[Value and limitation of pulmonary scintigraphy in the diagnosis of pulmonary embolism]

Perfusion lung scan, whether associated with a ventilation lung scan or not, is frequently used in the diagnosis of pulmonary emboli. The characteristics of perfusion lung scan are reviewed. The added diagnostic value of standard chest X-ray and of ventilation scan is discussed, as well as its use in the intensive care unit.

Nasal positive pressure ventilation in patients with acute respiratory failure. Difficult and time-consuming procedure for nurses

Intubation and mechanical ventilation are well-established techniques in the management of patients with acute respiratory failure; however, there are situations in which these procedures cannot be used safely for various reasons. A recently described noninvasive technique, nasal positive-pressure ventilation (NPPV), has been developed for home ventilation of certain patients with chronic ventilatory insufficiency. We hypothesized that NPPV could be used in selected patients in whom intubation and mechanical ventilation were clearly indicated, but not immediately possible, or even contraindicated. Six patients were treated with NPPV during an episode of acute respiratory failure and enrolled in a prospective study. We found that NPPV was successful in avoiding intubation, but only in the three patients suffering from a restrictive pulmonary disorder, whereas the procedure was unsuccessful in patients with obstructive disorders. Moreover, in every patient, acute NPPV was very time-consuming for the nursing staff: in patients with restrictive disorders, a nurse had to monitor a patient submitted to NPPV during 41 +/- 9 percent of the duration of ventilation and during 91 +/- 9 percent of the NPPV time in patients with obstructive disorders. We conclude that acute NPPV may be attempted in selected patients with acute respiratory failure, predominantly patients with restrictive respiratory disorders, but that this procedure is very time-consuming for nurses.

[Barbiturate coma in the treatment of refractory status epilepticus in adults. Usefulness of continuous electroencephalography in intensive care]

Status epilepticus represents one of the most frequent neurological reasons for admission to the intensive care ward. If it resists well-managed treatment, more aggressive measures must be taken. We report 3 such situations in which patients were treated by barbiturate coma under continuous electroencephalographic monitoring. On the basis of this experience we attempt to elaborate guidelines for the use of this technique.

[The DO2/VO2 relationship: and approach to cellular metabolism in "crisis" situations]

The relationship between the organism's oxygen consumption (VO2) and its transport to the cells (DO2), termed the DO2/VO2 relationship, has been the subject of many publications during the past decade. The pathological changes occurring in this relationship in intensive care patients has been much studied, and certain conclusions drawn with regard to monitoring and therapeutic goals. After a brief review of the pathophysiological mechanisms involved we examine the practical implications of the DO2/VO2 concept, focusing on the many methodological and interpretation problems raised.

Aggressive intensive care treatment of very elderly patients with tetanus is justified

Tetanus is now rare in industrialized countries, occurring mainly in elderly patients. To assess whether aggressive therapy of these patients in the intensive care unit is justified, we retrospectively studied all patients with tetanus hospitalized in our institution between 1968 and 1989. Patients over the age of 70 years fared as well as those under 70 years and recovered without sequelae. These results favor aggressive treatment of elderly patients with tetanus in the intensive care unit.