Critical care : the official journal of the Critical Care Forum
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Comparative Study
Uncalibrated pulse power analysis fails to reliably measure cardiac output in patients undergoing coronary artery bypass surgery.
Uncalibrated arterial pulse power analysis has been recently introduced for continuous monitoring of cardiac index (CI). The aim of the present study was to compare the accuracy of arterial pulse power analysis with intermittent transpulmonary thermodilution (TPTD) before and after cardiopulmonary bypass (CPB). ⋯ Uncalibrated pulse power analysis was significantly influenced by MAP and was not able to reliably measure CI compared with TPTD. Calibration improved accuracy, but pulse power analysis was still not consistently interchangeable with TPTD. Only calibrated pulse power analysis was able to reliably track haemodynamic changes and trends.
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In ICUs, fluid administration is frequently used to treat hypovolaemia. Because volume expansion (VE) can worsen acute respiratory distress syndrome (ARDS) and volume overload must be avoided, predictive indicators of fluid responsiveness are needed. The purpose of this study was to determine whether passive leg raising (PLR) can be used to predict fluid responsiveness in patients with ARDS treated with venovenous extracorporeal membrane oxygenation (ECMO). ⋯ In patients treated with venovenous ECMO, a > 10% ΔPLRSV may predict fluid responsiveness. ΔPLRPP and ΔPLRPO cannot predict fluid responsiveness.
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Because of disturbed renal autoregulation, patients experiencing hypotension-induced renal insult might need higher levels of mean arterial pressure (MAP) than the 65 mmHg recommended level in order to avoid the progression of acute kidney insufficiency (AKI). ⋯ MAP about 72 to 82 mmHg could be necessary to avoid acute kidney insufficiency in patients with septic shock and initial renal function impairment.