Journal of critical care
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Journal of critical care · Jun 2012
The sensitivity and specificity of ultrasound estimation of central venous pressure using the internal jugular vein.
The fluid volume status of a patient is difficult to assess clinically. The aim of this study was to compare the ultrasound estimation of the height of the right internal jugular vein (CVP(IJV)) with direct estimation of central venous pressure (CVP) (CVP(CVC)). ⋯ Ultrasound estimation of CVP using a portable ultrasound machine and the internal jugular vein is simple, noninvasive, and accurate.
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Journal of critical care · Jun 2012
Variation of left ventricular outflow tract velocity and global end-diastolic volume index reliably predict fluid responsiveness in cardiac surgery patients.
The ability of the global end-diastolic volume index (GEDVI) and respiratory variations in left ventricular outflow tract velocity (ΔVTI(LVOT)) for prediction of fluid responsiveness is still under debate. The aim of the present study was to challenge the predictive power of GEDVI and ΔVTI(LVOT) compared with pulse pressure variation (PPV) and stroke volume variation (SVV) in a large patient population. ⋯ In contrast to CVP, GEDVI and ΔVTI(LVOT) reliably predicted fluid responsiveness under closed-chest conditions. Pulse pressure variation and SVV showed the highest accuracy.
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Journal of critical care · Jun 2012
Impaired renal function is associated with greater urinary strong ion differences in critically ill patients with metabolic acidosis.
Urinary excretion of chloride corrects metabolic acidosis, but this may be hampered in patients with impaired renal function. We explored the effects of renal function on acid-base characteristics and urinary strong ion excretion using the Stewart approach in critically ill patients with metabolic acidosis. ⋯ In critically ill patients with metabolic acidosis, impaired renal function was associated with greater urinary SIDs. Subsequently, the higher urinary SIDs values were related to lower pH levels, illustrating the importance of renal chloride excretion to correct for acidosis.
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Journal of critical care · Jun 2012
Diagnostic value of positron emission tomography combined with computed tomography for evaluating patients with septic shock of unknown origin.
(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) combined with computed tomography (CT) is a promising new tool for the identification of infectious foci. The aim of our work was to evaluate the diagnostic value of FDG-PET/CT in critically ill patients with septic shock of unknown origin. ⋯ The FDG-PET/CT is a valuable tool for the localization of infectious foci in critically ill patients with severe sepsis/septic shock in whom conventional diagnostic methods fail to detect these foci. Prospective studies with more patients are warranted to further evaluate the diagnostic accuracy and feasibility of this diagnostic tool in critically ill patients with severe sepsis.
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Journal of critical care · Jun 2012
Ventricular dysfunction and dilation in severe sepsis and septic shock: relation to endothelial function and mortality.
The aim of this study was to evaluate echocardiography-based indices of myocardial function and markers of vascular inflammation and endothelial dysfunction in the early phases of severe sepsis. ⋯ Both LV and RV systolic dysfunctions are prevalent in severe sepsis, being directly associated with markers of endothelial dysfunction. Left ventricular nondilation, RV dysfunction, and diastolic dysfunction seem related to poor prognosis in this scenario.