Intensive care medicine
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Intensive care medicine · Jan 2004
Assessment of cardiac preload and left ventricular function under increasing levels of positive end-expiratory pressure.
(1) To assess the impact of high intrathoracic pressure on left ventricular volume and function. (2) To test the hypothesis that right ventricular end-diastolic volume (RVEDV) and intrathoracic blood volume (ITBV) represent cardiac preload and are superior to central venous pressure (CVP) or pulmonary capillary wedge pressure (PCWP). The validity of these parameters was tested by means of correlation with left ventricular end-diastolic volume (LVEDV), the true cardiac preload. ⋯ In the present study, (1) ventilation with increasing levels of PEEP did not alter RV function, while LV function was impaired at the highest level of PEEP; (2) unlike cardiac filling pressures, ITBV and RVEDV both provide valid estimates of cardiac preload even at high intrathoracic pressures.
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Intensive care medicine · Jan 2004
Energy expenditure in ischemic stroke patients treated with moderate hypothermia.
To determine total energy expenditure (TEE) in patients with acute ischemic stroke in the territory of the middle cerebral artery (MCA), treated with moderate hypothermia (33 degrees C). ⋯ We found a significant fall in TEE in sedated, curarized, and ventilated ischemic stroke patients during moderate hypothermia. Indirect calorimetry appears to be a useful tool for measuring energy expenditure in these patients, as predicted basal energy expenditure overestimates the caloric requirements during hypothermia.
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Intensive care medicine · Jan 2004
Compartmentalisation of cytokines and cytokine inhibitors in ventilator-associated pneumonia.
To examine whether cytokine concentrations change in the pulmonary compartment during the development of ventilator-associated pneumonia (VAP). ⋯ Our results suggest that the production of important cytokines and cytokine inhibitors is compartmentalised within the lung in critically ill mechanically ventilated patients who develop VAP.
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Intensive care medicine · Jan 2004
The prognostic value of transcranial Doppler studies in children with moderate and severe head injury.
To assess the potency of transcranial Doppler (TCD) to predict prognosis in children with moderate and severe head trauma. ⋯ In children with moderate and severe head trauma, our data suggest an association between the results of TCD assessment on arrival in the emergency room and the outcome at discharge from the hospital.
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Intensive care medicine · Jan 2004
Case ReportsNeurochemical monitoring using intracerebral microdialysis during cardiac resuscitation.
After cardiac resuscitation, hypoxic encephalopathy often is the limiting factor regarding outcome due to the oxygen sensitivity of the brain. Intracerebral microdialysis is a highly sensitive technique to monitor cerebral energy metabolism and for the early detection of cerebral hypoxia. PATIENT AND INTERVENTIONS: A 34-year-old male patient who had to be craniectomized due to a mass demanding middle cerebral artery infarct. A microdialysis catheter was inserted into the left frontal lobe and, as control, into the abdominal subcutaneous adipose tissue. Pulmonary embolism and asystolia leading to cardiac resuscitation occurred. ⋯ This is the first reported case of monitoring neurochemical markers using intracerebral microdialysis during cardiac resuscitation. The findings indicate the importance of early and efficient resuscitation and demonstrate that deviations in cerebral energy metabolism are reversible.