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  • 1
    Electronic Resource
    Electronic Resource
    Alveolar and plasma concentrations of interleukin-8 and vascular endothelial growth factor following oesophagectomy (2004)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 59 (2004), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The acute respiratory distress syndrome occurs in approximately 10% of all patients undergoing elective oesophagectomy. Local increases in lung pro-inflammatory cytokines have been previously detected in high-risk patients before the development of the acute respiratory distress syndrome. We hypothesised that similar changes would occur following oesophagectomy. Two groups of patients were studied. In the collapsed lung group (n = 11), interelukin-8 and vascular endothelial growth factor were measured in bronchoalveolar lavage samples obtained from the intra-operative collapsed lung after operation. In the ventilated lung group (n = 10), bronchoalveolar lavage was performed after operation from the ventilated lung and cytokines measured. Cytokines were also measured in peripheral blood samples before and after operation. Bronchoalveolar lavage cytokine levels in both lungs were of an order of magnitude greater than in peripheral blood. Pulmonary pro-inflammatory cytokine release occurs following oesphageal surgery and may indicate subclinical lung injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.2004.03672.x
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  • 2
    Electronic Resource
    Electronic Resource
    The need for a regional weaning centre, a one-year survey of intensive care weaning delay in the Northern Region of England〈link href="#fn1-1"〉*〈/link〉 (2003)
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 58 (2003), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Summary Over a period of one year, a weekly telephone survey identified 161 stable patients with weaning delay (defined as patients ventilated for at least 6 h per day for more than 2 weeks) in intensive care units in the Northern Region of England. Their median age was 69 years (range 21–88 years). Sixty patients (37%) were admitted with medical conditions, 89 (55%) were postoperative patients, whereas 12 (8%) were surgical but required non-operative admission. One hundred and thirty (89%) were weaned and discharged from the intensive care unit during the year. Twenty-two (14%) died and two were transferred to the home ventilation service. Seven patients remained ventilated in intensive care at the end of the study period. Twenty patients (12%) required more than 28 days of respiratory support. These patients occupied on average 6.0% of available intensive care unit beds in the region. This study suggests that in the Northern Region of England there are a significant number of stable but ventilator-dependent patients occupying intensive care beds.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1046/j.1365-2044.2003.02964_1.x
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Sleep-related breathing disorders following discharge from intensive care (2000)
    Springer
    Intensive care medicine 26 (2000), S. 426-433 
    Details
    ISSN: 1432-1238
    Keywords: Key words Outcomes ; Hypoxaemia ; Sleep-related breathing disorders ; Obstructive sleep apnoea ; Central sleep apnoea ; Mechanical ventilation ; Complications ; Intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To determine the incidence of sleep-related breathing disorders and nocturnal hypoxaemia in patients discharged from ICU following prolonged mechanical ventilation.¶Design: Prospective, consecutive patient observational study.¶Setting: The medical and surgical wards of a University Hospital.¶Patients and participants: Fifteen consecutive, adult patients discharged from the ICU who had received more than 48 h of mechanical ventilation were studied. Ten healthy volunteers acted as controls.¶Measurements and results: Overnight, multi-channel pneumographic studies were performed on all patients and controls. Chest and abdominal wall movement, air flow, oxygen saturation and snoring were continuously recorded. Data was analysed by both visual inspection of the traces and by computer-based algorithms. An apnoea/hypopnoea index was calculated for each patient and volunteer. Volunteers had an apnoea/hypopnoea index of less than 5 and had no episodes of nocturnal oxygen desaturation (SaO2 〈 90 %). Despite oxygen therapy 13/15 patients had episodes of desaturation and 9/15 spent more than 2 h with an SaO2 〈 90 %. Eleven patients had an abnormal apnoea/hypopnoea index (range 5–34 events/h). Four patients had predominantly obstructive events while 7 primarily had hypopnoeas.¶Conclusions: Significant overnight oxygen desaturation is common in patients discharged from ICU who have received prolonged mechanical ventilation. This group also has a significant incidence of sleep-related breathing disorders and this mechanism is likely to be important in the pathogenesis of the hypoxaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051177
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  • 4
    Electronic Resource
    Electronic Resource
    TISS and mortality after discharge from intensive care (1999)
    Springer
    Intensive care medicine 25 (1999), S. 1061-1065 
    Details
    ISSN: 1432-1238
    Keywords: Key words TISS ; Intensive Care ; Outcomes ; Workload
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To examine the effect of high levels of pre-intensive care unit (ICU) discharge care, as assessed by the Therapeutic Intervention Scoring System (TISS), on subsequent hospital mortality.¶Design: A 1-year prospective, observational study.¶Setting: The ICU and wards of a university teaching hospital with no high dependency facility (HDU).¶Patients: A total of 283 patients were discharged to hospital wards between July 1997 and June 1998.¶Results: 11 % of all ICU discharges subsequently died in hospital. Patients discharged with a TISS of 20 or greater had a 21.4 % mortality compared to 3.7 % for those with a TISS of less than 10. Increasing age, Acute Physiology Score (APS) on admission and male sex were also significantly associated with post-discharge death.¶Conclusions: In a hospital without HDU facilities, patients who are receiving HDU levels of care on discharge from the ICU have a high in-hospital mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051012
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  • 5
    Electronic Resource
    Electronic Resource
    Continuous veno-venous haemofiltration following cardio-pulmonary bypass (1993)
    Springer
    Intensive care medicine 19 (1993), S. 290-293 
    Details
    ISSN: 1432-1238
    Keywords: Acute renal failure ; Cardio-pulmonary bypass ; Haemofiltration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To study the impact of continuous veno-venous haemofiltration on survival in patients with acute renal failure (ARF) following cardio-pulmonary bypass (CPB) surgery. Design A retrospective study of all patients requiring haemofiltration after CPB over a 2 year period. Setting A 20 bedded, adult cardothoracic intensive care unit in a postgraduate teaching hospital. Patients 35 patients (26 male, age range 24–74 years) required haemofiltration (2.7% of the total number of patients undergoing CPB). Main results Cardiovascular failure post CPB was the commonest causes of ARF (n=16). Indications for haemofiltration were ureamia (21), oligo-anuria (11), volume overload (2) and hyperkalaemia (1). Mean time from CPB to the initiation of haemofiltration was 8 days (range 0–15 days). Mean urea was 30 mmol/l and creatinine 362 μmol/l immediately prior to treatment. Urea was well-controlled in all patients, although 2 needed haemodiafiltration. Twenty-six patients died during their admission to the ICU (74% mortality). A further 3 patients died during their hospital admission, following discharge from ICU. Outcome was particularly poor in patients with cardiovascular failure following CPB (16 cases, 0 survivors). Survivors tended to commence filtration earlier (mean of 4 vs 7 days for non-survivors) and required treatment for a mean period of 8 days (range 1–26 days). Survival was determined by the number of failed organ systems at the start of haemofiltration. Thus, 100% of patients with single system failure survived, compared to only 10% with 3 or more system failure. Conclusions Despite the theoretical advantages of haemofiltration and the effective control of uraemia the mortality associated with ARF following CPB remains high and is probably determined by the number of failed organs systems.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01690550
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