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  • 1
    Electronic Resource
    Electronic Resource
    The acute respiratory distress syndrome: Definitions, severity and clinical outcome An analysis of 101 clinical investigations (1996)
    Springer
    Intensive care medicine 22 (1996), S. 519-529 
    Details
    ISSN: 1432-1238
    Keywords: ARDS ; Severity ; Outcome ; Oxygenation index ; Ventilatory support
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To determine possible changes in outcome from acute respiratory distress syndrome (ARDS) and to compare severity of lung injury and methods of treatment from 1967 to 1994. Data sources Computerized (Medline, Current Contents) and manual (Cumulated Index Medicus) literature search using the key word and/or title ARDS. Study selection Only clinical studies published as full papers reporting data on both patient mortality (survival) and oxygenation index (PaO2/FIO2) were included. Single case reports, abstracts, reviews and editorials were excluded from evaluation. Data extraction Relevant data were extracted in duplicate, followed by quality checks on approximately 80% of data extracted. Data synthesis 101 papers reporting on 3264 patients were included: 48 studies (2207 patients) were performed in the USA, 43 studies (742 patients) in Europe and 10 studies (315 patients) elsewhere. Mortality reported in these studies was 53±22% (mean±SD), with no apparent trend towards a higher survival (1994: 22 studies, mortality 51±19%). The mean PaO2/FIO2 ratio remained unchanged throughout the observation period (118±47 mmHg). No correlation could be established between outcome and PaO2/FIO2 or lung injury score. Patients who underwent pressure-limited ventilation had a significantly lower mortality (35±20%) than patients on volume-cycled ventilation (54±22%) or patients for whom there was no precise information on ventilatory support (59±19%). Significantly lower PaO2/FIO2 ratios (61±17 mmHg) were observed in patients prior to extracorporeal lung assist, together with mortality rates in the range of those for conventionally treated patients (55±22%). Conclusions The mortality of ARDS patients remained constant throughout the period studied. Therefore, the standard for outcome in ARDS should be a mortality in the 50% range. Neither PaO2/FIO2 ratio nor lung injury score was a reliable predictor for outcome in ARDS. Patients might benefit from pressure-limited ventilatory support, as well as extracorporeal lung assist. Since crucial data were missing in most clinical studies, thus preventing direct comparison, we emphasize the importance of using standardized definitions and study entry criteria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708091
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Reply (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1289-1289 
    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/s001340050505
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Antioxidant status in patients with acute respiratory distress syndrome (1999)
    Springer
    Intensive care medicine 25 (1999), S. 180-185 
    Details
    ISSN: 1432-1238
    Keywords: Key words ARDS ; Antioxidants ; Vitamins ; Selenium ; Acute lung injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Reactive oxygen species (ROS) have been implicated in the pathophysiology of ARDS. We investigated the pattern of antioxidants in plasma and ROS production by neutrophils in patients with ARDS over 6 days. Design: Observational study. Blood samples were taken when the diagnosis was made (D0) and after 3 (D3) and 6 days (D6) during therapy. Setting: Intensive care units at a University Hospital. Patients: Eight patients with ARDS were investigated, 17 healthy volunteers served as controls. Measurements and results: Plasma levels of ascorbate, α-tocopherol, retinol, β-carotene, selenium and lipid peroxidation products (MDA) were determined and the activities of the antioxidative enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione-peroxidase (GSH-PX) in erythrocytes were measured. In addition, ROS production (superoxide anion and hydrogen peroxide) in activated neutrophils was assessed. Plasma levels of α-tocopherol, ascorbate, β-carotene and selenium were reduced from the onset of illness. MDA plasma levels were increased throughout the illness. ROS generation from neutrophils was normal on D0 and decreased to D6 in ARDS patients. Conclusion: The antioxidative system is severely compromised in patients with ARDS. Plasma levels of α-tocopherol, ascorbate, β-carotene and selenium are decreased. Elevated MDA levels provide further evidence of massive oxidative stress. The routine replacement of micronutrients according to recommended daily allowances was inadequate to compensate for the increased requirements.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050813
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  • 4
    Electronic Resource
    Electronic Resource
    Prognostic performance and customization of the SAPS II: results of a multicenter Austrian study (1999)
    Springer
    Intensive care medicine 25 (1999), S. 192-197 
    Details
    ISSN: 1432-1238
    Keywords: Key words Severity of illness ; Outcome ; Customization ; Mortality prediction ; Uniformity ; of fit ; SAPS II
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To evaluate the prognostic performance of the original Simplified Acute Physiology Score (SAPS) II in Austrian intensive care patients and to evaluate the impact of customization. Design: Analysis of the database of a multicenter study. Setting: Nine adult medical, surgical, and mixed intensive care units (ICUs) in Austria. Patients: A total of 1733 patients consecutively admitted to the ICUs. Measurements and results: The database included admission data, SAPS II, length of stay, and hospital mortality. The Hosmer–Lemeshow goodness-of-fit test for the SAPS II showed a lack of uniformity of fit (H = 89.1, 10 df, p 〈 0.0001; C = 91.8, 10 df, p 〈 0.0001). Subgroup analysis showed good performance in patients with cardiovascular (medical and surgical) diseases as the primary reasons for admission. A new predictive equation was derived by means of the logistic regression. Goodness-of-fit was excellent for the customized model (SAPS IIAM) (H = 11.2, 9 df, p = 0.33, C = 11.6, 9 df, p = 0.24). The mean standardized mortality ratio (SMR) changed from 0.81 ± 0.26 to 0.93 ± 0.29 with customization. Conclusions: SAPS II was not well calibrated when applied to all patients. However, it performed well for patients with cardiovascular diseases as the primary reason for admission and may thus be applied to these patients. Standardized mortality ratios that are calculated from scoring systems without known calibration must be viewed with skepticism.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050815
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Improved outcome of ARDS patients: are we really performing better? (1999)
    Springer
    Intensive care medicine 25 (1999), S. 887-889 
    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/s001340050975
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    The acute respiratory distress syndrome: definitions, severity and clinical outcome (1996)
    Springer
    Intensive care medicine 22 (1996), S. 519-529 
    Details
    ISSN: 1432-1238
    Keywords: Key words ARDS ; Severity ; Outcome ; Oxygenation index ; Ventilatory support
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To determine possible changes in outcome from acute respiratory distress syndrome (ARDS) and to compare severity of lung injury and methods of treatment from 1967 to 1994. Data sources: Computerized (Medline, Current Contents) and manual (Cumulated Index Medicus) literature search using the key word and/or title ARDS. Study selection: Only clinical studies published as full papers reporting data on both patient mortality (survival) and oxygenation index (PaO2/FIO2) were included. Single case reports, abstracts, reviews and editorials were excluded from evaluation. Data extraction: Relevant data were extracted in duplicate, followed by quality checks on approximately 80% of data extracted. Data synthesis: 101 papers reporting on 3264 patients were included: 48 studies (2207 patients) were performed in the USA, 43 studies (742 patients) in Europe and 10 studies (315 patients) elsewhere. Mortality reported in these studies was 53±22% (mean±SD), with no apparent trend towards a higher survival (1994: 22 studies, mortality 51±19%). The mean PaO2/FIO2 ratio remained unchanged throughout the observation period (118±47 mmHg). No correlation could be established between outcome and PaO2/FIO2 or lung injury score. Patients who underwent pressure-limited ventilation had a significantly lower mortality (35±20%) than patients on volume-cycled ventilation (54±22%) or patients for whom there was no precise information on ventilatory support (59±19%). Significantly lower PaO2/FIO2 ratios (61±17 mmHg) were observed in patients prior to extracorporeal lung assist, together with mortality rates in the range of those for conventionally treated patients (55±22%). Conclusions: The mortality of ARDS patients remained constant throughout the period studied. Therefore, the standard for outcome in ARDS should be a mortality in the 50% range. Neither PaO2/FIO2 ratio nor lung injury score was a reliable predictor for outcome in ARDS. Patients might benefit from pressure-limited ventilatory support, as well as extracorporeal lung assist. Since crucial data were missing in most clinical studies, thus preventing direct comparison, we emphasize the importance of using standardized definitions and study entry criteria.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01708091
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 7
    Electronic Resource
    Electronic Resource
    PA catheterization – quo vadis? (1997)
    Springer
    Intensive care medicine 23 (1997), S. 605-609 
    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/s001340050379
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    Paper (German National Licenses)
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  • 8
    Electronic Resource
    Electronic Resource
    The use of the antioxidant tirilazad mesylate in human liver transplantation: is there a therapeutic benefit? (1999)
    Springer
    Intensive care medicine 25 (1999), S. 616-619 
    Details
    ISSN: 1432-1238
    Keywords: Key words Tirilazad mesylate ; Liver transplantation ; Malonaldehyde ; Ischaemia-reperfusion injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To test the hypothesis whether in patients undergoing liver transplantation the antioxidant tirilazad mesylate can reduce hepatic ischaemia-reperfusion injury and improve postoperative outcome. Design: Prospective, randomised, placebo controlled trial. Setting: University hospital. Patients: 20 patients were randomised to receive either tirilazad mesylate or placebo (saline). Interventions: Patients in the tirilazad group (n = 10) received four intravenous infusions of tirilazad at 6-h intervals (men 3 mg/kg, women 3.75 mg/kg) after the induction of anaesthesia. The other patients (n = 10) served as controls. Measurements and results: Plasma levels of malonaldehyde (MDA) were determined after the induction of anaesthesia prior to the infusion of tirilazad (baseline), during the anhepatic period, and 5 min and 24 h after reperfusion. Postoperatively, alanine aminotransferase, aspartate aminotransferase, prothrombin time, and serum cholinesterase were determined daily for 1 week. Compared to baseline, plasma MDA levels did not significantly change during the anhepatic period and after reperfusion and they did not differ between groups. Postoperative liver enzymes and prothrombin time did not differ between groups, but on the first (p = 0.03) and second (p = 0.01) postoperative day cholinesterase levels were significantly higher in tirilazad-treated patients than in control patients. For neither length of stay in the intensive care unit nor hospital stay were any differences observed between groups. Conclusions: In patients undergoing liver transplantation, tirilazad does not improve overall outcome. Whether the higher cholinesterase levels on the first 2 postoperative days in tirilazad treated patients indicates an earlier recovery of liver function remains to be tested.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050912
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  • 9
    Electronic Resource
    Electronic Resource
    Prognosis of ARDS patients: light at the end of the tunnel? (1997)
    Springer
    Intensive care medicine 23 (1997), S. 803-805 
    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/s001340050414
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    Paper (German National Licenses)
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  • 10
    Electronic Resource
    Electronic Resource
    Peri-operative liver graft function: monitoring using the relationship between blood glucose and oxygen consumption during anaesthesia (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 purpose of our study was to test the hypothesis that the quotient between plasma glucose and whole body oxygen consumption (V̇o2) as a ‘metabolic index’ is a sensitive indicator of early graft function. Arterial levels of glucose and oxygen consumption were determined in 100 consecutive patients during orthotopic liver transplantation performed without anhepatic veno-venous bypass. Patients were divided into survivors with no obvious problems related to graft function and those with primary nonfunction of the graft. The neohepatic increase in V̇o2 was significantly higher in survivors (112 + 4 vs 88 + 11 ml.min−1.m2; p 〈 0.05), whereas blood glucose levels after reperfusion were higher (352 + 18 vs. 287+36 mg dl−1) in those with primary non-function of the graft. The calculated metabolic index was also higher (4.02 + 0.93 vs 2.67+ 0.45, p 〈 0.05) in patients with primary nonfunction of the graft. Our principal conclusion was that 92% of normal functioning liver grafts could be classified correctly by the metabolic index immediately after reperfusion, whereas glucose levels and V̇o2 alone classified only 67% and 70% of normal functioning liver grafts correctly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1111/j.1365-2044.1992.tb03197.x
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