Are blood transfusions associated with greater mortality rates? Results of the Sepsis Occurrence in Acutely Ill Patients study.

Background: Studies have suggested worse outcomes in transfused patients and improved outcomes in patients managed with restricted blood transfusion strategies. The authors investigated the relation of blood transfusion to mortality in European intensive care units (ICUs).

Methods: The Sepsis Occurrence in Acutely Ill Patients study was a multicenter, observational study that included all adult patients admitted to 198 European ICUs between May 1 and May 15, 2002 and followed them until death, until hospital discharge, or for 60 days.

Severe ARDS may cause right heart failure with extreme hepatomegaly but without hepatic failure.

A young trauma patient developed severe adult respiratory distress syndrome (ARDS), right heart failure, hepatic congestion and an extreme hepatomegaly but no hepatic failure. The patient needed 100% oxygen during ventilatory support for 80 days and was weaned from the ventilator after more than 100 days. The hepatomegaly gradually disappeared.

Autocycling and increase in intrinsic positive end-expiratory pressure during mechanical ventilation.

Modern ventilators are complicated electronic instruments with microprocessors and software, with the possibility of technical errors and problems such as autocycling. Despite autocycling being recognized as a problem in textbooks and reviews, there are few reports about autocycling in the literature. We report a case where a sudden increase in respiratory frequency due to autocycling resulted in a dangerous increase in intrinsic positive end-expiratory pressure (intrinsic PEEP, PEEPi).

Acute epiglottitis in a rural area: experiences with an anesthesiologist-staffed ambulance helicopter.

The majority of fatalities due to acute epiglottitis (AE) result from prehospital airway problems. We reviewed the courses of 14 patients with AE treated by an aeromedical team consisting of an anesthesiologist and a paramedic. Eight patients were transported from a physician's office or from the patient's own home.

[Limits of intensive care].

The decision to withdraw or withhold life support for critically ill patients with no hope of survival is well established and widely accepted. The decision not to treat should be made by more than one doctor, and should be documented in each patient's file. Patients with a bad but not hopeless prognosis should not be weighed against other patients awaiting treatment.

Severe anaphylactic reactions outside hospital: etiology, symptoms and treatment.

Twenty-seven patients with severe anaphylactic reactions were treated by two anesthesiologist-staffed ambulance helicopters during a 5-year period. All patients had signs of respiratory and/or circulatory failure. Cutaneous symptoms were described in 70% of the patients, gastrointestinal symptoms in 30% and central nervous symptoms in 85%.

The effect of positive end expiratory pressure after three types of open heart surgery.

It has previously been shown that patients who have undergone mitral valve replacement (MVR) tolerate a positive end expiratory pressure (PEEP) of 1.0 kPa better than patients who have had aortic valve replacement (AVR). the difference was explained by the fact that the mitral patients had pre-existing pulmonary vascular disease.

Weaning from mechanical ventilation by means of intermittent assisted ventilation I.A.V. Case reports.

A new ventilator is described which is capable of interposing controlled breaths synchronized with the patient's own breathing rhythm. This ventilation pattern is called "intermittent assisted ventilation" (IAV). It differs from intermittent mandatory ventilation (IMV) in that each ventilator cycle is triggered by the patient.