Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Mar 2013
Distant effects of nitric oxide inhalation in lavage-induced lung injury in anaesthetised pigs.
Inhalation of nitric oxide (INO) exerts both local and distant effects. INO in healthy pigs causes down-regulation of endogenous nitric oxide (NO) production and vasoconstriction in lung regions not reached by INO, especially in hypoxic regions, which augments hypoxic pulmonary vasoconstriction. In contrast, in pigs with endotoxemia-induced lung injury, INO causes increased NO production in lung regions not reached by INO. The aim of this study was to investigate whether INO exerts distant effects in surfactant-depleted lungs. ⋯ Regional INO did not increase endogenous NO production in lavage-injured lung regions not directly reached by INO, but instead down-regulated the constitutive calcium-dependent nitric oxide synthase activity, indicating that NO may inhibit its own synthesis.
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Acta Anaesthesiol Scand · Mar 2013
Case ReportsUse of extracorporeal membrane oxygenation in combination with high-frequency oscillatory ventilation in post-traumatic ARDS.
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are life-threatening complications in trauma patients. Despite the implantation of a veno-venous extracorporeal membrane oxygenation (vv ECMO), sufficient oxygenation (arterial SaO(2) > 90%) is not always achieved. The additive use of high-frequency oscillation ventilation (HFOV) and ECMO in the critical phase after trauma could prevent the occurrence of life-threatening hypoxaemia and multi-organ failure. ⋯ With HFOV, almost complete recruitment of the lung was achieved, and the fraction of inspired oxygen (FiO(2) ) was significantly reduced. The pelvic fracture was treated non-operatively. The HFOV was terminated after 3 days, and the ECMO was stopped after 19 days.
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Acta Anaesthesiol Scand · Mar 2013
The incidence of delirium in Norwegian intensive care units; deep sedation makes assessment difficult.
Delirium in critically ill patients is associated with increased length of hospital stay, mortality and costs, and may lead to long-term cognitive impairment. It is often overlooked by clinicians if structured observation is not performed routinely. A national Norwegian survey reported that systematic screening and assessment of delirium were never or seldom performed. The purpose of this study was to test the usefulness of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and to describe the incidence of delirium in critically ill patients at two Norwegian hospitals. ⋯ Of the patients, 23% were classed as delirious (CAM-ICU positive) at least once during their stay. The CAM-ICU was difficult to use in patients with sedation so deep that they hardly gave eye contact and responded only weakly to verbal stimulation. Focusing on less sedation and further modifications to the CAM-ICU may benefit ICU patients in the future.