Library

X
feed icon rss

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    Electronic Resource
    Electronic Resource
    Limitation of life support: Frequency and practice in a London and a Cape Town intensive care unit (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1020-1025 
    Details
    ISSN: 1432-1238
    Keywords: Critical care ; Ethics ; Resuscitation orders ; Advance directives ; Life support withdrawal ; Prognosis ; Severity of illness index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. Design Prospective survey. Ethical approval was obtained. Setting ICUs in tertiary centres in London and Cape Town. Patients All patients who died or had life support limited. Interventions Data collection only. Results There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 354 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p=0.6) of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p=0.014) and mean APACHE II scores 18.5 and 22.6 (p=0.19) respectively. The most common reason for limiting therapy in both centres was multiple organ failure. Both medical and nursing staff were involved in most decisions, which were only implemented once wide consensus had been reached and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn. The mean time from admission to the decision to limit therapy was 11.2 days in London and 9.6 days in Cape Twon. The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively. Conclusions Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699222
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Limitation of life support: frequency and practice in a London and a Cape Town intensive care unit (1996)
    Springer
    Intensive care medicine 22 (1996), S. 1020-1025 
    Details
    ISSN: 1432-1238
    Keywords: Key words Critical care ; Ethics ; Resuscitation orders ; Advance directives ; Life support withdrawal ; Prognosis ; Severity of illness index
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To examine the frequency of limiting (withdrawing and withholding) therapy in the intensive care unit (ICU), the grounds for limiting therapy, the people involved in the decisions, the way the decisions are implemented and the patient outcome. Design: Prospective survey. Ethical approval was obtained. Setting: ICUs in tertiary centres in London and Cape Town. Patients: All patients who died or had life support limited. Interventions: Data collection only. Results: There were 65 deaths out of 945 ICU discharges in London and 45 deaths out of 354 ICU discharges in Cape Town. Therapy was limited in 81.5% and 86.7% respectively (p=0.6) of patients who died. The mean ages of patients whose therapy was limited were 60.2 years and 51.9 years (p=0.014) and mean APACHE II scores 18.5 and 22.6 (p=0.19) respectively. The most common reason for limiting therapy in both centres was multiple organ failure. Both medical and nursing staff were involved in most decisions, which were only implemented once wide consensus had been reached and the families had accepted the situation. Inotropes, ventilation, blood products, and antibiotics were most commonly withdrawn. The mean time from admission to the decision to limit therapy was 11.2 days in London and 9.6 days in Cape Town. The times to outcome (death in all patients) were 13.2 h and 8.1 h respectively. Conclusions: Withdrawal of therapy occurred commonly, most often because of multiple organ failure. Wide consensus was reached before a decision was made, and the time to death was generally short.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01699222
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Adult respiratory distress syndrome following cardiopulmonary bypass: incidence and prediction (1992)
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 47 (1992), S. 0 
    Details
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The outcome of adult respiratory distress syndrome complicating cardiopulmonary bypass has changed little in recent years. A retrospective, case-controlled study was designed to assess the incidence of the adult respiratory distress syndrome in these circumstances and the extent to which it could be linked with pre and peri-operative predictive factors. Eleven patients who developed the syndrome out of 840 who underwent cardiopulmonary bypass over a 9 month period were compared with 53 controls matched for sex, operation and surgeon. The incidence of adult respiratory distress syndrome and its mortality were 1.3% and 53% respectively. Significant predictors were a high intra and postoperative intervention score, the total volume of blood pumped during bypass (〉300 l) and age (〉60 years). These risk factors should alert the clinician to the possibility of severe postoperative pulmonary complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb02134.x
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 4
    facet.materialart.
    Unknown
    An individual action-research method for intensive exploration of adaptive difficulties in the prepuberty stage (1964)
    Provincetown, Mass., etc. : Periodicals Archive Online (PAO)
    Journal of Psychology. 58 (1964) 439 
    Details
    ISSN: 0022-3980
    Topics: Psychology
    URL: http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&res_dat=xri:pao:&rft_dat=xri:pao:article:1140-1964-058-00-000051
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Blood lactate and mixed venous-arterial PCO2 gradient as indices of poor peripheral perfusion following cardiopulmonary bypass surgry (1991)
    Springer
    Intensive care medicine 17 (1991), S. 320-324 
    Details
    ISSN: 1432-1238
    Keywords: Blood lactate ; Acid base balance ; Cardiopulmonary bypass
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Conventional indices of tissue perfusion after surgery involving cardiopulmonary bypass (CPB) may not accurately reflect disordered cell metabolism. Venous hypercarbia leading to an increased veno-arterial difference in CO2 tensions (V-aCO2 gradient) has been shown to reflect critical reductions in systemic and pulmonary blood flow that occur during cardiorespiratory arrest and septic shock. We therefore measured plasma lactate levels and V-aCO2 gradients in 10 patients (mean age 57.2 years) following CPB and compared them with conventional indices of tissue perfusion. Plasma lactate levels, cardiac index (CI) and oxygen uptake $$(\dot VO_2 )$$ all increased significantly (p〈0.05 vs baseline levels) up to 3h following surgery. Oxygen delivery $$(\dot DO_2 )$$ did not change. Plasma lactate levels correlated significantly with CI (r=0.47,p〈0.01). V-aCO2 fell significantly with time (p〈0.01 vs baseline). There was an inverse relationship between V-aCO2 and cardiac index and V-aCO2 and lactate (r=−0.37,p〈0.05;r=−0.3,p〈0.05 respectively). We conclude that blood lactate, CI and $$\dot VO_2 $$ increase progressively following CPB. An increase in lactate was associated with a decrease in V-aCO2. An increase in V-aCO2 was not therefore associated with evidence of inadequate tissue perfusion as indicated by an increased blood lactate concentration.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01716189
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 6
    Electronic Resource
    Electronic Resource
    The use of radionuclide techniques in the assessment of alveolar-capillary membrane permeability on the intensive care unit (1990)
    Springer
    Intensive care medicine 16 (1990), S. 363-371 
    Details
    ISSN: 1432-1238
    Keywords: Intensive care ; Radionuclides ; Lung injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusion Three isotopic methods of estimating alveolar-capillary membrane permeability have been described. The first, radiolabelled HSA, is crude, and appears to have no clinical applications. Pulmonary99mTc-DTPA clearance studies are relatively easy to perform, but suffer from their high sensitivity and variations in technique from centre to centre. The double isotopic measurement of PAI has only been adopted by a few centres, but may offer reliable assessment of the pulmonary endothelial permeability which is probably an early marker of acute lung injury. None of these techniques has proved predictive of outcome in ARDS. However, trials where alveolar-capillary membrane permeability is assessed before clinical evidence of lung injury is apparent have yet to be conducted. Thus at present, methods of assessing alveolar-capillary membrane permeability, particularly capillary endothelial integrity, may prove to be more useful in monitoring new therapeutic interventions in lung injury, rather predicting outcome.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01735173
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 7
    Electronic Resource
    Electronic Resource
    Acute renal failure following cardiopulmonary bypass: a changing picture (2000)
    Springer
    Intensive care medicine 26 (2000), S. 565-571 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiopulmonary bypass ; Acute renal failure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the incidence of acute renal failure (ARF) developing perioperatively in adult patients requiring cardiopulmonary bypass surgery (CPB) and to make comparisons with data from the same institution published earlier. Design: Prospective, observational. Setting: Tertiary referral centre for cardiopulmonary medicine. Patients and participants: All patients admitted to the intensive care unit (ICU) who developed ARF perioperatively necessitating continuous veno-venous haemofiltration (CVVH) during the 24 months January 1997–December 1998. Interventions: None. Measurements and results: Of 2337 adult patients undergoing cardiac surgery, 47 (2.0 %) needed CVVH. Patients were excluded from analysis who underwent cardiac transplantation (n = 4), pericardial surgery (n = 3) or insertion of a left ventricular assist device (n = 1). Of the remaining 39, 21 patients died in ICU (53.8 % mortality). Relatively more non-survivors suffered from diabetes, hypertension and preoperative renal dysfunction. A previous report from our Unit revealed that, in 1989–90, 2.7 % of all patients undergoing CPB required CVVH with an in-hospital mortality of 83 %. The current study population were older (65.3 vs 56.0 years in 1990), and more severely ill as evidenced by a higher percentage of patients requiring redo (30 % vs 8.6 % in 1990) and emergency (50 % vs 25.7 % in 1990) surgery. Conclusions: The need for CVVH following CPB may be diminishing despite increased risk factors. ARF-associated mortality in these circumstances is falling.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051205
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 8
    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
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 9
    Electronic Resource
    Electronic Resource
    Horizontal transport of the regolith, modification of features, and erosion rates on the lunar surface (1975)
    Springer
    Earth, moon and planets 13 (1975), S. 67-79 
    Details
    ISSN: 1573-0794
    Source: Springer Online Journal Archives 1860-2000
    Topics: Geosciences , Physics
    Notes: Abstract New lunar soils, freshly deposited as impact ejecta, evolve into more mature soils by a complex set of processes involving both near-surface effects and mixing. Poor vertical mixing statistics and interregional exchange by impact ejection complicate the interpretation of soil maturization. Impact ejecta systematics are developed for the smaller cratering events which, with cumulative crater populations observed in young mare regions and on Copernicus ejecta fields, yield rates and a range distribution for the horizontal transport of material by impact processes. The deposition rate for material originating more than 1 m away is found to be about 8 mm m.y.−1 Material from 10 km away accumulates at a rate of about 0.08 mm m.y.−1, providing a steady influx of foreign material. From the degradation of boulder tracks, a rate of 5±3 cm m.y.−1 is computed for the filling of shallow lunar depressions on slopes. Mass wastage and downslope movement of bedrock outcroppings on Hadley Rille seems to be proceeding at a rate of about 8 mm m.y.−1 The Camelot profile is suggestive of a secondary impact feature.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00567508
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 10
    Electronic Resource
    Electronic Resource
    Cosmic ray exposure ages of features and events at the apollo landing sites (1975)
    Springer
    Earth, moon and planets 13 (1975), S. 259-276 
    Details
    ISSN: 1573-0794
    Source: Springer Online Journal Archives 1860-2000
    Topics: Geosciences , Physics
    Notes: Abstract Cosmic ray exposure ages of lunar samples have been used to date surface features related to impact cratering and downslope movement of material. Only when multiple samples related to a feature have the same rare gas exposure age, or when a single sample has the same81Kr-Kr and track exposure age can a feature be considered reliably dated. Because any single lunar sample is likely to have had a complex exposure history, assignment of ages to features based upon only one determination by any method should be avoided. Based on the above criteria, there are only five well-dated lunar features: Cone Crater (Apollo 14) 26 m.y., North Ray Crater (Apollo 16) 50 m.y., South Ray Crater (Apollo 16) 2 m.y., the emplacement of the Station 6 boulders (Apollo 17) 22 m.y., and the emplacement of the Station 7 boulder (Apollo 17) 28 m.y. Other features are tentatively dated or have limits set on their ages: Bench Crater (Apollo 12) ⩽99 m.y., Baby Ray Crater (Apollo 16) ⩽2 m.y., Shorty Crater (Apollo 17) ≈ 30 m.y., Camelot Crater (Apollo 17) ⩽140 m.y., the emplacement of the Station 2 boulder 1 (Apollo 17) 45–55 m.y., and the slide which generated the light mantle (Apollo 17) ⩾50 m.y.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00567518
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...