in Portugal.