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  • 1
    Electronic Resource
    Electronic Resource
    Clinical evaluation of a continuous intra-arterial blood gas system in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1162-1168 
    Details
    ISSN: 1432-1238
    Keywords: Blood gas monitor ; Critical care ; Equipment ; Acute respiratory distress syndrome ; Hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the clinical performance of a new, continuous intra-arterial blood gas monitoring system (CIABG) in abnormal ranges of blood gases, and during episodes of low blood pressure, in critically ill patients. Design Prospective study. Settings Medical ICU, University Hospital. Methods The CIABG system, based on fluorescent dyes, consists of a fiber-optic sensor introduced through an arterial catheter. Twenty-one sensors were evaluated in 15 acutely ill patients. A high failure rate (6/21) was found, due to the brittleness of the fibers. The bias, between CIABG and standard method, and precision were determined for each fiber and for the overall values. Analysis focused on the data collected in patients with arterial oxygen tension (PaO2) values below 75 mmHg, pH lower than 7.35 and arterial carbon dioxide partial pressure (PaCO2) values exceeding 50 mmHg and during episodes of low blood pressure. The accuracy of the CIABG to follow sequential changes in blood gases was studied among the abnormal values. Results Measurements with CIABG among the abnormal values showed biases of +2 mmHg, +0.1 mmHg and +0.005 for PaO2, PaCO2 and pH, respectively, and precisions of 9.0 mmHg, 3.5 mmHg and 0.027, respectively. Bias and precision were not influenced by hemodynamic instability. A substantial difference in the performance of individual CIABG was observed for PaO2 analysis, with 30% of the fibers having a much poorer performance than the others. The sensors were kept in place for 5±2 days and the drift rate per day was 0.005 for pH, 0.6 mmHg for PaCO2 and −1.2 mmHg for PaO2. Conclusion In situations of severe hypoxemia, hypercapnia and acidosis, the agreement between CIABG and arterial blood sampling (ABS) is better for PaCO2 and pH than for PaO2, and is not influenced by episodes of low blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709330
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Intrapleural administration of streptokinase in complicated purulent pleural effusion: A CT-guided strategy (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1351-1353 
    Details
    ISSN: 1432-1238
    Keywords: Empyema ; Pleural ; Computed tomography scan ; Fibrinolytics ; Streptokinase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To determine the usefulness and the results of a strategy using intrapleural streptokinase (SK) instillation guided by repeated computed tomography (CT) scan examinations in pleural empyemas unresponsive to chest tube drainage. Design A retrospective chart review. Setting The medical Intensive Care Unit and Department of Radiology, in a university hospital. Patients Sixteen patients with empyema who had a persistent pleural effusion despite drainage, among 37 patients with infectious pleural effusion. Interventions In the 16 patients, CT examination was performed before and at least once after SK. Intrapleural SK was instilled, either through the chest tube or via a needle puncture, according to the CT scan, results. Results The first CT scan confirmed a persistent effusion in all, showing a multiloculated effusion in 13 patients, and an ectopic loculus in one. The first SK instillation resulted in a dramatic increase of fluid drained per day (from 68±28 ml to 567±262 ml;p〈0.001), leading to complete resolution in 11 patients, while the others required a second CT scanguided procedure. In one, the chest tube was misplaced, while in two, transparietal injection was needed. Finally, a complete resolution was observed in 14 (87.5%) of the patients. Two patients had a poor initial response to SK and were eventually scheduled for video-thoracoscopy. A single episode of chills and fever was observed among 32 SK instillations. Conclusion CT-guided SK instillation in pleural empyema appears to be safe, and allowed complete resolution in 87.5% of our patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709550
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Effects of ventilation in ventral decubitus position on respiratory mechanics in adult respiratory distress syndrome (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1219-1224 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute respiratory failure ; Gas exchange ; Mechanics ; Body position ; Compliance of respiratory system ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the potential benefits of a period of ventilation in ventral decubitus (VD) on oxygenation and respiratory mechanics in the adult respiratory distress syndrome (ARDS). Design: In a stable condition during baseline ventilation in dorsal decubitus (DD), after 15 min of ventilation in VD and after 10 min of restored DD, the following parameters were studied: arterial blood gas tension, haemodynamics and static respiratory compliance (Crs), evaluated with the rapid airway occlusion technique. Setting: The study was completed in the intensive care units of university hospitals as part of the management of the patients studied. Patients: Twelve patients (7 males, 5 females, mean age 51.8 ± 16.6 years) suffering from ARDS of different aetiologies. Interventions: Before and during each evaluation, the patients were kept under stable haemodynamic and metabolic conditions. The ventilatory setting was kept constant. All the patients were sedated, paralysed and mechanically ventilated. Results: A statistically significant increase in the ratio between the arterial partial pressure of oxygen and fractional inspired oxygen (p 〈 0.01) was observed between the baseline conditions (mean 123.9 ± 22.6) and VD (mean 153.0 ± 16.9), while no statistical significance was noted between baseline conditions and after 10 min of restored DD (mean 141.1 ± 19.7). A significant increase in Crs (p 〈 0.001) was observed between baseline conditions (mean 42 ± 10.1) and VD (mean 48.8 ± 9.6) and between baseline conditions and restored DD (mean 44.7 ± 10.6). Two patients were considered non-responders. All the patients were haemodynamically stable. No side effects were noted. Conclusions: We observed an increase in oxygenation and Crs when the patients were turned from the supine to the prone position with the upper thorax and pelvis supported.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050489
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    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    Prevalence, etiologies and outcome of the acute respiratory distress syndrome among hypoxemic ventilated patients (1999)
    Springer
    Intensive care medicine 25 (1999), S. 920-929 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute lung injury ; Acute respiratory distress syndrome ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the prevalence and outcome of the acute respiratory distress syndrome (ARDS) among patients requiring mechanical ventilation. Design: A prospective, multi-institutional, initial cohort study including 28-day follow-up. Settings: Thirty-six French intensive care units (ICUs) from a working group of the French Intensive Care Society (SRLF). Patients: All the patients entering the ICUs during a 14-day period were screened prospectively. Hypoxemic patients, defined as having a PaO2/FIO2 ratio (P/F) of 300 mmHg or less and receiving mechanical ventilation, were classified into three groups, according to the Consensus Conference on ARDS: group 1 refers to ARDS (P/F: 200 mmHg or less and bilateral infiltrates on the chest X-ray); group 2 to acute lung injury (ALI) without having criteria for ARDS (200 〈 P/F ≤ 300 mmHg and bilateral infiltrates) and group 3 to patients with P/F of 300 mmHg or less but having exclusion criteria from the previous groups. Results: Nine hundred seventy-six patients entered the ICUs during the study period, 43 % of them being mechanically ventilated and 213 (22 %) meeting the criteria for one of the three groups. Among all the ICU admissions, ARDS, ALI and group 3 patients amounted, respectively, to 6.9 % (67), 1.8 % (17) and 13.3 % (129) of the patients, and represented 31.5 %, 8.1 % and 60.2 % of the hypoxemic, ventilated patients. The overall mortality rate was 41 % and was significantly higher in ARDS patients than in the others (60 % vs 31 % p 〈 0.01). In group 3, 42 patients had P/F less than 200 mmHg associated with unilateral lung injury; mortality was significantly lower (40.5 %) than in the ARDS group. In the whole group of hypoxemic, ventilated patients, septic shock and severity indices but not oxygenation indices were significantly associated with mortality, while the association with immunosuppression revealed only a trend (p = 0.06). Conclusions: In this survey we found that very few patients fulfilled the ALI non-ARDS criteria and that the mortality of the group with ARDS was high.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050983
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Clinical evaluation of a continuous intra-arterial blood gas system in critically ill patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1162-1168 
    Details
    ISSN: 1432-1238
    Keywords: Key words Blood gas monitor ; Critical care ; Equipment ; Acute respiratory distress syndrome ; Hypotension
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the clinical performance of a new, continuous intra-arterial blood gas monitoring system (CIABG) in abnormal ranges of blood gases, and during episodes of low blood pressure, in critically ill patients. Design: Prospective study. Settings: Medical ICU, University Hospital. Methods: The CIABG system, based on fluorescent dyes, consists of a fiber-optic sensor introduced through an arterial catheter. Twenty-one sensors were evaluated in 15 acutely ill patients. A high failure rate (6/21) was found, due to the brittleness of the fibers. The bias, between CIABG and standard method, and precision were determined for each fiber and for the overall values. Analysis focused on the data collected in patients with arterial oxygen tension (PaO2) values below 75 mmHg, pH lower than 7.35 and arterial carbon dioxide partial pressure (PaCO2) values exceeding 50 mmHg and during episodes of low blood pressure. The accuracy of the CIABG to follow sequential changes in blood gases was studied among the abnormal values. Results: Measurements with CIABG among the abnormal values showed biases of +2 mmHg, +0.1 mmHg and +0.005 for PaO2, PaCO2 and pH, respectively, and precisions of 9.0 mmHg, 3.5 mmHg and 0.027, respectively. Bias and precision were not influenced by hemodynamic instability. A substantial difference in the performance of individual CIABG was observed for PaO2 analysis, with 30% of the fibers having a much poorer performance than the others. The sensors were kept in place for 5±2 days and the drift rate per day was 0.005 for pH, 0.6 mmHg for PaCO2 and –1.2 mmHg for PaO2. Conclusion: In situations of severe hypoxemia, hypercapnia and acidosis, the agreement between CIABG and arterial blood sampling (ABS) is better for PaCO2 and pH than for PaO2, and is not influenced by episodes of low blood pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709330
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 6
    Electronic Resource
    Electronic Resource
    Intrapleural administration of streptokinase in complicated purulent pleural effusion: a CT-guided strategy (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1351-1353 
    Details
    ISSN: 1432-1238
    Keywords: Key words Empyema ; Pleural ; Computed tomography scan ; Fibrinolytics ; Streptokinase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine the usefulness and the results of a strategy using intrapleural streptokinase (SK) instillation guided by repeated computed tomography (CT) scan examinations in pleural empyemas unresponsive to chest tube drainage. Design: A retrospective chart review. Setting: The medical Intensive Care Unit and Department of Radiology, in a university hospital. Patients: Sixteen patients with empyema who had a persistent pleural effusion despite drainage, among 37 patients with infectious pleural effusion. Interventions: In the 16 patients, CT examination was performed before and at least once after SK. Intrapleural SK was instilled, either through the chest tube or via a needle puncture, according to the CT scan results. Results: The first CT scan confirmed a persistent effusion in all, showing a multiloculated effusion in 13 patients, and an ectopic loculus in one. The first SK instillation resulted in a dramatic increase of fluid drained per day (from 68±28 ml to 567±262 ml; p〈0.001), leading to complete resolution in 11 patients, while the others required a second CT scan-guided procedure. In one, the chest tube was misplaced, while in two, transparietal injection was needed. Finally, a complete resolution was observed in 14 (87.5%) of the patients. Two patients had a poor initial response to SK and were eventually scheduled for video-thoracoscopy. A single episode of chills and fever was observed among 32 SK instillations. Conclusion: CT-guided SK instillation in pleural empyema appears to be safe, and allowed complete resolution in 87.5% of our patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709550
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 7
    Electronic Resource
    Electronic Resource
    Intensive care use in a developing country: a comparison between a Tunisian and a French unit (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1144-1151 
    Details
    ISSN: 1432-1238
    Keywords: Key words Simplified Acute Physiology Score ; Omega system ; Severity of illness index ; Workload ; Outcome assessment ; Intensive care unit comparison ; Cost-effectiveness analysis ; Evaluation studies ; Organization ; Quality of care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To compare the variations in intensive care (ICU) outcome in relation to variations in resources utilization and costs between a developed and a developing country with different medical and economical conditions. Design and setting: Prospective comparison between a 26-bed French ICU and an 8-bed Tunisian ICU, both in university hospitals. Patients: Four hundred thirty and 534 consecutive admissions, respectively, in the French and Tunisian ICUs. Measurements: We prospectively recorded demographic, physiologic, and treatment information for all patients, and collected data on the two ICU structures and facilities. Costs and ICU outcome were compared in the overall population, in three groups of severity indexes and among selected diagnostic groups. Results: Tunisian patients were significantly younger, were in better health previously and were less severely ill at ICU admission (p 〈 0.01). French patients had a lower overall mortality rate (17.2 vs 22.5 %; p 〈 0.01) and received more treatment (p 〈 0.01). In the low severity range, the outcome and costs were similar in the two countries. In the highest severity range, Tunisian and French patients had similar mortality rates, while the former received less therapy throughout their ICU stays (p 〈 0.05). Conversely, in the mid-range of severity, mortality was higher among Tunisian patients, and a difference in management was identified in COPD patients. Conclusion: Although the Tunisian ICU might appear more cost-effective than the French one in the highest severity group of patients, most of this difference appeared in relation to shorter lengths of ICU stay, and a poorer efficiency and cost-effectiveness was suggested in the mid-range severity group. Differences in economical constraints may partly explain differences in ICU performances. These results indicate where resource allocation could be directed to improve the efficiency of ICU care.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050737
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 8
    Electronic Resource
    Electronic Resource
    Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1237-1244 
    Details
    ISSN: 1432-1238
    Keywords: Key words Toxic epidermal necrolysis ; Stevens-Johnson syndrome ; Pulmonary complications ; Fiberoptic bronchoscopy ; Bronchial epithelial necrosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate the incidence, clinical features, and prognosis of pulmonary complications associated with toxic epidermal necrolysis Design: Prospective study. Setting: Dermatology intensive care unit in Mondor Hospital, France. Patients: 41 consecutive patients. Interventions: On admission, then daily, respiratory evaluation was based on clinical examination, chest X-ray, and arterial blood gas analysis. When clinical symptoms, X-ray abnormalities, or hypoxemia [partial pressure of oxygen (PO2) 〈 80 mm Hg] were present, fiberoptic bronchoscopy was performed. Results: 10 patients presented early manifestations: dyspnea (n = 10), bronchial hypersecretion (n = 7), marked hypoxemia (n = 10) (PO2 = 59 ± 8 mm Hg). Chest X-ray was normal (n = 8) or showed interstitial infiltrates (n = 2). In these 10 patients, fiberoptic bronchoscopy demonstrated sloughing of bronchial epithelium in proximal airways. Delayed pulmonary complications occurred in 6 of these 10 patients from day 7 to day 15: pulmonary edema (n = 2), atelectasis (n = 1), bacterial pneumonitis (n = 4). Mechanical ventilation was required in 9 patients. A fatal outcome occurred in 7 patients. Seven patients did not develop early pulmonary manifestations (PO2 on admission 87 ± 6 mm Hg) but only delayed pulmonary symptoms related to atelectasis (n = 1), pulmonary edema (n = 4), and bacterial pneumonitis (n = 3); bronchial epithelial detachment was not observed. None of them required mechanical ventilation and all recovered with appropriate therapy. Conclusions:“Specific” involvement of bronchial epithelium was noted in 27 % of cases and must be suspected when dyspnea, bronchial hypersecretion, normal chest X-ray, and marked hypoxemia are present during the early stages of toxic epidermal necrosis. Bronchial injury seems to indicate a poor prognosis, as mechanical ventilation was required for most of these patients and was associated with a high mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050492
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
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