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  • 1
    Electronic Resource
    Electronic Resource
    Quadrupole mass spectrometry and mass-resolved time-of-flight velocity spectrometry of water cluster beams
    Amsterdam : Elsevier
    Surface Science 106 (1981), S. 178 
    Details
    ISSN: 0039-6028
    Source: Elsevier Journal Backfiles on ScienceDirect 1907 - 2002
    Topics: Physics
    Type of Medium: Electronic Resource
    URL: http://linkinghub.elsevier.com/retrieve/pii/0039-6028(81)90198-9
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  • 2
    Electronic Resource
    Electronic Resource
    Measurement of cardiac output by transesophageal echocardiography in mechanically ventilated patients (1997)
    Springer
    Intensive care medicine 23 (1997), S. 753-759 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiac output ; Thermodilution ; Transesophageal echocardiography ; Arterial-venous oxygen content difference
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The determination of basal cardiac output (CO) and of its variations during different therapeutic interventions liable to increase or decrease it in mechanically ventilated patients using transesophageal echocardiography (TEE). Design: To compare CO measurements simultaneously obtained by transmitral single-plane TEE and thermodilution. Setting: Medical intensive care unit. Patients: Twenty-two consecutive mechanically ventilated patients hospitalized for various medical conditions were included. Interventions: The comparisons between transmitral single-plane TEE and thermodilution measurements were made at baseline and after different therapeutic interventions affecting CO (fluids or dobutamine infusion or positive end-expiratory pressure titration). Measurements: Seventy-four measurements were obtained. Cardiac output using TEE was the product of the mitral valve area, the time-velocity integral of flow at the same site and the heart rate. Results: A significant correlation was observed between thermodilution and TEE measurements of CO (n = 74, r = 0.78, p 〈 0.001) despite wide limits of agreement (mean ± 2SD = –0.3 ± 3.1 l/min). Thermodilution and TEE CO determinations both had significant inverse correlation with the arterial-venous oxygen content difference in ten consecutive patients (r = 0.77, p 〈 0.01 and r = 0.71, p 〈 0.01, respectively). The correlation between variations of CO greater than 20 % obtained by thermodilution and TEE was significant (r = 0.89, p 〈 0.001). The operative characteristics implied the ability of TEE to predict significant variations of thermodilution CO (sensitivity 85 % and negative predictive values 86 %). Moreover, arterial-venous oxygen content difference changes of 5 % or more were better detected using TEE than thermodilution. Conclusions: These results suggest that although transesophageal CO measurements cannot replace thermodilution ones, the determination of CO variations obtained using TEE may be useful in the management of critically ill mechanically ventilated patients. This technique may make it possible to monitor hemodynamics during initial therapeutic interventions in those patients in whom right heart catheterization cannot be performed immediately.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050405
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  • 3
    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
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  • 4
    Electronic Resource
    Electronic Resource
    The American-European Consensus Conference on ARDS, Part 2 (1998)
    Springer
    Intensive care medicine 24 (1998), S. 378-398 
    Details
    ISSN: 1432-1238
    Keywords: Key words Adult respiratory distress syndrome ; Acute lung injury ; Mechanical ventilation ; Pharmacologic therapy ; Lung remodeling ; Supportive care ; Coordination
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The acute respiratory distress syndrome (ARDS) continues as a contributor to the morbidity and mortality of patients in intensive care units throughout the world, imparting tremendous human and financial costs. During the last ten years there has been a decline in ARDS mortality without a clear explanation. The American-European Consensus Committee on ARDS was formed to re-evaluate the standards for the ICU care of patients with acute lung injury (ALI), with regard to ventilatory strategies, the more promising pharmacologic agents, and the definition and quantification of pathological features of ALI that require resolution. It was felt that the definition of strategies for the clinical design and coordination of studies between centers and continents was becoming increasingly important to facilitate the study of various new therapies for ARDS.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050585
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  • 5
    Electronic Resource
    Electronic Resource
    Barotrauma is volutrauma, but which volume is the one responsible? (1992)
    Springer
    Intensive care medicine 18 (1992), S. 139-141 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709236
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  • 6
    Electronic Resource
    Electronic Resource
    From ventilator-induced lung injury to multiple organ dysfunction? (1998)
    Springer
    Intensive care medicine 24 (1998), S. 102-104 
    Details
    ISSN: 1432-1238
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050529
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  • 7
    Electronic Resource
    Electronic Resource
    Does the stress of admission to an intensive care unit influence arginine vasopressin secretion and renal diluting ability? (1990)
    Springer
    Intensive care medicine 16 (1990), S. 323-327 
    Details
    ISSN: 1432-1238
    Keywords: Arginine vasopressin ; Renal diluting ability ; Stress
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The pathogenesis of excessive arginine vasopressin (AVP) release and hyponatraemia in euvolaemic intensive care unit (ICU) patients is poorly understood. Stress has frequently been proposed as a possible determinant, but its actual responsibility has not been adequately assessed. Therefore, water-load tests were prospectively performed in 11 patients admitted to the ICU for severe or potentially severe diseases, but who had no other condition which could result in excessive AVP release or impairment of renal diluting ability. Renal diluting ability was normal in 9 patients. Two patients exhibited very slight defects, which might be the consequence of subclinical haemodynamic alterations, since one had a pulmonary embolism and the other manifested a gastrointestinal haemorrhage just after the completion of the water load. Nevertheless, plasma AVP levels decreased in response to the water load in all the patients, resulting in a significant decrease in mean values. Plasma norepinephrine values were found to be elevated both before and after water loading. A highly significant correlation existed between the levels of norepinephrine and those of AVP measured before the load, but was lost after it. In addition, norepinephrine values were markedly elevated in two patients who exhibited strictly normal renal diluting abilities, and no correlation was found between plasma norepinephrine values and any parameter of renal water excretion. Our study shows that the stress of a serious illness and of admission to an ICU does not seem to interfere, by itself, with osmotic regulation of AVP secretion and renal diluting ability, and that sympathetic activation is not, under such circumstances, a predominant stimulus for AVP release. Caution is advisable before attributing to medical stress alone the responsibility for hyponatraemia in ICU patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01706358
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  • 8
    Electronic Resource
    Electronic Resource
    Is penicillin G an adequate initial treatment for aspiration pneumonia? (1993)
    Springer
    Intensive care medicine 19 (1993), S. 279-284 
    Details
    ISSN: 1432-1238
    Keywords: Aspiration pneumonia ; Protected specimen brush ; Antibiotics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate the bacteriology of early aspiration pneumonia using a protected specimen brush and quantitative culture techniques, and whether penicillin G is adequate as initial treatment pending culture results. Patients and methods 52 patients (of which 45 required mechanical ventilation) meeting usual clinical criteria for aspiration pneumonia were prospectively included. On admission, patients were given intravenous penicillin G and a protected specimen brush was performed ≤48 h after. Results Cultures of the brush were negative (〈103 CFU/ml) in 33 patients (1 had blood cultures positive withS. pneumoniae) and positive (≥103 CFU/ml) forS. pneumoniae in 2 patients. Seventeen patients had a positive culture (≥103 CFU/ml) for at least one penicillin G resistant microorganism, with a total of 20 organisms (S. aureus: 6;H. influenzae: 2;Enterobacteriaceae: 8;P. aeruginosa: 3;C. albicans: 1). In 4 of these patients, a penicillin-sensitive pathogen was also recovered in significant concentrations (S. pneumoniae: 2;Streptococcus sp.: 2). These 17 patients with a resistant pathogen did not differ from the 35 other patients with respect to need for ventilatory support and mortality rate. By contrast, they were older (61.1±21.9 vs 42.9±18.8 years;p〈0.005) and required longer mechanical ventilation (6.1±4.6 vs. 3.5±2.7 days;p〈0.03) and hospitalization (11.2±8.8 vs. 6.7±4.7 days;p〈0.02). Of 17 patients 12 with penicillin G resistant organisms versus 0/35 without, were in-hospital patients and/or had a digestive disorder (p〈0.001). Conclusion The broad range of offending organisms seen in early aspiration pneumonia precludes use of any single empiric regimen, making protected specimen brush mandatory in many patients. Nevertheless, the involvement ofS. pneumoniae in a notable proportion of our patients suggests that routine penicillin prophylaxis after early aspiration (at least in most patients with community-acquired aspiration) is warranted given the potential severity of pneumococcal sepsis in such patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01690548
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