1,536 research outputs found
Het "Waarom" van de Intensive Care
Rede, in verkorte vorm, uitgesproken bij het aanvaarden van het ambt van bijzonder hoogleraar met als leeropdracht Intensive Care aan het Erasmus MC, faculteit van de Erasmus Universiteit Rotterdam, op 13 april 200
Accidental methanol ingestion: case report.
BACKGROUND: The incidence of methanol (CH3OH) intoxication differs enormously from country to country. Methanol intoxication is extremely rare in the Dutch population. Even a low dose can already be potentially lethal. Patients are conventionally treated with hemodialysis. Therefore we'd like to present a report of a foreign sailor in Rotterdam who accidentally caused himself severe methanol intoxication, with a maximum measured concentration of 4.4 g/L. CASE PRESENTATION: The patient presented with hemodynamic instability and severe metabolic acidosis with pH 6.69. The anion gap was 39 mmol/L and the osmol gap 73 mosmol/kg. Treatment with ethanol and continuous venovenous hemodiafiltration (CVVH-DF) was initiated. Despite the hemodynamic instability it is was possible to achieve rapid correction of pH and methanol concentration with CVVH-DF while maintaining a stable and therapeutic ethanol serum concentration. Despite hemodynamic and acid-base improvement, our patient developed massive cerebral edema leading to brain death. Permission for organ donation was unfortunately not ascertained. CONCLUSIONS: We conclude that in a hemodynamic instable situation high methanol concentrations and methanol-induced derangements of homeostasis are safely and effectively treated with CVVH-DF and that severe cerebral edema is another possible cause of death rather than the classical bleeding in the putamen area
Starling curves and central venous pressure
Recent studies challenge the utility of central venous
pressure monitoring as a surrogate for cardiac preload.
Starting with Starling’s original studies on the
regulation of cardiac output, this review traces the
history of the experiments that elucidated the role of
central venous pressure in circulatory physiology.
Central venous pressure is an important physiologic
parameter, but it is not an independent variable that
determines cardiac output
Gram-negative antibiotic resistance: there is a price to pay
Resistance rates are increasing among several problematic Gram-negative pathogens that are often responsible for serious nosocomial infections, including Acinetobacter spp., Pseudomonas aeruginosa, and (because of their production of extended-spectrum β-lactamase) Enterobacteriaceae. The presence of multiresistant strains of these organisms has been associated with prolonged hospital stays, higher health care costs, and increased mortality, particularly when initial antibiotic therapy does not provide coverage of the causative pathogen. Conversely, with high rates of appropriate initial antibiotic therapy, infections caused by multiresistant Gram-negative pathogens do not negatively influence patient outcomes or costs. Taken together, these observations underscore the importance of a 'hit hard and hit fast' approach to treating serious nosocomial infections, particularly when it is suspected that multiresistant pathogens are responsible. They also point to the need for a multidisciplinary effort to combat resistance, which should include improved antimicrobial stewardship, increased resources for infection control, and development of new antimicrobial agents with activity against multiresistant Gram-negative pathogens
Monitoring coherence between the macro and microcirculation in septic shock
Purpose of review
Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early
phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the
ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these
currently used signs of shock and the improvement in these signs actually correspond to the changes in the
microcirculation.
Recent findings
Recent studies have shown that during the development of shock the deterioration in the macrocirculatory
parameters are followed by the deterioration of microcirculatory perfusion. However, in many cases the
restoration of adequate macrocirculatory parameters is frequently not associated with improvement in
microcirculatory perfusion. This relates not only to the cause of shock, where there are some differences
between different forms of shock, but also to the type of treatment.
Summary
The improvement in macrohemodynamics during the resuscitation is not consistently followed by subsequent
changes in the microcirculation. This may result in both over-resuscitation and under-resuscitation le
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