Critical care medicine
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Critical care medicine · Aug 2009
Regional aeration and perfusion distribution in a sheep model of endotoxemic acute lung injury characterized by functional computed tomography imaging.
Sepsis-related lung injury is the most common and morbid form of acute lung injury. The objective of this study was to develop an ovine model of septic acute lung injury and characterize its pathophysiology regarding its recruitability and changes in regional aeration and perfusion distributions at injury and during injury evolution. ⋯ The severe hypoxemia, moderate volume loss, and perfusion patterns are consistent with an injury model in which hypoxemia is exacerbated by endotoxin-mediated failure of hypoxic pulmonary vasoconstriction.
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Critical care medicine · Aug 2009
Comparative StudyPreserved cerebral microcirculation during cardiogenic shock.
To hypothesize that in severe states of cardiogenic shock with profound decreases in buccal microcirculation, the cerebral microcirculation may be selectively protected. Decreases in buccal microcirculatory flow are closely associated with the severity and outcomes of circulatory shock. ⋯ In contrast to striking reduction in cardiac output and arterial pressures together with buccal microcirculatory flow, cerebral cortical microcirculatory flow was fully preserved during cardiogenic shock. These findings further document a dissociation between the systemic and cerebral circulations and potentially explain earlier clinical and experimental observations that the brain is selectively protected during severe states of cardiogenic shock in the absence of cardiac arrest.
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Critical care medicine · Aug 2009
Hypothermia-treated cardiac arrest patients with good neurological outcome differ early in quantitative variables of EEG suppression and epileptiform activity.
To evaluate electroencephalogram-derived quantitative variables after out-of-hospital cardiac arrest. ⋯ Quantitative electroencephalographic variables may be used to differentiate patients with good neurologic outcomes from those with poor outcomes after out-of-hospital cardiac arrest. The predictive values need to be determined in a larger, separate group of patients.
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Critical care medicine · Aug 2009
Hypercapnic acidosis attenuates shock and lung injury in early and prolonged systemic sepsis.
To investigate whether acute hypercapnic acidosis--induced by adding CO2 to inspired gas--would protect against severe systemic sepsis-induced lung and systemic organ injury resulting from cecal ligation and puncture. Acute hypercapnic acidosis protects against lung injury after both nonseptic and early pneumonia-induced lung injury. In contrast, prolonged hypercapnia worsens pneumonia-induced lung injury. The effects of hypercapnia and acidosis in the setting of systemic sepsis remain to be determined. ⋯ Hypercapnic acidosis exerts beneficial effects in early and prolonged cecal ligation and puncture-induced polymicrobial systemic sepsis.
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Critical care medicine · Aug 2009
Hemodynamic, metabolic, and organ function effects of pure oxygen ventilation during established fecal peritonitis-induced septic shock.
To test the hypothesis whether pure oxygen ventilation is equally safe and beneficial in fully developed fecal peritonitis-induced septic shock as hyperoxia initiated at the induction of sepsis. ⋯ When compared with the previous report on hyperoxia initiated simultaneously with induction of sepsis, i.e., using a pretreatment approach, pure oxygen ventilation started when porcine fecal peritonitis-induced septic shock was fully developed proved to be equally safe with respect to lung function and oxidative stress, but exerted only moderate beneficial effects.