European journal of intensive care medicine最新文献

Right heart catheterisation was undertaken in six patients with accidental deep hypothermia. Studies were carried out before and after rapid blood volume expansion, with and without Isoproterenol infusion, and were repeated at normal body temperatures. The initial haemodynamic pattern indicated a marked hypovolemia with a simultaneous decrease of both cardiac output and ventricular filling pressures, and a decreased measured total blood volume. Rapid correction of the hypovolemia revealed cardiac insufficiency, in part due to the persisting bradycardia. Left ventricular function was depressed in patients with prolonged cold exposure and normal in patients with short exposure. These abnormalities disappeared after Isoproterenol infusion during hypothermia, and spontaneously after return to normothermia. No imbalance existed between the decreased cardiac output and oxygen uptake in hypothermia, arterio-venous oxygen difference being within normal limits.

In a study on 29 patients for 152 hours a continuous monitoring system has been shown to have a reliability of 90.53% for pulse rate and 82.20% for arterial blood pressure, but for approximately half of the period of unreliable monitoring a not obviously artifactual reading was being displayed. The relevance of this to possible incorrect diagnosis and management is discussed. The monitor and a nurse using traditional chart keeping methods gave equivalent charts with respect to average levels and trends, but the monitor assisted chart showed a much greater variability. The latter tended to obscure underlying trends and render clinical diagnosis from the chart more difficult.

During eight post-traumatic days, the blood loss and severity of trauma were correlated with the blood levels of lactate, creatinine and catecholamines in 45 patients with multiple blunt injuries. During two days these biochemical indicators correlated with the extent of thoracoabdominal, pelvic and cerebral injuries. In the critically injured patients all three parameters were elevated throughout the observation period. No correlations were observed between plasma catecholamines and lower limb injuries, which seems to make the importance of catecholamines for predicting the onset of fat embolism syndrome less useful.

Epidural analgesia can be the choice of therapy for all patients with ribfractures and only minor coexisting injuries who are conscious and able to cooperate. In these cases we believe that EA is equivalent or even better than artificial ventilation with all its problems. Generally these patients are far easier to handle and one needs less nursing staff. The dignity of the patients can be maintained and the convalescent time in the intensive care unit is shorter. The criteria for the treatment and for measuring the progress of the patients with multiple ribfractures are discussed.

The development of pediatric intensive medicine in the past 10 years has today made it possible to carry out specific longterm infusion therapy even in severely ill newborn and premature infants. The present study discusses the various technical possibilities and indications for the introduction of a caval catheter in newborn and premature infants. Although we only used a caval catheter for longterm parenteral nutrition in 9 newborn infants from 1965 to 1969, improved techniques have enabled us over the past 2 years to choose this method in 43 newborn and premature infants presenting with a wide variety of clinical conditions. We conclude that the use of caval catheters still requires a very strong indication.