摘要:

As we exit the last 25 years of this century and what, in essence, has been the first 25 years of the organized delivery of critical care, we can assess where we are and what we have accomplished. Great technological strides have been made, and each year this has enabled us to care for and keep alive sicker and sicker patients. An unwillingness to accept thestatus quoand the push beyond accepted boundaries has led to improved outcomes and survivals.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

The gastrointestinal tract and the generalized inflammatory response initiated by severe injury or infection have been implicated in the pathophysiology of multiple-organ system failure. Once multiple-organ system failure has occurred, treatment focuses on supporting end-organ function. Recent studies have shown, however, that it may be possible to reduce the incidence and prevalence of multiple-organ system failure by controlling the reperfusion injury cascade, normalizing gastrointestinal blood flow and preserving the integrity of the gastrointestinal immune barrier. Curr Opin Anaesthesiol 12:115-119.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

This article presents an analysis of the literature of the last 2 years on the treatment of sepsis and septic shock. It appears that most of the antimediator therapies applied in phase II or III clinical trials yielded disappointing results. But, many other therapeutic approaches are proposed or are ongoing, and many papers report critical analysis of the reasons for the lack of success of past clinical trials. Curr Opin Anaesthesiol 12:121-127.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Investigators have been trying to develop ways to measure cardiac function that are less invasive and more cost-effective than a pulmonary artery catheter. None of the technologies currently available are yet ready for routine use in assessing cardiac function in the operating room and in the intensive cardiac unit. Curr Opin Anaesthesiol 12:129-132.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Over the past year a large number of innovations in mechanical ventilation have been evaluated. Three of the most exciting are non-invasive positive pressure ventilation, tracheal gas insufflation and partial liquid ventilation. Non-invasive positive pressure ventilation is now clearly a standard of care in the management of an acute exacerbation of chronic obstructive pulmonary disease. In addition, its use in other clinical settings is being actively explored. Tracheal gas insufflation appears to be a useful adjunct to mechanical ventilation for the management of carbon dioxide but requires manufacturer-designed devices for safe application. The effects of partial liquid ventilation on lung injury have been more clearly defined in the past year as well as approaches to provide gas ventilation during partial liquid ventilation. Curr Opin Anaesthesiol 12:133-141.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

In randomized controlled trials, inhaled nitric oxide failed to provide significant clinical benefit in patients with acute lung injury. Despite temporary improvement in oxygenation, inhaled nitric oxide neither improved survival, nor decreased length of mechanical ventilation. Thus, with the exception of severe hypoxaemia refractory to conventional therapy, inhaled nitric oxide is not indicated in patients with acute lung injury. Inhalation of prostacyclin and prostaglandin E1, respectively, has been associated with an improvement in oxygenation and a decrease in pulmonary artery pressure. Prospective randomized trials are warranted to assess the impact of inhaled prostaglandins on the outcome of patients with acute lung injury. Curr Opin Anaesthesiol 12:143-147.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Blood transfusion remains an important part of treatment in critically ill patients. While the known infectious risks continue to decrease, concerns remain about the effects of allogeneic blood on the immune system. Some patients tolerate anemia much better than others; the optimal hemoglobin level, however, is difficult to define in any individual patient. Curr Opin Anaesthesiol 12:149-153.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Mouth-to-mouth rescue breathing is a barrier to the performance of bystander cardiopulmonary resuscitation. Experimental data suggest that mouth-to-mouth rescue breathing may not be necessary for brief periods of bystander cardiopulmonary resuscitation until defibrillation is available. These data are insufficient to recommend changes in cardiopulmonary resuscitation guidelines, but are compelling enough to recommend further experimental and human trials. Curr Opin Anaesthesiol 12:159-164.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

Ventilation is essential for oxygenation of the alveoli and arterial blood. Comatose humans have upper airway soft tissue obstruction unless the head is tilted backwards and sometimes, in addition, the jaw thrust forward. In 1960, measurements on comatose humans with or without cardiac arrest, with or without a tracheal tube, showed essentially no ventilation by sternal compressions alone. This led to combining step A (airway control), step B (mouth-to-mouth ventilation), and step C (sternal (cardiac) compressions) into basic life support. In animal models, sternal compressions alone can produce some ventilation with or without a tracheal tube, because the straight upper airways of animals do not obstruct in coma. In witnessed sudden cardiac death, the C-A-B sequence makes physiological sense, but other causes of sudden coma need the A-B-C sequence. Lay persons should continue to be taught cardiopulmonary resuscitation steps A-B-C. Curr Opin Anaesthesiol 12:165-171.

ISSN:0952-7907    

出版商:OVID    

年代:1999

数据来源: OVID