Chest
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Comparative Study Retracted Publication
Platelet function in critically ill patients.
The critically ill patient is at risk to develop coagulation abnormalities at different levels. Platelet dysfunction in these patients is of multifactorial origin, including drug interactions, hormonal response, and infection. The time course of platelet function in severely traumatized patients was studied. ⋯ Platelet function in patients with isolated trauma recovered during the following 5 days. When sepsis complicated trauma, complex derangements in platelet function were present as seen by altered platelet aggregometry despite adequate platelet count.
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Retracted Publication
Efficacy of the phosphodiesterase inhibitor enoximone in complicated cardiac surgery.
Acute myocardial dysfunction during cardiac surgery involves various pathophysiologic mechanisms such as reduction in myocardial contractility and an increase in afterload induced by peripheral vasoconstriction. In 30 consecutive patients undergoing coronary artery bypass grafting (CABG) and ten consecutive patients with aortic valve replacement (AVR), in whom therapy with catecholamines was expected to be necessary during and after weaning from cardiopulmonary bypass (CPB) on the basis of a retrospective study ("control" patients), 1.0 mg/kg of the phosphodiesterase (PDE) inhibitor enoximone was administered ten minutes prior to weaning from bypass (enoximone group). In eight CABG and four AVR patients weaning was possible without further pharmacologic support. ⋯ Hemodynamic monitoring revealed a higher level in heart rate in the control patients with arrhythmia in seven of the CABG patients: MAP, right atrial pressure, cardiac index, and pulmonary capillary wedge pressure were without significant differences between the groups. Pulmonary artery pressure and TSR, however, increased more in the control group, indicating an increase in right and left ventricular afterload. The results of this study demonstrate that patients at risk of circulatory failure during or after weaning from CPB profit from pretreatment with PDE-III inhibitor enoximone due to a reduction in catecholamines and an improvement in hemodynamics.
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Retracted Publication
Influence of PEEP ventilation immediately after cardiopulmonary bypass on right ventricular function.
Ventilation with positive end-expiratory pressure (PEEP) is often the appropriate therapy for treating patients with impaired pulmonary function after cardiac surgery procedures. Circulatory depression, however, sometimes limits the level of PEEP. This study was conducted to investigate the effects of PEEP ventilation (+15 cmH2O) immediately after weaning from cardiopulmonary bypass 1) period of PEEP application and 45 min thereafter; 2) period of PEEP application on right ventricular hemodynamics using a new thermodilution technique for measuring right ventricular ejection fraction (RVEF), right ventricular end-diastolic and end-systolic volumes (RVEDV, RVESV). ⋯ We conclude that hemodynamic changes related to PEEP ventilation are minimal in the intact right ventricle. Abnormalities in right ventricular function due to stenosis of the RCA, however, have had marked clinical influence on the circulatory response. Monitoring of right ventricular function seems to be of benefit for cardiac surgery patients in this situation.
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Retracted Publication
Age and cardiac surgery. Influence on extravascular lung water.
This study was designed in order to evaluate the influence of advanced age on extravascular lung water (EVLW) content. Forty patients undergoing aortocoronary bypass grafting were prospectively divided into two groups according to age below 45 years (group 1; n = 20) and above 65 years (group 2; n = 20). The EVLW was measured using the double indicator dilution technique with indocyanine green as the nondiffusible indicator. ⋯ Simultaneously, PaO2 was decreased (-114 mm Hg) and intrapulmonary shunt fraction (Qs/Qt) was increased only in this group. Within the next five hours after ECC, lung water returned nearly to baseline values and pulmonary function was normalized. It is concluded that increasing age was associated with a transient increase in EVLW after ECC due to a more pronounced fragility of the pulmonary endothelial membrane or/and to depressed left ventricular performance.