Intensive care medicine
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Intensive care medicine · Jun 2011
Comparative StudyScanographic comparison of high frequency oscillation with versus without tracheal gas insufflation in acute respiratory distress syndrome.
In acute respiratory distress syndrome (ARDS), combined high frequency oscillation (HFO) and tracheal gas insufflation (TGI) improves oxygenation versus standard HFO, likely through TGI-induced lung recruitment. Experimental data suggest that steady flows such as TGI favor the filling of the lower (i.e., subcarinal) lung. We used whole-lung computerized tomography (CT) to determine whether HFO-TGI versus HFO improves the recruitment of the lower lung, and especially of its dependent region, where loss of aeration is maximized in ARDS. ⋯ HFO-TGI improves oxygenation versus HFO and CMV through the recruitment of previously nonaerated lower lung units.
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Intensive care medicine · Jun 2011
ReviewAcute intestinal failure in critically ill patients: is plasma citrulline the right marker?
Small bowel functions are more complex than colon functions, and short bowel conditions are associated with increased mortality. Gastrointestinal dysfunction in critically ill patients is common, probably underestimated, and associated with a poor prognosis. However, a validated definition of acute intestinal failure is lacking, in absence of a marker to measure it. Consequently, small bowel dysfunction is not clearly integrated into the overall approach used to treat ICU patients. ⋯ On the one hand, small bowel ischemia is related to acute reduction of enterocyte mass and loss of gut barrier function by epithelial lifting of villi. On the other hand, systemic inflammatory response syndrome (SIRS) and sepsis could be linked to an acute dysfunction of enterocytes without enterocyte reduction. Citrulline is an amino acid mainly synthesized by small bowel enterocytes. Various contexts of chronic and acute reduction of enterocyte mass have been correlated with low plasma citrulline concentration. Critically ill patients with shock have an acute reduction of enterocyte mass and reduced gut citrulline synthesis, leading to a low plasma citrulline concentration. Acute intestinal failure could be defined as an acute reduction of enterocyte mass and/or acute dysfunction of enterocytes, associated or not with loss of gut barrier function. The influence of SIRS and acute renal failure on plasma citrulline concentration and the value of this concentration as an indicator of acute intestinal failure in critically ill patients must be further evaluated.
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Intensive care medicine · Jun 2011
Comparative StudyChanges in pulse pressure following fluid loading: a comparison between aortic root (non-invasive tonometry) and femoral artery (invasive recordings).
To document the relationship between stroke volume (SV) and pulse pressure (PP) recorded at the femoral and aortic sites during volume expansion (VE) in patients in shock. We hypothesized that non-invasively estimated aortic PP would exhibit the same ability as PP recorded invasively at the femoral level to track SV changes. ⋯ The ability of non-invasively estimated aortic PP to track fluid response was the same as that of invasively recorded femoral PP. This may have implications for non-invasive haemodynamic monitoring.
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Intensive care medicine · Jun 2011
Randomized Controlled TrialLong-term sedation in intensive care unit: a randomized comparison between inhaled sevoflurane and intravenous propofol or midazolam.
To evaluate efficacy and adverse events related to inhaled sevoflurane for long-term sedation compared with standard intravenous (i.v.) sedation with propofol or midazolam. ⋯ Long-term inhaled sevoflurane sedation seems to be a safe and effective alternative to i.v. propofol or midazolam. It decreases wake-up and extubation times, and post extubation morphine consumption, and increases awakening quality.
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Intensive care medicine · Jun 2011
Short-term effects of terlipressin bolus infusion on sublingual microcirculatory blood flow during septic shock.
Terlipressin bolus infusion may contribute to overshooting increases in systemic vascular resistance with concomitant reductions in systemic blood flow and oxygen delivery. Whether these effects negatively impact on microcirculatory perfusion is still not known. The objective of the present study was, therefore, to elucidate the effects of a single terlipressin bolus dose of 0.5 mg on microcirculatory perfusion in patients with catecholamine-dependent septic shock. ⋯ In fluid-resuscitated patients with septic shock (with a MAP between 65 and 75 mmHg), a bolus infusion of 0.5 mg terlipressin was effective in reducing NE requirements without worsening microcirculatory blood flow. Randomized clinical trials are now warranted to verify these preliminary results.