Intensive care medicine
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Intensive care medicine · Jul 2007
Variation in natriuretic peptides and mitral flow indexes during successful ventilatory weaning: a preliminary study.
To assess the cardiac consequences of successful respiratory weaning using the variations of circulating B-type and atrial natriuretic peptides (BNP, ANP) and Doppler mitral flow. ⋯ During successful weaning from mechanical ventilation ANP levels increase in all patients whereas changes in BNP levels depend on underlying cardiac function. Changes in Doppler mitral flow indexes following ventilator disconnection suggest an increase in left-ventricular filling pressure.
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Intensive care medicine · Jul 2007
Can dynamic indicators help the prediction of fluid responsiveness in spontaneously breathing critically ill patients?
To investigate whether the respiratory changes in arterial pulse (DeltaPP) and in systolic pressure (DeltaSP) could predict fluid responsiveness in spontaneously breathing (SB) patients. Because changes in intrathoracic pressure during spontaneous breathing (SB) might be insufficient to modify loading conditions of the ventricles, performances of indicators were also assessed during a forced respiratory maneuver. ⋯ Due to their lack of sensitivity and their dependence to respiratory status, DeltaPP and DeltaSP are clearly less reliable to predict fluid responsiveness during SB than in mechanically ventilated patients. However, when their baseline value is high without acute right ventricular dysfunction in a participating patient, a positive response to fluid is likely.
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Intensive care medicine · Jul 2007
Echocardiographic prediction of volume responsiveness in critically ill patients with spontaneously breathing activity.
In hemodynamically unstable patients with spontaneous breathing activity, predicting volume responsiveness is a difficult challenge since the respiratory variation in arterial pressure cannot be used. Our objective was to test whether volume responsiveness can be predicted by the response of stroke volume measured with transthoracic echocardiography to passive leg raising in patients with spontaneous breathing activity. We also examined whether common echocardiographic indices of cardiac filling status are valuable to predict volume responsiveness in this category of patients. ⋯ In our critically ill patients with spontaneous breathing activity the response of echocardiographic stroke volume to passive leg raising was a good predictor of volume responsiveness. On the other hand, the common echocardiographic markers of cardiac filling status were not valuable for this purpose.
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Intensive care medicine · Jul 2007
Detection of Neisseria meningitidis DNA from skin lesion biopsy using real-time PCR: usefulness in the aetiological diagnosis of purpura fulminans.
The present study evaluated the usefulness of a real-time polymerase chain reaction (rtPCR) assay for the detection of Neisseria meningitidis (Nm) and genogrouping on skin lesion biopsies in patients with purpura fulminans (PF). ⋯ In suspected PF cases, skin biopsy is more reliable to identify Nm and its genogroup than blood or, probably, CSF, especially when PCR methods are used. This could help the implementation of public health interventions, especially concerning a vaccination policy.
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Intensive care medicine · Jul 2007
Ceftazidime improves hemodynamics and oxygenation in ovine smoke inhalation injury and septic shock.
To investigate ceftazidime in acute lung injury (ALI) and sepsis. ⋯ In ovine lung injury ceftazidime improves global hemodynamics and oxygenation not only by bacterial clearance but also via reduction in toxic nitrogen species such as 3-nitrotyrosine. Therefore ceftazidime appears as a clinically relevant adjunct in the common setting of sepsis-associated lung injury.