Critical care medicine
-
Critical care medicine · Sep 2004
Postoperative troponin-T predicts prolonged intensive care unit length of stay following cardiac surgery.
To evaluate the use of postoperative cardiac troponin T (cTnT) for the prediction of prolonged intensive care unit length of stay following cardiac surgery. ⋯ Elevated postoperative cTnT concentrations can prospectively identify patients requiring prolonged intensive care unit length of stay after cardiac surgery.
-
Critical care medicine · Sep 2004
Amplitude spectrum area: measuring the probability of successful defibrillation as applied to human data.
The objective of our study was to examine the effectiveness of an electrocardiographic predictor, amplitude spectral area (AMSA), for the optimal timing of defibrillation shocks in human victims of cardiac arrest. Based on the spectral characteristics of ventricular fibrillation potentials, we examined the probability of successful conversion to an organized viable rhythm, including the return of spontaneous circulation. The incentive was to predict the likelihood of successful defibrillation and thereby improve outcomes by minimizing interruptions in chest compression and minimizing electrically induced myocardial injury due to repetitive high-current shocks. ⋯ AMSA predicts the success of electrical defibrillation with high specificity. AMSA therefore serves to minimize interruptions of precordial compression and the myocardial damage caused by delivery of repetitive and ineffective electrical shocks.
-
Critical care medicine · Sep 2004
Effect of vasopressin on postresuscitation ventricular function: unknown consequences of the recent Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
To compare the effect on postresuscitation left ventricular function of vasopressin vs. epinephrine used during cardiopulmonary resuscitation in a swine model of prolonged prehospital ventricular fibrillation. ⋯ Vasopressin use during cardiopulmonary resuscitation results in worse postresuscitation left ventricular function early but did not compromise 24-hr outcome. Reversal of vasopressin's effect with a specific V-1 antagonist in the postresuscitation period did not improve survival.
-
Critical care medicine · Sep 2004
ReviewNonselective beta-blocking agent improves the outcome of cardiopulmonary resuscitation in a rat model.
Postresuscitation myocardial dysfunction has been recognized as a leading cause of early death after initial successful resuscitation. Recent experimental and clinical studies have indicated that the beta-adrenergic effect of epinephrine significantly increases the severity of postresuscitation myocardial dysfunction. The fact that beta-adrenergic stimulation increases myocardial oxygen consumption during ventricular fibrillation is an important implication with respect to both the exogenous in terms of pharmacologic interventions during cardiopulmonary resuscitation and the endogenous as the result of intense sympathetic activation of cardiovascular collapse. Earlier experimental evidence has indicated that oxygenation improved by beta-blockade and beta1-blocking agent did offset the adverse effect of epinephrine. This prompted us to investigate the effect of beta-blockade on both exogenous and endogenous beta stimulation in an established rat model. ⋯ Nonselective beta-blockade improved the outcome of cardiopulmonary resuscitation in a rat model and deserves further evaluation in settings of cardiopulmonary resuscitation.
-
Critical care medicine · Sep 2004
Effects of intracerebroventricular application of brain-derived neurotrophic factor on cerebral recovery after cardiac arrest in rats.
After transient global cerebral ischemia, selective vulnerable brain areas show delayed neurodegeneration with characteristics of apoptosis. Recent data demonstrate potent neuroprotective effects of the application of endogenous growth hormones such as brain-derived neurotrophic factor (BDNF) after focal cerebral ischemia. To assess possible effects of the intracerebroventricular application of BDNF on cerebral recovery after global cerebral ischemia due to cardiac arrest in rats, various selective vulnerable brain areas were investigated. ⋯ Despite the well-known neuroprotective properties of BDNF in ischemic-induced neuronal degeneration, the present study did not reveal any beneficial effects regarding neurologic recovery and neurohistopathologic outcome after global cerebral ischemia in rats. Future investigations should focus on intracellular signaling cascades activated by BDNF after global cerebral ischemia.