Intensive Care Medicine
Công bố khoa học tiêu biểu
* Dữ liệu chỉ mang tính chất tham khảo
Sắp xếp:
Outcome of long-stay intensive care patients
Intensive Care Medicine - Tập 27 - Trang 779-782 - 2001
Objectives: To assess the numbers, characteristics and outcome for patients requiring long-term intensive care. Design and setting: Observational cohort study in 23 Scottish intensive care units over a 3-year period. Patients and participants: 323 patients with an ICU stay of 30 days or more. Measurements and results: Although representing only 1.6% of patients, those with long stays occupied 15.7% of bed-days. Hospital survival among these patients was 59.9%. With the available data it was not possible to discriminate survivors from non-survivors. Conclusions: Since these patients have a relatively high hospital survival, resources should not be withheld from them on the basis of prolonged ICU stay alone, even in countries with limited ICU provision.
Intratracheal administration of fentanyl: Pharmacokinetics and local tissue effects
Intensive Care Medicine - Tập 22 - Trang 129-133 - 1996
To study the pharmacokinetics and local tissue effects resulting from the intratracheal administration of preservative-free fentanyl. Prospective, randomized, blinded and controlled animal study. University research laboratory. Eighteen adult male New Zealand rabbits. Preservative-free fentanyl citrate or normal saline was administered by the intratracheal (i.t.) and intravenous (i.v.) routes to randomized groups of rabbits. The animals were killed at 24, 48 and 72 h following administration. Plasma concentrations of fentanyl were measured before administration and at 2, 5, 10, 30, 60 and 120 min following administration by a specific radioimmunoassay. A detailed histological examination of the lung and tracheal tissue was performed to identify local side effects. There were no significant differences in the plasma fentanyl concentrations resulting from the i.v. or i.t. route of administration. In both groups, the concentrations of fentanyl were within the therapeutic range (i.t. 2.37 ng/ml, i.v. 2.53 ng/ml) by 2 min after injection and reached a maximum concentration within 5 min. The bioavailability of i.t. fentanyl was 71%. Microscopic examination of the respiratory system did not show significant differences between the two random groups overall. However, in the sub-group of animals killed at 24 h, more animals in the i.t. group showed signs of inflammation in the lung parenchyma. There is rapid absorption of fentanyl following i.t. administration. Pharmacokinetic parameters for fentanyl were not significantly altered by the route of administration. Although there were no signs that i.t. administration of preservative-free fentanyl produces lung injury, a transient and mild inflammatory response was detected at 24 h after administration
Electron-microscopic description of accretions occurring on tips of infected and non-infected central venous catheters
Intensive Care Medicine - Tập 18 - Trang 464-468 - 1992
The purpose of the study was do describe the architecture of accretions occurring on the tips of central venous catheters (CVC). A conservative procedure was used followed by two different techniques of electron microscopy the study included 19 catheters which have been used on intensive cared adults, and which were chosen among those of parallel 300 CVC study. CVC were considered sterile, contaminated, colonized or infected according to microbiological and clinical criteria. CVC were found to remain much cleaner than in past clescriptions. When present, accretions were located on the olive-shaped end, and displayed stratified structures with three types of material: amorphous material, thrombus components and inflammatory cells. Bacteria were not seen, even on culture positive CVC.
Candida albicans was found on one CVC in the cytoplasm of ganulocytes, and made xio direct contact with the plastic surface. This technique should contribute to the understanding of the pathobiology of CVC infection and provide information proving or precluding the involvement of microbial adherence to polymers in vivo.
End-of-life decisions in intensive care units: attitudes of physicians in an Italian urban setting
Intensive Care Medicine - Tập 29 - Trang 1902-1910 - 2003
To assess the attitudes of physicians in Milan, Italy, intensive care units (ICUs) regarding end-of-life decisions. Anonymous self-administered questionnaire. All 20 ICUs in Milan. Physicians employed in the ICUs. The response rate was 87% (225 of 259). Eighty-two percent of respondents estimated that <10% of deaths in their ICU followed foregoing treatment, whereas 6% estimated that more of 25% deaths followed foregoing treatment. Male gender, long professional experience, and activity mainly in the ICU were significantly associated with greater willingness to forego life-sustaining treatments. Eighty-nine percent of respondents said ethical consultation on end-of-life decisions was never sought; 58% said they would not respect the expressed desire of the patient to forego treatment; and 48% never noted the decision to forgo treatment on the clinical record. After a decision to withdraw treatment, 31% of physicians said they maintained ongoing treatment, but withheld CPR for cardiac arrest; 47% considered withholding and withdrawing life support were not ethically equivalent. Most physicians considered that most ICU deaths were not the result of deliberately foregoing life support. Although the overall trend was to intervene minimally in patients' dying, individual factors significantly influenced end-of-life decisions. Few physicians sought external ethical advice and decisions were entirely taken by the medical team. Direct involvement of family and treating physician was limited, and the expressed wishes of the patient were generally ignored.
Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial
Intensive Care Medicine - Tập 43 - Trang 1637-1647 - 2017
We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline variables were reasonably balanced between the two groups. The EGDN group had less negative energy (p < 0.001) and protein (p < 0.001) balances in the ICU as compared to the standard of care group. The PCS score at 6 months did not differ between the two groups (mean difference 0.0, 95% CI −5.9 to 5.8, p = 0.99); neither did mortality, rates of organ failures, serious adverse reactions or infections in the ICU, length of ICU or hospital stay, or days alive without life support at 90 days. EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients.
Clinicaltrials.gov identifier no. NCT01372176.
Recommendations for infection management in patients with sepsis and septic shock in resource-limited settings
Intensive Care Medicine - Tập 42 - Trang 2040-2042 - 2016
International guideline development for the determination of death
Intensive Care Medicine - Tập 40 - Trang 788-797 - 2014
This report summarizes the results of the first phase in the development of international guidelines for death determination, focusing on the biology of death and the dying process, developed by an invitational forum of international content experts and representatives of a number of professional societies. Precise terminology was developed in order to improve clarity in death discussion and debate. Critical events in the physiological sequences leading to cessation of neurological and/or circulatory function were constructed. It was agreed that death determination is primarily clinical and recommendations for preconditions, confounding factors, minimum clinical standards and additional testing were made. A single operational definition of human death was developed: ‘the permanent loss of capacity for consciousness and all brainstem functions, as a consequence of permanent cessation of circulation or catastrophic brain injury’. In order to complete the project, in the next phase, a broader group of international stakeholders will develop clinical practice guidelines, based on comprehensive reviews and grading of the existing evidence.
Teaching difficult airway management: is virtual reality real enough?
Intensive Care Medicine - - 2005
Meprobamate poisoning, hypotension and the swan-ganz catheter
Intensive Care Medicine - Tập 14 - Trang 437-438 - 1988
A case is described in which voluntary ingestion of 72 g meprobamate (mpb) was complicated by shock ascribed to cardiac failure and vasodilation, documented by hemodynamic monitoring. Forced diuresis and cardiac inotropic support were added to the therapy. We recommend Swan-Ganz monitoring in any case of mpb overdosage associated with hypotension and suggest that forced diuresis is not contraindicated if appropriate assessment of the patient's hemodynamic condition is performed.
Infection management in patients with sepsis and septic shock in resource-limited settings
Intensive Care Medicine - Tập 42 - Trang 2117-2118 - 2016
Tổng số: 9,200
- 1
- 2
- 3
- 4
- 5
- 6
- 10