European journal of intensive care medicine最新文献

A case of fulminant bacteroides plus anaerobic streptococcus bacteraemia is reported. Therapy included the use of extracorporeal membrane oxygenation for the resultant acute respiratory failure. The problem of bacteroides infections is reviewed.

The value of ICU treatment in the management of septic abortion has been assessed. Of patients subjected to hysterectomy, the mortality is now 20%, as opposed to 37% prior to the advent of ICU. It would therefore appear that these patients can benefit from intensive nursing and medical attention.

The correlations between the haemodynamic and transthoracic electrial impedance changes resulting from a progressive reduction in the circulating blood volume were studied in four intact mongrel dogs artificially ventilated with a mixture of halothane in nitrous oxide-oxygen. The cardiac output of the dogs was measured by both the electrical impedance and the fibre optic dye dilution techniques. It was found that significant correlations existed between the blood lloss and the arterial blood pressure, the maximum first derivative of the transthoracic impedance, the Heather Index, the transthoracic impedance, the maximum rate of change of aortic pressure and the cardiac stroke work. There was also a good correlation between the dye and impedance cardiac output values, the impedance value always being higher than the corresponding dye value. The correlation between the Heather Index and the PEP/LVET ratio and 1/PEP2 varied markedly from dog to dog.

Severe haemorrhagic shock was studied in a series of animal experiments. Reduction in myocardial oxygen and substrate utilisation in association with cardiac failure was demonstrated when the duration of shock was prolonged. The probable aetiological factors included ischaemia and the presence in the blood of certain vasoactive and metabolic depressant substances. It was concluded that the process leading to irreversible shock was multi-factorial in origin but failure appeared to play an important role.

It is suggested that there should be available post-graduate training schemes for members of the profession who ultimately wish to work on an Intensive Therapy Unit at Consultant level. The duties of the Medical Unit administrator are described and schemes are suggested for further training of an anaesthetist or physician particularly interested in critical patient care.

Acute intoxication by diethylene glycol (LD 50) in male rats is associated with a considerable urinary excretion of oxalate, which is significantly decreased by alkalinisatin and/or intraperitoneal injection of ethanol with hydration. Mortality during the five days following intoxication is significantly decreased by major hydration only or together with pyridoxine administration, but is cancelled by major hydration together with alkalinisation or intraperitoneal administration of ethanol, plus hydration, with or without alkalinisation. -- It might be inferred that diethylene glycol has the same metabolic pathway as ethylene glycol and treatment of acute intoxication by diethylene-glycol should be the same as that of acute poisoning with ethylene glycol.

Most difficulties with intravenous fluid charting are due to the inability to identify which bottle/bag on the balance sheet corresponds to the bottle/bag on the order sheet. These can be eliminated by allocating every bottle/bag a number in sequence and charting intravenous fluids in START and FINISH columns against a time scale. Accumulation of the Running Total minimises arithmetical errors as only two numbers are added together on any one occasion. A definitive balance form and order sheet, printed on both sides of a single sheet of A4 paper illustrates the "B Number" method with a reasonably complicated example of fluid balance.

The efficiency of applying continuous positive airway pressure (CPAP) by the nasal route was retrospectively nalyzed in 32 newborns with RDS (23 uncomplicated HMD with additional cardiac or pulmonary complications and 7 RDS of non-hyaline membrane etiology) who underwent nasal CPAP treatment at the Kinderspital Zurich from 1972--1974. 16 of the 23 infants with uncomplicated HMD were successfully treated with CPAP. They showed a significant rise in PaO2 as well as a significant drop in respiratory frequency during nasal CPAP application, the PaCO2 did not change significantly. The remaining 7 infants in this group (7/23) had to be intubated and mechanically ventilated owing to a persistent high FIO2 (4 infants), technical difficulties (1) or nasal hypersecretion (2). Two of these 23 infants died, one of meningitis, one of cerebral hemorrhage. The two infants with HMD and additional cardiac or pulmonary complications and 3 of 7 infants with RDS of non-hyaline membrane etiology had to be intubated and mechanically ventilated after failure of nasal CPAP. All 9 infants in these two groups survived. The nasal CPAP system as described is a simple, inexpensive and effective method of applying CPTPP in newborns with uncomplicated HMD, except radiological stage IV. In HMD with additional cardiac or pulmonary complications and in RDS of non-hyaline membrane etiology the results of nasal CPAP treatment were not convincing.

Four cases are reported where patients reacted with severe restlessness, violence or hallucinations at low doses of doxapram infusion. A possible association with hepatic dysfunction is discussed. These reactions persisted long after the cessation of doxapram infusion and the various treatments used are described.

CPPV (continuous positive pressure ventilation) is obviously superior to IPPV (intermittent positive pressure ventilation) for the treatment of patients with acute respiratory insufficiency (ARI) and results within a few minutes in a considerable increase in the oxygen transport. The principle is to add a positive end-expiratory plateau (PEEP) to IPPV, with a subsequent increase in FRC (functional residual capacity) resulting in re-opening in first and foremost the declive alveolae, which can then once again take part in the gas exchange and possibly re-commence the disrupted surfactant production. In this manner the ventilation/perfusion ratio in the diseases lungs is normalized and the intrapulmonary shunting of venous blood (Qs/Qt) will decrease. At the same time the dead space ventilation fraction (VD/VT) normalizes and the compliance of the lungs (CL) increases. The PEEP value, which results in a maximum oxygen transport, and the lowest dead space fraction, also appears to result in the greatest total static compliance (CT) and the greatest increase in mixed venous oxygen tension (PVO2); this value can be termed "optimal PEEP". The greater the FRC is, with an airway pressure = atmospheric pressure, the lower the PEEP value required in order to obtain maximum oxygen transport. If the optimal PEEP value is exceeded the oxygen transport will fall because of a falling Qt (cardiac output) due to a reduction in venous return. CT and PVO2 will fall and VD/VT will increase. Increasing hyperinflation of the alveolae will result in a rising danger of alveolar rupture. The critical use of CPPV treatment means that the lungs may be safeguarded against high oxygen percents. The mortality of newborn infants with RDS (respiratory distress syndrome) has fallen considerably after the general introduction of CPPV and CPAP (continuous positive airway pressures). The same appears to be the case with adults suffering from ARI (acute respiratory insufficiency).