Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Jul 2012
Haemodynamic stability and pulmonary shunt during spontaneous breathing and mechanical ventilation in porcine lung collapse.
We investigated the haemodynamic stability of a novel porcine model of lung collapse induced by negative pressure application (NPA). A secondary aim was to study whether pulmonary shunt correlates with cardiac output (CO). ⋯ This porcine lung collapse model is reasonably stable in terms of haemodynamics for at least 2 h irrespective of the mode of ventilation. SB achieves higher PaO(2) /FiO(2) and lower Q(va) /Q(t) compared with MV. During SB, Q(va) /Q(t) seems to be less, if at all, affected by CO compared with MV.
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Acta Anaesthesiol Scand · Jul 2012
Positive fluid balance is associated with reduced survival in critically ill patients with cancer.
There are no studies that describe the impact of the cumulative fluid balance on the outcomes of cancer patients admitted to intensive care units ICUs. The aim of our study was to evaluate the relationship between fluid balance and clinical outcomes in these patients. ⋯ A cumulative positive fluid balance higher than 1100 ml/24 h was independently associated with mortality in patients with cancer. These findings highlight the importance of improving the evaluation of these patients' volemic state and indicate that defined goals should be used to guide fluid therapy.
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Acta Anaesthesiol Scand · Jul 2012
Effect of a fluid challenge on the Surgical Pleth Index during stable propofol-remifentanil anaesthesia.
The Surgical Pleth Index (SPI), derived from pulse amplitude and heartbeat interval, is proposed to monitor anti-nociception during anaesthesia. Its response to noxious stimulation can be affected by the intravascular volume status. This study investigated the effect of a fluid challenge (FC) on SPI during steady-state conditions. ⋯ During stable anaesthesia and surgery, SPI may change in response to FC. The effect of FC on SPI is influenced by volaemia and Ce(PPF) through pulse wave amplitude modifications. These situations may confound the interpretation of SPI as a surrogate measure of the nociception-anti-nociception balance.
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Acta Anaesthesiol Scand · Jul 2012
Randomized Controlled Trial Comparative StudyIntubation of the morbidly obese patient: GlideScope(®) vs. Fastrach™.
Several potential problems can arise from airway management in morbidly obese patients, including difficult mask ventilation and difficult intubation. We hypothesised that endotracheal intubation of morbidly obese patients would be more rapid using the GlideScope(®) (GS) (Verathon Inc Corporate Headquarters, Bothell, WA, USA) than with the Fastrach™ (FT) (The Laryngeal Mask Company Ltd, Le Rocher, Victoria, Mahe, Seychelles). ⋯ No significant difference between the two methods was found. The GS and the FT may therefore be considered to be equally good when intubating morbidly obese patients.
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Acta Anaesthesiol Scand · Jul 2012
Impact of shed blood products on stimulated cytokine release in an in vitro model of transfusion.
Blood transfusion is reported to suppress the recipient's immune system. To avoid allogenic transfusion, post-operative shed blood retransfusion is a commonly used method. The aim of this study was to investigate the dose-related impact of post-operatively collected shed blood products on the stimulated cytokine release in an in vitro model of transfusion. ⋯ Shed blood and its components caused a dose-independent immunomodulation as indicated by a suppressed stimulated TNF-α release. Leukocytes seem to play a minor role, as we observed a sustained suppression after transfusion of γ-irradiated shed blood. Only the elimination of soluble factors by centrifugation and followed by an additional washing step prevented the observed suppression of TNF-α. Thus, we assume that washing of shed blood can prevent potential detrimental effects.