European journal of intensive care medicine最新文献

Tobramycin was used in the treatment of 35 severe infections. Its clinical effectiveness was confirmed in broncho-pulmonary infections without septicemia and in septicemia without lung involvement. Poor results were obtained in septicemia where the initial site 9 infection was in the lungs. This antibiotic appeared as a very good antistaphylococcal agent. In vitro superiority over gentamicin against Pseudomonas was not be confirmed clinically. Tobramycin deserves to be administered initially in serious infections because of the possibility that the causative organism might be a gentamicin-resistant, tobramycin susceptible strain. Three such cases were observed in our 35 patients. This susceptibility dissociation in favor of tobramycin was demonstrated in two strains of Klebsiella and one strain of Enterobacter. A dosage regimen in patients with impaired renal function is proposed. It requires confirmation.

A nomogram to simplify the determination of pulmonary shunt is presented. It is based on Leigh's et al. shunt-equation (1969). The nomogram aggregates the factors which contribute most to the pulmonary shunt in acute respiratory failure. Arterial and venous oxygen saturation, Hb content, arterial oxygen tension and barometric pressure do influence strongly the result of calculated shuntflow. For the factors with little importance in the calculation (vapor pressure, mixed venous oxygen tension, alveolar-CO2 tension), international mean values are used. The shunt determined with the nomogram deviates less than 1% from the calculated values, if the range of PCO2 is between 32 and 52 mm Hg and the error does not exceed 1,5% with a PCO2 up to 82 mm Hg unless it is combined with a very low Hb and a high mixed venous saturation. By the nomogram the effect of the different parameters on the shunt can be very well illustrated. Especially mistakes in determination of the mixed venous saturation and of arterial O2 tension result in errors. Too high saturation values in mixed venous blood occur in distally located catheters due to pulmonary capillary admixtures. This contamination can be easily detected if the relationship between PVO2 and PACO2 is examined. The other source of error lies in the technical problems of PO2 determination in high ranges and is caused by escape of O2 into the PO2-electrode and O2-consumption of the blood. The end effect which the factors of O2 escape have on the accuracy of PO2 determination in high ranges is demonstrated with blood samples which have been equilibrated with different gas mixtures at different temperatures and had their PO2 measured at regular intervals. The error in PaO2 measurement can be reduced if blood-gas analyses are performed immediately or on cooled samples.

The importance of the method of administration of acid glucose infusions for the venous inflammatory response has been investigated in two series of experimental trials. 60 ml of 5% glucose solution was administered into rabbit-ear veins in three ways: 1) continuously over 5 hours (slow infusion), 2) continuously over 1 hour (rapid infusion), 3) discontinuously during 2 X 30 minutes with an interval of 4 hours (discontinuous infusion). Microscopical examination of the veins revealed that the inflammatory changes were less pronounced after rapid and discontinuous infusions than after slow infusions.

In a patient with acute respiratory failure due to aspiration pneumonia, PaO2 decrease and Qs/Qt increase were observed during continuous positive pressure ventilation. This paradoxical finding was attributted to vascular collapse in well ventilated upper alveoli associated with blood flow redistribution to dependent hypoventilated areas with low ventilation-perfusion relationships.

Cardiopulmonary abnormalities are frequently encountered in myotonic dystrophy. We present five patients with myotonic dystrophy who entered the intensive care unit in acute respiratory failure. The possible etiologic factors of pulmonary complications are reviewed. The most important is probably aspiration pneumonia. The difficulties in the treatment of the respiratory failure are emphasezed. Myotonia of the chest muscles and diaphragm make artificial ventilation difficult. Recovery is delayed chiefly by swallowing disturbances. General anaesthesia is hazardous. Four patients presented cardiac arrhythmias and/or conduction abnormalities which were transient.

An experimental method is presented, which compares the tendency of different infusions to cause thrombophlebitis. It is based ona quantitative histological analysis of the inflammatory changes in the veins of rabbit ears after infusions under standardized conditions. By means of this method the inflammatory changes in the veins have been shown to be significantly less pronounced when the pH of glucose solutions is altered from 3.0 to 3.6. This pH change has been prescribed in the 1971 corrections to Pharmacopoea Nordica 1963. By complete neutralization of 5% glucose a further reduction of the damage to the veins has been obtained. For this purpose phosphate buffer is recommended.

Forty ICU patients were studied as to the prevalence and importance of organic acidaemia. It was observed that organic acidaemia was extremely common, secondly that a persistence of such an acidaemia heralded a poor prognosis and finally that the acidaemia rarely needed treatment in its own right.

Two electrodes placed at the tip of catheters for in vivo determinations of PCO2 and PO2 respectively, were tested in dogs. Results were satisfactory when compared to a highly accurate reference method, correlation coefficients were close to 1 (P less than 10(-9)). Means of the differences were respectively --1.74 +/- 1.14 toor for the PO2 probe (P less than 0.01) and --1.62 +/- 0.72 torr for the PCO2 sensor (P less than 0.0001). While no drift was detected in the PCO2 electrode, that of the PO2 was significant but negligible compared to the variability of measurements. Thus, for PCO2 values between 20 and 85 torr, and PO2 values between 20 and 140 torr, in vivo monitoring is sufficiently reliable for clinical use.

A case is described of accidental inhalation of ethylene imine vapour in a chemical worker. This resulted in glottic oedema which required tracheostomy. Artificial respiration was needed because of failure to maintain adequate arterial oxygen levels. The patient developed profuse salivation and sputum production. Endoscopy showed that the mucosal surfaces of the pharynx, trachea and major bronchi were destroyed. The patient was treated with steroids and antibiotics for pulmonary infection. Recovery was slow but he was eventually able to leave hospital. He was later readmitted with recurrent infection and developed acute airway obstruction from which he died. Post-mortem examination shoed extensive destruction of the mucosal lining with erosion and collapse of the cartilages. This was the cause of death. Previous reports of ethylene imine poisoning are reviewed. This appears to be the third fatal case.

The present state of organization of renal transplant intensive care in 14 centers of Austria, Germany and Switzerland is described. Special reference is given to the annual transplantation rate, the number of intensive care beds, the duration of intensive care, the aseptic conditions, the installations and apparatus, and to the medical supervision and the nursing care.