Abstract:
OBJECTIVE:To investigate the sources of hemorrhage and use of endoscopic hemostasis in patients with clinically significant upper gastrointestinal (UGI) hemorrhage after admission to the intensive care unit (ICU). DESIGN AND SETTING:Prospective study, 123 beds of ICU in a 1,629-bed medical center. MEASUREMENTS AND RESULTS:Of the 9,512 consecutive admissions over a 2-year period 105 UGI hemorrhage patients underwent urgent bedside UGI endoscopy. We compared two groups of these patients, one receiving and the other not receiving endoscopic hemostasis. Ulcers with profusely bleeding stigmata occurred in 31 patients (29.5%), ulcers with clean bases or firmly adherent blood clots in 27 (25.7%), stress-related mucosal diseases in 23 (21.9%), esophageal varices in 5 (4.8%), malignancy in 4 (3.8%), and no detectable bleeding site in 15 (14.3%). Endoscopic hemostasis was attempted in 34 patients (32.4%). Primary hemostasis for them was achieved in 67.6% and the rebleeding rate was 30.4%. In-hospital mortality rate was 77.1% and death related to hemorrhage 6.2%. Length of ICU stay before endoscopic diagnosis was significantly shorter in those who underwent endoscopic hemostasis than those who did not (28.2+/-26.3 vs. 41.2+/-57.5 days). CONCLUSIONS:Endoscopic hemostasis may be more beneficial when the period between ICU admission and development of hemorrhage is shorter. Bleeders can be more readily identified and controlled endoscopically in such patients. A significant proportion of bleeding sites cannot be identified by UGI endoscopy. It may indicate higher risk of small bowel hemorrhage in these critically ill patients.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Lee YC,Wang HP,Wu MS,Yang CS,Chang YT,Lin JTdoi
10.1007/s00134-003-1921-xkeywords:
subject
Has Abstractpub_date
2003-10-01 00:00:00pages
1723-8issue
10eissn
0342-4642issn
1432-1238journal_volume
29pub_type
杂志文章abstract:OBJECTIVE:While using a transcutaneous system for assessment of liver function by indocyanine green plasma disappearance rate (ICG-PDR) in critically ill patients, we compared the agreement between ICG-PDR obtained by the recommended standard ICG dosage (0.5 mg/kg) and a reduced dosage (0.25 mg/kg). DESIGN:Clinical st...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-003-2091-6
更新日期:2004-03-01 00:00:00
abstract:INTRODUCTION:A prospective physiological study was performed in 12 paediatric patients with acute moderate hypercapnic respiratory insufficiency to assess the ability of noninvasive positive pressure ventilation (NPPV) to unload the respiratory muscles and improve gas exchange. MATERIALS AND METHODS:Breathing pattern,...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-008-1202-9
更新日期:2008-12-01 00:00:00
abstract:PURPOSE:Mechanical ventilation with lower tidal volumes (≤6 ml/kg of predicted body weight, PBW) could benefit patients without acute respiratory distress syndrome (ARDS). However, tidal volume reduction could be associated with increased patient discomfort and sedation needs, and consequent longer duration of ventilat...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00134-014-3318-4
更新日期:2014-07-01 00:00:00
abstract:PURPOSE:Indications and optimal timing for tracheostomy in traumatic brain-injured (TBI) patients are uncertain. This study aims to describe the patients' characteristics, timing, and factors related to the decision to perform a tracheostomy and differences in strategies among different countries and assess the effect ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-020-05935-5
更新日期:2020-05-01 00:00:00
abstract::A 42 year old pregnant woman was admitted in acute respiratory failure. Viral pneumonia was suspected and oxygen therapy, CPAP, water restriction and diuretics were started with good response. She remained febrile and had an abnormal chest X-ray, a diagnosis of miliary tuberculosis was confirmed by transbronchial fibr...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01902549
更新日期:1978-11-01 00:00:00
abstract:PURPOSE:Hypoxic hepatitis (HH) is a form of hepatic injury following arterial hypoxemia, ischemia, and passive congestion of the liver. We investigated the incidence and the prognostic implications of HH in the medical intensive care unit (ICU). METHODS:A total of 1,066 consecutive ICU admissions at three medical ICUs...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2248-7
更新日期:2011-08-01 00:00:00
abstract:OBJECTIVE:To determine the relationship between ionized calcium concentrations and blood lactate levels during cardiac arrest and cardiopulmonary resuscitation (CPR). DESIGN:A prospective cohort study. SETTING:Emergency department (ED) and general intensive care unit in a city hospital (tertiary care center). PATIEN...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050493
更新日期:1997-12-01 00:00:00
abstract:OBJECTIVE:Intra-abdominal pressure (IAP) measurement is important in daily clinical practice. Most measurement techniques vary in automaticity and reproducibility. This study tested a new fully automated continuous technique for IAP measurement, the CiMON. METHODS:Three IAP measurement catheters (a Foley manometer and...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0952-0
更新日期:2008-04-01 00:00:00
abstract:OBJECTIVE:To evaluate compliance with recommended patient-care practices for the prevention of hospital-acquired infections (HAI) in the intensive care unit (ICU). DESIGN:European descriptive survey by questionnaire mailed to all the directors of ICUs. PATIENTS AND PARTICIPANTS:A total of 1642 general ICUs with more ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF02044110
更新日期:1996-09-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-010-1836-2
更新日期:2010-08-01 00:00:00
abstract::The endothelium is a highly dynamic cell layer that is involved in a multitude of physiological functions, including the control of vascular tone, the movement of cells and nutrients, the maintenance of blood fluidity and the growth of new vessels. During severe sepsis, the endothelium becomes proadhesive, procoagulan...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-010-1893-6
更新日期:2010-08-01 00:00:00
abstract:PURPOSE:Because non-invasive mechanical ventilation (NIV) is increasingly used, new devices, both ventilators and interfaces, have been continuously proposed for clinical use in recent years. To provide the clinicians with valuable information about ventilators and interfaces for NIV, several bench studies evaluating a...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2416-9
更新日期:2012-01-01 00:00:00
abstract::There has been little research on smoking cessation after critical illness. Smokers make up a high percentage of patients admitted to intensive care (ICU) and stopping smoking is one message that should be clearly given to recovering patients. The recovery period provides an important opportunity for patients to quit ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340101051
更新日期:2001-09-01 00:00:00
abstract::Pulmonary artery (PA) catheterization is now a routine procedure in the care of critically ill patients. We report a case in which a pulmonary artery catheter was a major factor in the demise of a patient who developed adult respiratory distress syndrome following a septic abortion. ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00295990
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:Do-not-resuscitate orders (DNR orders) and advance directives (AD) have been developed and their use by patients is increasing. The objective of the study was to evaluate the compliance with patient's wishes and doctors' and nurses' agreement on decision-making in the treatment of elderly patients from a cros...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000602
更新日期:2000-09-01 00:00:00
abstract:PURPOSE:To use the World Health Organisation's International Classification of Functioning to measure disability following critical illness using patient-reported outcomes. METHODS:A prospective, multicentre cohort study conducted in five metropolitan intensive care units (ICU). Participants were adults who had been a...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-017-4830-0
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:Lung injury is a severe complication of acute pancreatitis that increases the mortality rate of the disease. The pathophysiology of acute pancreatitis has been studied in several experimental models, but the kinetics of pulmonary complications in relation to the pancreatic disease is not completely understood...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0264-9
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:Five commercially available oesophageal balloon catheters (OBCs) were tested to evaluate the accuracy in transmitting fast-changing pressure signals which can be observed, for example, during phrenic nerve stimulation. SETTING:Research laboratory of a university hospital. METHOD:The OBCs tested varied in le...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051182
更新日期:2000-04-01 00:00:00
abstract::We compare two patients admitted after near drowning. Both presented a severe metabolic acidosis, but only one of them developed an acute pulmonary edema with hypoxemia. An increase of lipid peroxides associated with a reduction of vitamin E concentration has been observed in this later patient. Lipid peroxidation, on...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00254776
更新日期:1985-01-01 00:00:00
abstract:OBJECTIVES:To establish a preliminary list of critical incidents (CIs) associated with mechanical ventilation and to describe a CI reporting method. DESIGN:A list of CIs was established based on a consensus among ICU caregivers. The list was compared to CIs collected prospectively during a predefined study period. SE...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-002-1251-4
更新日期:2002-04-01 00:00:00
abstract:PURPOSE:Intensive care unit survivors suffer from prolonged impairment, reduced quality of life, and higher mortality rates after discharge compared to the general population. Socioeconomic status may play a partial but important role in mortality and recovery. Therefore, the detection of factors that are responsible f...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-018-5412-5
更新日期:2018-12-01 00:00:00
abstract:OBJECTIVE:To assess procalcitonin (PCT) and C-reactive protein (CRP) plasma concentrations and clearance in nonseptic end-stage renal failure patients undergoing their first three hemodialysis sessions. DESIGN AND SETTING:Prospective observational consecutive clinical study at a university hospital. PATIENTS:The stud...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-003-1664-8
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVE:To assess the relationship between the base deficit value in the immediate postoperative period of coronary surgery for cardiopulmonary bypass and the length of stay in the ICU. DESIGN AND SETTING:Prospective descriptive study in the department of anesthesia and cardiovascular surgery of a university hospita...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1587-9
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:To evaluate the nursing time required for difficult-to-wean patients in a dedicated weaning center (WC) and to examine the correlation of the nursing time with nursing workload (NW) scores and with clinical severity and dependency. SETTING:Four-bed WC of a pulmonary rehabilitation department. INTERVENTION:N...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051249
更新日期:2000-06-01 00:00:00
abstract:PURPOSE:Ventricular-arterial (V-A) decoupling decreases myocardial efficiency and is exacerbated by tachycardia that increases static arterial elastance (Ea). We thus investigated the effects of heart rate (HR) reduction on Ea in septic shock patients using the beta-blocker esmolol. We hypothesized that esmolol improve...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-016-4351-2
更新日期:2016-10-01 00:00:00
abstract:PURPOSE:Pneumonia associated with invasive mechanical ventilation (IMV) is one of the indicator infections of the German Nosocomial Infection Surveillance System. In 2005 surveillance was extended to include pneumonia associated with noninvasive ventilation (NIV). The aim of this study was to determine the utilization ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1863-z
更新日期:2010-06-01 00:00:00
abstract:INTRODUCTION:Microcirculatory abnormalities are frequently observed in patients with severe heart failure and correlate to worse outcomes. We tested the hypothesis that nitroglycerin dose-dependently improves perfusion in severe heart failure and that this could be monitored by measuring central-peripheral temperature ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1591-4
更新日期:2009-11-01 00:00:00
abstract:PURPOSE:We assessed outcomes in brain-injured patients after implementation of a multi-faceted approach to reduce respiratory complications in intensive care units. METHODS:Prospective nationwide before-after trial. Consecutive adults with acute brain injury requiring mechanical ventilation for ≥24 h in 20 French inte...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-017-4764-6
更新日期:2017-07-01 00:00:00
abstract:PURPOSE:Sepsis and its progression are known to have a major influence on the coagulation system. Current coagulation tests are of limited use when assessing coagulation in sepsis patients. This study aims to assess the potential for a new functional biomarker of clot microstructure, fractal dimension, to identify chan...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-016-4496-z
更新日期:2016-12-01 00:00:00
abstract::A 29-year-old woman was admitted to the Rouen University Hospital for attempted suicide by ingestion of a carbamate insecticide (Temik G, containing 10% aldicarb). Cardio-respiratory arrest occurred at the second hour and acute necrotic hemorrhagic pancreatitis on the second day. Further evolution was uneventful, and ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF02425057
更新日期:1994-01-01 00:00:00