Abstract
In September 2001, 147 patients were admitted to Parnu county hospital in Estonia with suspicion of acute methanol poisoning due to consumption of illegal alcohol. From these patients, 35 (22 male and 13 female, age from 19 to 74, mean 41 years) were transferred into Tartu University Clinics for further intensive care, particularly for hemodialysis. Most of the transferred patients appeared in coma, 29 were in shock. First-line therapy (before and during transport) consisted of artificial ventilation, fluid resuscitation, vasopressors, if needed, and i.v. infusion of 10% ethylalcohol as an antidote. Arterial pH prior to transport was in range from 6.49 to 7.29, and base excess from -12 to -30. In average 690 mmoles (from 200 to 1700 mmoles) of sodium bicarbonate was administered before dialysis for management of acidemia. In our department, 30 patients were treated with single hemodialysis for 6 hours, while three patients underwent continuous venovenous hemodialysis for 12 to 16 hours. The blood level of methanol was in range from 0.24 to 5.9 (mean 1.67) mg/dl before dialysis. After discontinuation of the dialysis, the methanol level remained between 0.05 and 1.6 (mean 0.59) mg/dl, and infusion of 10% ethyl alcohol was continued until methanol level below 0.3 mg/dl was detected. Neurological impairment was evident in seven patients after dialysis. In CT-scans, intracerebral haemorrhages, white-matter lesions, and severe brain oedema were the common findings. Four patients, who complained visual disturbances in immediate post-dialysis period, were treated with hyperbaric oxygenation, and in three of them the symptoms were effectively reversed. Overall, from 35 patients six died (mortality 17%), two remained with persistent neurological disability (encelopathy, coma), while 27 patients (77%) were discharged from hospital in normal health status. In conclusion, our experience demonstrates the importance of intravenous ethanol administration, hemodialysis, and hyperbaric oxygenation in the management of acute methanol poisoning.
Highlights
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]
Smaller aerosol particles resulted in greater drug delivery in vitro when using the modified Aeroneb Pro during controlled mechanical ventilation (CMV)
We retrospectively reviewed 107 procedures performed on 48 patients in the period between March 2000 and November 2001
Summary
Intra-abdominal pressure (IAP) is an important parameter and prognostic indicator of the patient’s underlying physiologic status [1]. The aim of this study was to assess the respiratory effects of sufentanil and remifentanil in postsurgical critically ill patients during spontaneous ventilation since the drugs show pharmacokinetic and pharmacodynamic properties which make them attractive for intensive care use. Preliminary evidence suggests that hU-II levels during cardiac surgery are increased in patients with myocardial dysfunction [2] It is not known, if hU-II plasma concentrations are related to pulmonary capillary wedge pressure (PCWP) as an estimate of left ventricular filling pressure. AAF in cardiac surgery postoperative period has been implicated as a complication that leads to longer ICU and hospital stay and to augmented costs It has not been associated with increased mortality rates. We aimed to investigate the effects of use of preoperative and early postoperative standard and immunonutrient products on immune system and acute inflammatory response in the patients undergoing gastrointestinal malignancy surgery.
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