Critical care : the official journal of the Critical Care Forum
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Lung protective ventilation requires low tidal volume and suitable positive end-expiratory pressure (PEEP). To date, few methods have been accepted for clinical use to set the appropriate PEEP. The aim of this study was to test the feasibility of PEEP titration guided by ventilation homogeneity using the global inhomogeneity (GI) index based on electrical impedance tomography (EIT) images. ⋯ According to the results, it is feasible and reasonable to use the GI index to select the PEEP level with respect to ventilation homogeneity. The GI index may provide new insights into the relationship between lung mechanics and tidal volume distribution and may be used to guide ventilator settings.
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Lipid emulsions based on soybean oil have been an integral part of parenteral nutrition supplying n-6 fatty acids, with possible negative effects in critically ill patients. Newer lipid emulsions supply less n-6 fatty acids. ⋯ Recent data suggest that beneficial effects may be achieved when used early but clearly more data are needed to come to a definitive conclusion. The present commentary will highlight current data in critically ill and septic patients and the use of fish oil as a part of parenteral nutrition.
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To examine the effects of positive end-expiratory pressure (PEEP) on intra-abdominal pressure (IAP) in patients with acute lung injury (ALI). ⋯ PEEP is a contributing factor that impacts IAP values. It seems necessary to take into account the level of PEEP whilst interpreting IAP values in patients under mechanical ventilation.
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We sought to examine the cardiac consequences of early administration of norepinephrine in severely hypotensive sepsis patients hospitalized in a medical intensive care unit of a university hospital. ⋯ Early administration of norepinephrine aimed at rapidly achieving a sufficient perfusion pressure in severely hypotensive septic-shock patients is able to increase cardiac output through an increase in cardiac preload and cardiac contractility. This effect remained in patients with poor cardiac contractility except when values of MAP ≥75 mm Hg were achieved.
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Schochl and co-authors have described a 5-year retrospective study that outlines a novel, important and controversial transfusion concept in seriously injured trauma patients. Traditionally, clinicians have been taught to use a serial approach, resuscitating hypovolemic trauma patients with a form of crystalloid or colloid, followed by red blood cells (RBCs), then fresh frozen plasma (FFP), and lastly platelets. ⋯ Conversely, Schochl and colleagues, in an innovative, retrospective study, describe the use of fibrinogen concentrate, plasma complex concentrate, RBCs, FFP, and platelets driven by a thromboelastometry-based algorithm. Finally, it appears that transfusion therapy is becoming driven by physiology.