ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

It is well recognized that a small group of patients exist who, when undergoing major surgery of any type, have a disproportionately higher morbidity and mortality than other healthier patients undergoing similar surgery. It is possible to identify this group of patients preoperatively and reduce their higher morbidity and mortality by optimizing their cardiorespiratory physiology during the perioperative period.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

As multiple trials have shown, empirically increased oxygen transport in critically ill patients does not improve outcome but may induce harm. The common denominator of these trials and resuscitative efforts in intensive care units has been the reliance on empirical, numerical goals rather than organ-based monitoring. Gut tonometry continues to provide useful prognostic and therapeutic information in the critical care unit by detecting increases in mucosal PCO2when perfusion to the mucosa is diminished. The technique is still evolving: air is likely to replace saline in gut tonometry; balloon tonometry may be replaced by solid state sensors; the calculation of intramucosal pH is likely to be supplanted by consideration of the difference between mucosal and arterial PCO2. Regardless of this evolution, gut tonometry remains the only practical organ-based monitor for tissue dysoxia in the current critical care armamentarium.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

It is generally accepted that intensive care unit patients benefit from early enteral nutrition. Animal studies have shown that enteral nutrition preserves the functional integrity of the gut better than parenteral nutrition or fasting and may reduce translocation, infection and multiple organ failure. Immunonutrition is an enteral nutrition enriched with special nutrients that enhance the immune function. The nutrients with an immune stimulatory function that have been most extensively studied are arginine, glutamine, glycine, omega-3 polyunsaturated fatty acids and nucleotides. Studies with early enteral immunonutrition for patients undergoing major surgery, trauma patients and burn patients showed promising results. However, at present, there is not yet sufficient evidence to recommend the use of early enteral immunonutrition on a routine basis for patients in intensive care units.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The prone position is used for mechanically ventilated patients with acute respiratory failure to improve oxygenation. Clinical studies have shown that although some patients may benefit from prone position (responders), others show no improvement in oxygenation (non-responders). The probable mechanism that increases the PaO2in the patients is the improvement of regional ventilation, redistribution of ventilation and relatively unchanged perfusion in dorsal lung regions, resulting in improved regional ventilation—perfusion matching and reduction of shunt perfusion. The difficulty in turning critically ill patients and the potential complications of the prone position can be significantly reduced by the use of air-fluidized beds.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Since percutaneous dilatational tracheostomy with graded dilators was first described by Ciagliaet al.in 1985, this method has been used widely in intensive care medicine. The obvious attractiveness of this procedure lies in its fast, bedside usability and the need for less equipment and personnel. Nevertheless, the procedure is invasive, and users must be familiar with all aspects of the technique and methods, including the contraindications, possible complications and late sequelae.

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1997

数据来源: OVID