Critical care medicine
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Critical care medicine · Mar 2009
The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients.
The physical examination of peripheral perfusion based on touching the skin or measuring capillary refill time has been related to the prognosis of patients with circulatory shock. It is unclear, however, whether monitoring peripheral perfusion after initial resuscitation still provides information on morbidity in critically ill patients. Therefore, we investigated whether subjective assessment of peripheral perfusion could help identify critically ill patients with a more severe organ or metabolic dysfunction using the Sequential Organ Failure Assessment (SOFA) score and lactate levels. ⋯ Subjective assessment of peripheral perfusion with physical examination following initial hemodynamic resuscitation in the first 24 hours of admission could identify hemodynamically stable patients with a more severe organ dysfunction and higher lactate levels. Patients with abnormal peripheral perfusion had significantly higher odds of worsening organ failure than did patients with normal peripheral perfusion following initial resuscitation.
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Critical care medicine · Mar 2009
Assessment of venous return curve and mean systemic filling pressure in postoperative cardiac surgery patients.
To measure the relationship between blood flow and central venous pressure (Pcv) and to estimate mean systemic filling pressure (Pmsf), circulatory compliance, and stressed volume in patients in the intensive care unit. ⋯ Pmsf can be determined in intensive care patients with an intact circulation with use of inspiratory pause procedures, making serial measures of circulatory compliance and circulatory stressed volume feasible.
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Critical care medicine · Mar 2009
The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications.
Intraventricular extension of intracerebral hemorrhage (IVH) is an independent predictor of poor outcome. IVH volume may be important in outcome prediction and management; however, it is difficult to measure routinely. ⋯ IVHS enables clinicians to rapidly estimate IVH volume. The addition of IVH to ICH volume increases its predictive power for poor outcome and mortality significantly. IVHS and TV may be used in clinical practice and clinical trials of patients with ICH.
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Aging is associated with increased inflammation following sepsis. The purpose of this study was to determine whether this represents a fundamental age-based difference in the host response or is secondary to the increased mortality seen in aged hosts. ⋯ Aged mice are more likely to die of sepsis than young mice when subjected to an equivalent insult, and this is associated with increases in both systemic and local inflammation. There is an exaggerated local but not systemic inflammatory response in aged mice compared with young mice when mortality is similar. This suggests that systemic processes that culminate in death may be age independent, but the local inflammatory response may be greater with aging.
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Critical care medicine · Mar 2009
Demand flow facilitates spontaneous breathing during high-frequency oscillatory ventilation in a pig model.
Maintenance breathing is advocated in mechanical ventilation, which is difficult for the high-frequency oscillatory (HFO) ventilation. To facilitate spontaneous breathing during HFO ventilation, a demand flow system (DFS) was designed. The aim of the present study was to evaluate the system. ⋯ In moderately lung-injured anesthetized pigs during HFO ventilation, demand flow facilitated spontaneous breathing and augmented gas exchange. Demand flow decreased total breathing effort as quantified by PTP. Imposed work caused by the HFO ventilator appeared totally reduced by demand flow.