Intensive care medicine
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Intensive care medicine · Jan 2007
Intensive care course after stage 1 Norwood procedure: are there early predictors of failure?
The purpose of this study was to review the early postoperative course of stage 1 Norwood with Blalock-Taussig shunt (BTS) or right ventricle-to-pulmonary artery conduit (RVPA) and to identify early predictors of failure. ⋯ Excessive pulmonary to systemic flow ratio and low blood pressure are associated with failure. High diastolic blood pressure more than low pulmonary to systemic flow ratio seems to account for more favorable outcomes in RVPA compared to BTS procedure.
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Intensive care medicine · Jan 2007
Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study.
To assess the feasibility and safety of remifentanil-based sedation during noninvasive ventilation (NIV) in patients with NIV failure. ⋯ This pilot study shows that remifentanil-based sedation is safe and effective in the treatment of NIV failure due to low tolerance.
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Intensive care medicine · Jan 2007
Increased intra-abdominal pressure affects respiratory variations in arterial pressure in normovolaemic and hypovolaemic mechanically ventilated healthy pigs.
To evaluate the effect of increased intra-abdominal pressure (IAP) on the systolic and pulse pressure variations induced by positive pressure ventilation in a porcine model. ⋯ In this model, the systolic pressure and pulse pressure variations, and inferior vena cava flow fluctuations were dependent on IAP values which caused changes in pleural pressure swing, and this dependency was more marked during hypovolaemia. The present study suggests that dynamic indices are not exclusively related to volaemia in the presence of increased IAP. However, their fluid responsiveness predictive value could not be ascertained as no fluid challenge was performed.
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Intensive care medicine · Jan 2007
Clinical TrialPositive end-expiratory pressure and pressure support in peripheral airways obstruction : work of breathing in intubated children.
Children with peripheral airways obstruction suffer the negative effects of intrinsic positive end-expiratory pressure: increased work of breathing and difficulty triggering assisted ventilatory support. We examined whether external positive end-expiratory pressure to offset intrinsic positive end-expiratory pressure decreases work of breathing in children with peripheral airways obstruction. The change in work of breathing with incremental pressure support was also tested. ⋯ For children with peripheral airways obstruction who require assisted ventilation, work of breathing during spontaneous breaths is decreased by the application of either compensatory positive end-expiratory pressure or pressure support.
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Intensive care medicine · Jan 2007
Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography.
To assess lung volume and compliance changes during open- and closed-system suctioning using electric impedance tomography (EIT) during volume- or pressure-controlled ventilation. ⋯ EIT can be used to monitor rapid lung volume changes. The two dorsal regions of the lavaged lungs are most affected by disconnection and suctioning with marked decreases in compliance. Volume-controlled ventilation can be used to rapidly restitute lung aeration and oxygenation after lung collapse induced by open suctioning.