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    85 results match your criteria Clinical Intensive Care[Journal]

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    Haemodynamic effects of pressure-controlled ventilation versus volume-controlled ventilation in patients submitted to cardiac surgery.
    Clin Intensive Care 1995 ;6(3):100-6
    Anesthesia and Critical Care Department, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil.
    Objective: To compare the haemodynamic effects of pressure-controlled ventilation (PCV) with volume-controlled ventilation (VCV) in patients after cardiac surgery.

    Design: Prospective clinical study.

    Setting: Post-operative cardiac surgical ICU. Read More

    The role of the gastric reservoir in ventilator-associated pneumonia.
    Clin Intensive Care 1995 ;6(4):174-80
    Department of Pneumology, Hospital Clinic, Department of Medicine, University of Barcelona, Spain.
    Ventilator-associated pneumonia (VAP) is a common complication of mechanical ventilation with an incidence ranging from 9-70% and averaging around 25%. The pathogenesis of VAP requires abnormal oropharyngeal and gastric colonisation and then aspiration of these contents into the lower airways. Another co-existing mechanism could be direct oropharyngeal or lower airways inoculation of microorganisms through contaminated respiratory therapy equipment. Read More

    The aetiology, consequences and prevention of barotrauma: a critical review of the literature.
    Clin Intensive Care 1995 ;6(4):166-73
    University of Toronto, Ontario, Canada.
    Purpose: To review critically the literature on pulmonary barotrauma in mechanically ventilated patients.

    Methods: Data sources included MEDLINE and citation lists of relevant articles. Articles investigating the aetiology or prevention of pulmonary barotrauma were critically evaluated according to published guidelines. Read More

    Cardiopulmonary resuscitation in cancer patients: indications and limits.
    Clin Intensive Care 1995 ;6(2):72-5
    Service de Médecine, Institut Jules Bordet, Université Libre de Bruxelles, Belgium.
    A presumption based on the literature obtained from general hospitals is widespread among physicians, namely that patients with active malignant disease, particularly if metastatic, should not be resuscitated if they have a cardiorespiratory arrest. This attitude is not supported by studies performed on cardiopulmonary resuscitation (CPR) in cancer centres which report results similar to those obtained in non-cancer patients. In fact, cancer, even if metastatic, is not a contraindication in itself to CPR. Read More

    Recent advances in the treatment of ARDS.
    Clin Intensive Care 1995 ;6(2):62-71
    Klinik für Anaesthesiologie und operative Intensivmedizin, Virchow Klinikum, Medizinische Fakultät, Humboldt-Universität, Berlin, Germany.
    Despite more than 25 years of extensive research the mortality of ARDS patients remains high. Besides the often deleterious course of the underlying disease, another reason for this high mortality lies in the aggressive ventilatory regimen which is required to maintain arterial blood gases in a more or less normal range. Therapeutic methods which are used to reduce iatrogenic damage to the lungs are pressure controlled ventilation with permissive hypercapnia, differential lung ventilation, positioning therapy, dehydration, and extracorporeal gas exchange with membrane lungs. Read More

    Subjective psychological status of severely ill patients discharged from mechanical ventilation.
    Clin Intensive Care 1995 ;6(2):57-61
    Medical Intensive Care Unit, Cochin-Port Royal University Hospital, Paris, France.
    Objective: To evaluate psychological status in consecutive survivors of ICU who needed mechanical ventilation (MV).

    Design: Prospective study.

    Setting: Twenty-four bed intensive care unit. Read More

    Pilot clinical trial of an anti-TNF alpha monoclonal antibody for the treatment of septic shock.
    Clin Intensive Care 1995 ;6(2):52-6
    Department of Anaesthesiology and Intensive Care, University Hospital, Besançon, France.
    Objective: To determine the safety and pharmacokinetics of an anti-tumour necrosis factor (TNF alpha) monoclonal antibody in the treatment of septic shock, and to evaluate the biological evolution of cytokine response.

    Design: Open-label, prospective, pilot trial with escalating doses of a murine monoclonal antibody (B-C7) directed against TNF alpha.

    Setting: University medical centre intensive care unit. Read More

    Markers of ventilator-associated pneumonia.
    Clin Intensive Care 1995 ;6(3):121-6
    Department of Pneumology, Hospital Clinic, University of Barcelona, Spain.
    The diagnosis of ventilator-associated pneumonia (VAP) is difficult for several reasons. Firstly, clinical markers show a large percentage of false-positive and false-negative results. Secondly, microbiological diagnosis based on quantitative cultures of protected specimen brush (PSB), bronchoalveolar lavage (BAL), and endotracheal aspirates also present false-positive and false-negative results. Read More

    Near infrared spectroscopy during and after cardiac arrest--preliminary results.
    Clin Intensive Care 1995 ;6(3):107-11
    Department of Emergency Medicine, Vienna General Hospital, University of Vienna Medical School, Austria.
    Objective: To evaluate if regional cerebrovascular oxygen saturation (rSO2) is linked to systemic oxygenation and if impaired regional cerebral oxygenation affects outcome in cardiac arrest patients.

    Design: Prospective, observational study.

    Setting: Emergency department of a University Hospital. Read More

    Comparison of APACHE III, II and the Glasgow Coma Scale for prediction of mortality in a neurosurgical intensive care unit.
    Clin Intensive Care 1995 ;6(1):9-14
    Division of Neurosurgery, Taichung Veterans General Hospital, Yang-Ming Medical University, Taiwan, China.
    Objectives: This study examined the efficacy of predicting power for hospital mortality of three different scoring systems in a neurosurgical intensive care unit (NICU).

    Setting: An eight-bed NICU in a 1,270-bed medical centre (Taichung Veterans General Hospital).

    Subjects: Two hundred patients with head injury, brain tumour, hypertensive intracerebral haemorrhage, rupture of aneurysm or arteriovenous malformation, or other categories were included in our study in a consecutive period of 14 months. Read More

    Clinical benefits of early post-injury enteral feeding.
    Clin Intensive Care 1995 ;6(1):21-7
    Department of Surgery, Denver General Hospital, CO 80204, USA.
    Over the past two decades, clinical studies have provided convincing evidence that early nutritional support benefits metabolically stressed surgical patients by preventing acute protein malnutrition. However, the optimal route of substrate delivery (ie, enteral versus parenteral) continues to be debated. Recent basic and clinical investigation offers the exciting possibility that the beneficial effects of traditional nutritional support can be amplified by supplementing specific nutrients that exert pharmacological immune-enhancing effects. Read More

    Metabolic effects of continuous veno-venous haemofiltration in critically ill patients.
    Clin Intensive Care 1994 ;5(6):293-5
    Department of Anesthesiology and Critical Care, Tel Aviv Medical Center, Ichilov Hospital, Israel.
    Objective: To evaluate the short-term metabolic and haemodynamic effects of continuous veno-venous haemofiltration (CVVH) in critically ill patients with acute renal failure (ARF).

    Design: Prospective study of nine consecutive critically ill patients with established acute oliguric renal failure.

    Setting: A general ICU in an 800-bed university hospital. Read More

    A heat and moisture exchanging filter in long-term ventilation.
    Clin Intensive Care 1994 ;5(6):289-92
    Intensive Care Unit, St George's Hospital, London, UK.
    We report our experience of using the Pall BB50T heat and moisture exchanging filter (HMEF) in critically ill patients undergoing long-term ventilation. Three hundred and sixty-four ventilated patients humidified with the Pall HMEF were studied prospectively. Thirty-five patients (mean APACHE II score 24. Read More

    Treatment of acute respiratory failure with non-invasive intermittent positive pressure ventilation in haematological patients.
    Clin Intensive Care 1994 ;5(6):282-8
    Service de réanimation, Hôpital E Herriot, Lyon, France.
    Objective: The aim of this study was to assess whether non-invasive positive pressure ventilation delivered intermittently (Ni-IPPV) by means of a facial or nasal mask is beneficial in haematological patients suffering from acute respiratory failure.

    Design: Prospective, open, non-randomised study.

    Setting: University Hospital, medical intensive care unit. Read More

    Quality of life at three months following admission to intensive and coronary care units.
    Clin Intensive Care 1994 ;5(6):276-81
    Central Middlesex Hospital, Park Royal, London, UK.
    Objective: Measurement of quality of life three months following critical illness, to assess impact on health expectations.

    Design: Continuous quantitative study of patients admitted to a combined intensive and coronary care unit during a nine-month period. Questionnaires giving baseline information were completed soon after admission, and postal questionnaires incorporating the Nottingham Health Profile were sent to surviving patients three months following discharge from the unit. Read More

    Sedation during weaning from mechanical ventilation.
    Clin Intensive Care 1994 ;5(5 Suppl):8-12
    Department of Anaesthesia, Hôpital Cantonal Universitaire, Geneva, Switzerland.
    The transition from mechanical ventilation to spontaneous breathing in the intensive care unit is a two-stage process: weaning and extubation. Certain parameters require consideration before the commencement of weaning, namely respiratory function (both pulmonary gas exchange and respiratory muscle strength), cardiovascular status, stability of clinical condition, low metabolic demands, psychological factors and, possibly, patient collaboration. Appropriate sedation is crucial for successful weaning to keep the patient rested and to maintain the oxygen consumption and carbon dioxide production low. Read More

    Controlling sedation rather than sedation controlling you.
    Clin Intensive Care 1994 ;5(5 Suppl):5-7
    Hôpital Universitaire Lariboisière, Paris, France.
    Sedation in the intensive care unit (ICU) aims to improve patient comfort and facilitate treatment procedures. Most units still rely on a combination of opioid and benzodiazepines with the addition of other drugs for specific requirements. However, the effect of sedative agents in critically ill patients is often unpredictable, so frequent assessment of the depth of sedation is essential to match the depth to patient requirements. Read More

    New horizons in ICU sedation: exploring non-sedative effects of ICU sedation.
    Clin Intensive Care 1994 ;5(5 Suppl):22-6
    Department of Anaesthesia, Addenbrooke's Hospital, Cambridge, UK.
    Sedative drugs are widely used in intensive care, primarily in ventilated patients. The common actions and side-effects of these agents are widely recognised. However, recent evidence suggests that opiates and other sedative agents that are used in this situation also have important, but not widely appreciated, effects on metabolism, physiological signalling and disease mechanisms. Read More

    Cost of ICU sedation: comparison of empirical and controlled sedation methods.
    Clin Intensive Care 1994 ;5(5 Suppl):17-21
    Intensive Care Unit, SCIAS, Hospital de Barcelona, Spain.
    A randomised crossover study was undertaken to compare the quality and cost of controlled versus empirical sedation with midazolam in critically ill patients. Patients (n = 40) entering the ICU were enrolled provided they satisfied the strict entry criteria. During 90 hours of midazolam sedation, patients received randomly allocated 10-hour periods of controlled or empirical sedation. Read More

    Long-term sedation in the ICU: enteral versus parenteral feeding.
    Clin Intensive Care 1994 ;5(5 Suppl):13-6
    Intensive Therapy Unit, AZ Stuivenberg, Antwerp, Belgium.
    An open, prospective study was carried out on 45 patients with multiple injuries to compare the mortality and incidence of sepsis between those given early total enteral nutrition (TEN) when sedated with propofol and historical controls who had been given total parenteral nutrition (TPN) and sedated with midazolam. TEN was instituted immediately after surgery via gastrostomy and/or jejunostomy tube inserted during laparotomy or via an endoscope and was continued for the whole stay in the intensive care unit (ICU). Dramatic reductions in both mortality (24. Read More

    Lower anion gap increases sensitivity in predicting elevated lactate.
    Clin Intensive Care 1994 ;5(5):221-4
    Department of Pediatric Intensive Care, Children's Hospital of Eastern Ontario, Ottawa, Canada.
    Objective: The normal reference range for the anion gap (AG) has recently been questioned by several authors. Lowering the upper limit of normal of the AG has been found to be more sensitive in predicting elevated lactate in critically ill adults. The objectives of this study are i) to define a new upper limit of normal of the AG in a study population of healthy adult volunteers, ii) to determine the sensitivity, specificity, the positive predictive value and the negative predictive value of the new upper limit for AG in detecting elevated lactate in critically ill children and to compare these results to the old upper limit of normal of AG (16 mmol/l), iii) to construct a receiver-operating-characteristic (ROC) curve for anion gap as a predictor of elevated lactate, iv) to determine the relationship between anion gap and serum lactate levels in critically ill patients. Read More

    Prevention of atmospheric contamination during isoflurane sedation.
    Clin Intensive Care 1994 ;5(5):217-20
    Abbott Laboratories Ltd, Queenborough, UK.
    With a view to minimising staff exposure to exhaled isoflurane which had been used for sedation, we assessed the efficacy of either activated charcoal adsorption or active or passive mechanical scavenging systems in intensive care units (ICUs). Personal monitoring revealed minimal exposure of staff to the sedating agent. Infra-red analyses of ambient air rarely showed isoflurane levels greater than 26 ppm, with mean concentrations of around 1 ppm. Read More

    A multi-disciplinary approach to families of brain dead children.
    Clin Intensive Care 1994 ;5(4):191-6
    Department of Pediatrics, University of Rochester School of Medicine and Dentistry, NY, USA.
    Objective: To relate our multi-disciplinary approach to families of brain dead children.

    Data Sources: The professional experiences of critical care health care providers and the review of the medical and legal literature.

    Setting: Paediatric Intensive Care Unit. Read More

    The role of the microcirculation in the multi-organ dysfunction syndrome.
    Clin Intensive Care 1994 ;5(4):186-90
    Intensive Care Unit, St James's University Hospital, Leeds, UK.
    The systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) are significant causes of morbidity and mortality in the intensive care unit. The pathogenesis of MODS is poorly understood; however, endotoxin (LPS) and cytokines (for example interleukins, tumor necrosis factor and platelet activating factor) are thought to play a major role by inducing microvascular injury. A crucial step in the normal functioning of the immune system is the adhesion of cells to each other and, via extravasation, penetration of the extracellular matrix. Read More

    Providing psychological support for patients after critical illness.
    Clin Intensive Care 1994 ;5(4):176-9
    G16 Intensive Care Unit, Whiston Hospital, Prescot, Merseyside, UK.
    The majority of patients have little or no memory of their stay in ICU or remember only pain, suctioning or lack of sleep. Dreams and nightmares while in the intensive care unit (ICU) and after discharge home have also been reported. The few studies investigating the longer-term psychological problems of critical illness point to a picture of social isolation with patients avoiding company and showing less affection to their partners. Read More

    Non-invasive measurement of cardiac output in patients with acute lung injury using the carbon dioxide rebreathing method.
    Clin Intensive Care 1994 ;5(4):172-5
    Service d'Urgence Respiratoire et de Réanimation Médicale, Hôpital Calmette, Lille, France.
    Study Objective: To compare measurement of cardiac output by the CO2 rebreathing method with the thermodilution cardiac output technique in mechanically ventilated patients with acute lung injury.

    Design: Prospective study comparing two methods of cardiac output measurement in 22 consecutive patients with acute lung injury.

    Setting: Intensive care unit of a university hospital. Read More

    The paediatric chest tube.
    Clin Intensive Care 1994 ;5(3):123-9
    Department of Surgery, Baylor College of Medicine, Houston, TX 77030-2399, USA.
    Chest tubes are placed to empty the pleural space of air or fluid which prohibits full lung expansion. The function of these tubes is dependent on adequate placement, effective drainage and frequent re-evaluation of the patient and the chest drainage system. Knowledge of the principles of chest tube drainage is important to evaluate adequately the function of a tube thoracostomy. Read More

    The value of serum C-reactive protein levels as a marker of sepsis in intensive care unit patients.
    Clin Intensive Care 1994 ;5(3):106-13
    Department of Microbiology, Central Middlesex Hospital NHS Trust, London, UK.
    A one-year prospective study was carried out to assess the value of routine serum C-reactive protein (CRP) measurement in the early diagnosis of infection in ICU patients of a District General Hospital. Ninety-one patients were included in the study. Sixty-eight patients yielded 28 proved and 77 suspected episodes of infection. Read More

    Impaired glucose and lipid metabolism seen in intensive care patients is related to severity of illness and survival.
    Clin Intensive Care 1994 ;5(3):100-5
    Department of Medicine, Uppsala University Hospital, Sweden.
    Objective: To relate glucose and lipid metabolism to the severity of illness and survival in critically ill patients.

    Design: Cross-sectional and prospective cohort study.

    Setting: Secondary referral ICU. Read More

    Usefulness of (Tc 99m) HM-PAO scan in supporting clinical brain death in children: uncoupling flow and function.
    Clin Intensive Care 1994 ;5(2):71-4
    Paediatric Critical Care Unit, Department of Paediatrics and Department of Nuclear Medicine, University of Western Ontario, Children's Hospital of Western Ontario, Canada.
    Objective: To determine the usefulness of (Tc 99m) HM-PAO scan in supporting the clinical diagnosis of brain death.

    Design: Retrospective review.

    Setting: Paediatric Intensive Care Unit. Read More

    A re-evaluation of the ventilator score as an indicator of prognosis in the adult respiratory distress syndrome.
    Clin Intensive Care 1994 ;5(2):60-3
    Intensive Care Unit, University Hospital of South Manchester, Withington, UK.
    Objective: To determine whether the ventilator score of Smith and Gordon (1986) can accurately predict outcome in patients with severe Adult Respiratory Distress Syndrome (ARDS).

    Design: Retrospective study of data from case records and flow sheets.

    Setting: University Hospital Intensive Care Unit. Read More

    Continuous invasive cardiac output monitoring--the Baxter/Edwards Critical-Care Swan Ganz IntelliCath and Viligance system.
    Clin Intensive Care 1994 ;5(2):52-5
    Department of Intensive Care Medicine, Queen Alexandra Hospital, Portsmouth, UK.
    We evaluated the Baxter/Edwards Critical-Care Swan Ganz IntelliCath continuous cardiac output catheter and Vigilance continuous cardiac output monitor in critically ill adult intensive care patients, and compared cardiac output measurements obtained from this new system with those from a standard bolus thermodilution technique using cold normal saline. Nine Swan Ganz IntelliCath catheters were inserted into patients selected at random, following the decision that pulmonary artery catheter monitoring was required. A total of 100 comparisons were made in nine patients. Read More

    The use of pulmonary artery catheters in intensive care: time for reappraisal?
    Clin Intensive Care 1994 ;5(1):15-9
    Nuffield Department of Anaesthetics, Oxford and Intensive Care Unit, Royal Berkshire Hospital, Reading, UK.
    The precise role of the pulmonary artery catheter (PAC) in reducing the morbidity and mortality of intensive care patients remains uncertain. Future studies of the different patient groups who possibly benefit from their use may well require multicentre trials in order to include sufficient numbers and produce significant conclusions. This would suggest a need for a consensus opinion on how PACs are actually used to obtain the different physiological variables which can influence patient management. Read More

    Oxygen extraction in patients with sepsis and heart failure: another look at clinical studies.
    Clin Intensive Care 1994 ;5(1):4-14
    Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
    We collected all complete sets of measurements of cardiac index and oxygen-derived variables available in the recent literature (1975-1991; computerised Medline search) on critically ill patients with sepsis (n=21 studies), septic shock (n=20 studies) or severe heart failure (n=13 studies). For each study, the mean value for cardiac index, oxygen delivery (DO 2), oxygen uptake (VO 2), oxygen extraction ratio (O 2ER) and lactate concentration (when available) were analysed together with mortality rates. There was a significant relationship between VO 2 and DO 2 for the studies on patients with severe heart failure (r=0. Read More

    Intra-operative assessment of myocardial ischaemia during general surgery by transoesophageal echocardiography: present state and future perspectives.
    Clin Intensive Care 1993 ;4(5):232-40
    CNR Institute of Clinical Physiology, University of Pisa, Italy.
    This paper reviews the present state and future perspectives of the peri-operative application of Transoesophageal Echocardiography (TEE) for early detection of myocardial ischaemia during general surgery. The increasing clinical relevance of this problem parallels the progressively higher frequency of surgery performed in patients at relatively high cardiovascular risk, due to a longer life-span and improved anaesthetic techniques. TEE potentially provides a powerful method for detailed cardiac monitoring in patients undergoing general surgery. Read More

    Ultrasound-guided positioning of temporary pacing catheters and pulmonary artery catheters after echogenic marking.
    Clin Intensive Care 1993 ;4(1):4-7
    Clinic III for Internal Medicine, University of Cologne.
    Pacing of the heart is one of the most effective emergency measures in the management of critical bradycardic arrhythmias. Positioning of the pacing catheter is safest under fluoroscopic control; however, this facility is not always readily available in emergency situations. A procedure was therefore developed by which pacing catheters could be easily positioned under echocardiographic control after echogenic marking. Read More

    Reproducibility and comparison of cardiac output measurement by transthoracic bioimpedance and thermodilution methods in critically ill patients.
    Clin Intensive Care 1993 ;4(5):217-21
    Departments of Pharmacology and Therapeutics, Royal Liverpool University Hospital, UK.
    The short-term reproducibility in cardiac output (CO) and stroke volume (SV) measurements by transthoracic electrical bioimpedance (TEB) and thermodilution (TH) and their agreement were studied in 31 consecutive patients in the Intensive Care Unit (ICU). For comparison of changes in CO and SV, six patients were studied separately. TEB data were not obtainable in four patients due to interference with impedance signals or heart rate detection. Read More

    Echocardiographic diagnosis of mechanical complications in acute myocardial infarction.
    Clin Intensive Care 1993 ;4(6):276-83
    Cardiovascular Center, Department of Internal Medicine, University of Iowa, Iowa City 52242.
    Myocardial infarction occurs with an incidence of approximately 1.5 million cases annually in the United States. Mortality remains at about 12% despite recent advances in medical and interventional therapies. Read More

    Percutaneous tracheostomy.
    Clin Intensive Care 1993 ;4(6):270-5
    General Infirmary at Leeds, UK.
    Percutaneous dilational tracheostomy (PDT) originated in the USA and now an increasing number of UK centres are adopting the technique. It compares favourably with traditional surgical tracheostomy; PDT can be performed more satisfactorily at the bedside, avoiding the transport of critically ill patients to the operating theatre. It is a more rapid and convenient technique and evidence increasingly suggests that it is associated with significantly fewer and less severe complications. Read More

    Liver function tests in the critically ill patient.
    Clin Intensive Care 1993 ;4(4):174-82
    Addenbrooke's Hospital, Cambridge, UK.
    The liver has a wide range of functions that may be disturbed in different ways by the many diseases which affect it and, in consequence, there are a large number of tests which look at different aspects of its function. Specific diagnoses are made using a range of clinical, biochemical, histological and radiological methods. Measurement of the plasma concentration of alanine aminotransferase (ALT, SGPT), gamma-glutamyl transpeptidase (gammaGT) and albumin are particularly valuable as these substances are specifically affected by liver disease. Read More

    A tool to measure the change in health status of selected adult patients before and after intensive care.
    Clin Intensive Care 1993 ;4(4):160-5
    Intensive Care Unit, Whiston Hospital, Prescot, UK.
    If the effect of intensive care on the patient is to be fully assessed then the health status of patients before and after admission to ICU must be measured. The validity of a simplified system which can also use relatives, where necessary, as informants on the patients' pre-morbid health status has been evaluated. In a District General Hospital Intensive Care Unit a questionnaire based survey of 85 patients admitted over a period of eight months used a new specially-designed instrument and compared this with the Functional Limitations Profile (FLP) and the Perceived Quality of Life instrument (PQL). Read More

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