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https://www.readbyqxmd.com/read/29760928/aneurysmal-subarachnoid-hemorrhage-intensive-care-for-improving-neurological-outcome
#1
REVIEW
Tomoya Okazaki, Yasuhiro Kuroda
Background: Aneurysmal subarachnoid hemorrhage is a life-threatening disease requiring neurocritical care. Delayed cerebral ischemia is a well-known complication that contributes to unfavorable neurological outcomes. Cerebral vasospasm has been thought to be the main cause of delayed cerebral ischemia, and although several studies were able to decrease cerebral vasospasm, none showed improved neurological outcomes. Our target is not cerebral vasospasm but improving neurological outcomes...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/29756414/arterial-to-end-tidal-carbon-dioxide-tension-difference-co-2-gap-as-a-prognostic-marker-for-adverse-outcomes-in-emergency-department-patients-presenting-with-suspected-sepsis
#2
Amith Shetty, Sebastian Sparenberg, Kristian Adams, Selwyn Selvedran, Benjamin Tang, Kim Hanna, Jonathan Iredell
OBJECTIVE: The arterial to end-tidal carbon dioxide tension difference (CO2 gap) correlates with physiologic dead space. The prognostic value of increased CO2 gap in trauma and respiratory distress patients is documented. Transpulmonary arteriovenous shunting is identified as a predictor of mortality in non-pulmonary sepsis. We set out to investigate the prognostic value of the CO2 gap in a pilot study of patients with suspected sepsis from non-respiratory causes. METHODS: Patients presenting to tertiary Australian ED with suspected sepsis (n = 215) underwent near-simultaneous end-tidal carbon dioxide and partial pressure of carbon dioxide measurements...
May 13, 2018: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/29752666/lung-water-assessment-from-gravimetry-to-wearables
#3
Frederic Michard
Several techniques are now available to detect and quantify pulmonary edema, from the laboratory postmortem method (gravimetry) to non-invasive wearable sensors. In critically ill patients with adult respiratory distress syndrome (ARDS), computed tomography scans are often performed to visualize lung lesions and quantify lung aeration, but their value seems somewhat limited to quantify pulmonary edema on a routine basis and of course to track changes with therapy. In this context, transpulmonary thermodilution is a convenient technique...
May 11, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29749700/influence-of-blood-purification-and-differential-injection-sites-of-cold-saline-on-transpulmonary-thermodilution-values
#4
Takahiro Kawaji, Toshikazu Sakai, Kazuhiro Moriyama, Yoshitaka Hara, Tomoyuki Nakamura, Naohide Kuriyama, Yasuyo Shimomura, Yu Kato, Hidefumi Komura, Chizuru Yamashita, Yasuyoshi Kurimoto, Daisuke Hasegawa, Osamu Nishida
We aimed to investigate the effects of blood purification and cold saline injection sites on the transpulmonary thermodilution values. We measured the cardiac output of eight pigs in every combination of cold saline injection (left jugular and femoral veins) and blood purification sites (right jugular and femoral veins), with or without blood purification. We examined the influence of the difference between the presence and absence of blood purification, vascular sites for blood purification, and sites for cold saline injection on the transpulmonary thermodilution values...
May 10, 2018: Therapeutic Apheresis and Dialysis
https://www.readbyqxmd.com/read/29743121/high-frequency-oscillatory-ventilation-guided-by-transpulmonary-pressure-in-acute-respiratory-syndrome-an-experimental-study-in-pigs
#5
Philipp Klapsing, Onnen Moerer, Christoph Wende, Peter Herrmann, Michael Quintel, Annalen Bleckmann, Jan Florian Heuer
BACKGROUND: Recent clinical studies have not shown an overall benefit of high-frequency oscillatory ventilation (HFOV), possibly due to injurious or non-individualized HFOV settings. We compared conventional HFOV (HFOVcon ) settings with HFOV settings based on mean transpulmonary pressures (PLmean ) in an animal model of experimental acute respiratory distress syndrome (ARDS). METHODS: ARDS was induced in eight pigs by intrabronchial installation of hydrochloric acid (0...
May 9, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29725794/cardiac-output-measurement-in-liver-transplantation-patients-using-pulmonary-and-transpulmonary-thermodilution-a-comparative-study
#6
Luigi Vetrugno, Elena Bignami, Federico Barbariol, Nicola Langiano, Francesco De Lorenzo, Carola Matellon, Giuseppe Menegoz, Giorgio Della Rocca
During liver transplantation surgery, the pulmonary artery catheter-despite its invasiveness-remains the gold standard for measuring cardiac output. However, the new EV1000 transpulmonary thermodilution calibration technique was recently introduced into the market by Edwards LifeSciences. We designed a single-center prospective observational study to determine if these two techniques for measuring cardiac output are interchangeable in this group of patients. Patients were monitored with both pulmonary artery catheter and the EV1000 system...
May 3, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29718770/endothelial-nitric-oxide-synthase-genotype-is-associated-with-pulmonary-hypertension-severity-in-left-heart-failure-patients
#7
Julio D Duarte, Mayank Kansal, Ankit A Desai, Katherine Riden, Meghan J Arwood, Alex A Yacob, Thomas D Stamos, Larisa H Cavallari, Roham T Zamanian, Sanjiv J Shah, Roberto F Machado
The biological mechanisms behind the development of pulmonary hypertension in the setting of left heart failure (HF-PH), including combined pre- and post-capillary pulmonary hypertension (Cpc-PH), remains unclear. This study aimed to use candidate polymorphisms in nitric oxide synthase (NOS) genes to explore the role of NOS in HF-PH. DNA samples from 118 patients with HF-PH were genotyped for the NOS3 rs1799983 and NOS2 rs3730017 polymorphisms. A multiple regression model was used to compare hemodynamic measurements between genotype groups...
April 2018: Pulmonary Circulation
https://www.readbyqxmd.com/read/29708892/continuous-negative-abdominal-pressure-reduces-ventilator-induced-lung-injury-in-a-porcine-model
#8
Takeshi Yoshida, Doreen Engelberts, Gail Otulakowski, Bhushan Katira, Martin Post, Niall D Ferguson, Laurent Brochard, Marcelo B P Amato, Brian P Kavanagh
BACKGROUND: In supine patients with acute respiratory distress syndrome, the lung typically partitions into regions of dorsal atelectasis and ventral aeration ("baby lung"). Positive airway pressure is often used to recruit atelectasis, but often overinflates ventral (already aerated) regions. A novel approach to selective recruitment of dorsal atelectasis is by "continuous negative abdominal pressure." METHODS: A randomized laboratory study was performed in anesthetized pigs...
April 27, 2018: Anesthesiology
https://www.readbyqxmd.com/read/29698719/serum-chloride-levels-track-with-survival-in-patients-with-pulmonary-arterial-hypertension
#9
Tawfeq Naal, Batool Abuhalimeh, Ghaleb Khirfan, Raed A Dweik, W H Wilson Tang, Adriano R Tonelli
BACKGROUND: Serum chloride is an important homeostatic biomarker in left heart failure, with significant prognostic implications. The impact of serum chloride in the long-term survival of pulmonary arterial hypertension (PAH) patients is unknown. We tested whether serum chloride levels are associated with long-term survival in PAH patients. METHODS: We included patients with idiopathic or heritable PAH who had a basic metabolic panel performed at the time of their diagnostic right heart catheterization...
April 23, 2018: Chest
https://www.readbyqxmd.com/read/29681957/mechanical-circulatory-support-is-effective-to-treat-pulmonary-hypertension-in-heart-transplant-candidates-disqualified-due-to-unacceptable-pulmonary-vascular-resistance
#10
Michał Zakliczyński, Jerzy Pacholewicz, Izabela Copik, Marcin Maruszewski, Tomasz Hrapkowicz, Roman Przybylski, Marian Zembala
Introduction: High pulmonary vascular resistance (PVR) in orthotopic heart transplantation (OHT) candidates is a risk factor of right ventricle failure after the procedure. However, the increase of PVR may be a consequence of the life-threatening deterioration of the left ventricle function. The use of mechanical circulatory support (MCS) seems to be the best solution, but it is reimbursed only in active OHT candidates. Aim: We performed a retrospective analysis of MCS effectiveness in maintaining PVR at values accepted for OHT...
March 2018: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/29680878/quantitative-computed-tomography-in-comparison-with-transpulmonary-thermodilution-for-the-estimation-of-pulmonary-fluid-status-a-clinical-study-in-critically-ill-patients
#11
Bernd Saugel, Moritz Wildgruber, Albrecht Staudt, Michael Dieckmeyer, Konstantin Holzapfel, Georgios Kaissis, Mikhail Y Kirov, Vsevolod V Kuzkov, Roland M Schmid, Wolfgang Huber
Extravascular lung water (index) (EVLW(I)) can be estimated using transpulmonary thermodilution (TPTD). Computed tomography (CT) with quantitative analysis of lung tissue density has been proposed to quantify pulmonary edema. We compared variables of pulmonary fluid status assessed using quantitative CT and TPTD in critically ill patients. In 21 intensive care unit patients, we performed TPTD measurements directly before and after chest CT. Based on the density data of segmented CT images we calculated the tissue volume (TV), tissue volume index (TVI), and the mean weighted index of voxel aqueous density (VMWaq)...
April 21, 2018: Journal of Clinical Monitoring and Computing
https://www.readbyqxmd.com/read/29670537/impact-of-different-tidal-volume-levels-at-low-mechanical-power-on-ventilator-induced-lung-injury-in-rats
#12
Lillian Moraes, Pedro L Silva, Alessandra Thompson, Cintia L Santos, Raquel S Santos, Marcos V S Fernandes, Marcelo M Morales, Vanessa Martins, Vera L Capelozzi, Marcelo G de Abreu, Paolo Pelosi, Patricia R M Rocco
Tidal volume (VT ) has been considered the main determinant of ventilator-induced lung injury (VILI). Recently, experimental studies have suggested that mechanical power transferred from the ventilator to the lungs is the promoter of VILI. We hypothesized that, as long as mechanical power is kept below a safe threshold, high VT should not be injurious. The present study aimed to investigate the impact of different VT levels and respiratory rates (RR) on lung function, diffuse alveolar damage (DAD), alveolar ultrastructure, and expression of genes related to inflammation [interleukin (IL)-6], alveolar stretch (amphiregulin), epithelial [club cell secretory protein (CC)16] and endothelial [intercellular adhesion molecule (ICAM)-1] cell injury, and extracellular matrix damage [syndecan-1, decorin, and metalloproteinase (MMP)-9] in experimental acute respiratory distress syndrome (ARDS) under low-power mechanical ventilation...
2018: Frontiers in Physiology
https://www.readbyqxmd.com/read/29655977/dexmedetomidine-or-fentanyl-cardiovascular-stability-and-analgesia-during-propofol-ketamine-total-intravenous-anaesthesia-in-experimental-pigs
#13
Andreas Lervik, Joanna Raszplewicz, Birgit Ranheim, Susanna Solbak, Simen F Toverud, Henning A Haga
OBJECTIVE: To compare cardiovascular function and response to nociception during total intravenous anaesthesia in pigs with propofol, ketamine and either dexmedetomidine or fentanyl administered as a continuous infusion. STUDY DESIGN: Blinded, randomized, balanced, crossover study ANIMALS: Eight immunocastrated male, mixed breed pigs with a mean ± standard deviation body weight of 26.4 ± 1.9 kg for dexmedetomidine and 27.5 ± 3.8 kg for fentanyl treatment...
May 2018: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29652273/assessment-of-the-effect-of-two-regimens-of-milrinone-infusion-in-pediatric-patients-undergoing-fontan-procedure-a-randomized-study
#14
Rabie Soliman, Adel Ragheb
Objective: The aim of the study was to compare the effect of two different regimens of milrinone on hemodynamics and oxygen saturation in pediatric patients undergoing Fontan procedure. Design: This was a randomized study. Setting: Cardiac centers. Patients: This study included 116 patients undergoing Fontan procedure. Material and Methods: Group E: Milrinone was started as infusion 0.5 μg/kg/min without a loading dose at the beginning of cardiopulmonary bypass (CPB) followed by infusion 0...
April 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29643065/pulmonary-effective-arterial-elastance-as-a-measure-of-right-ventricular-afterload-and-its-prognostic-value-in-pulmonary-hypertension-due-to-left-heart-disease
#15
Emmanouil Tampakakis, Sanjiv J Shah, Barry A Borlaug, Peter J Leary, Harnish H Patel, Wayne L Miller, Benjamin W Kelemen, Brian A Houston, Todd M Kolb, Rachel Damico, Stephen C Mathai, Edward K Kasper, Paul M Hassoun, David A Kass, Ryan J Tedford
BACKGROUND: Patients with combined post- and precapillary pulmonary hypertension due to left heart disease have a worse prognosis compared with isolated postcapillary. However, it remains unclear whether increased mortality in combined post- and precapillary pulmonary hypertension is simply a result of higher total right ventricular load. Pulmonary effective arterial elastance (Ea) is a measure of total right ventricular afterload, reflecting both resistive and pulsatile components. We aimed to test whether pulmonary Ea discriminates survivors from nonsurvivors in patients with pulmonary hypertension due to left heart disease and if it does so better than other hemodynamic parameters associated with combined post- and precapillary pulmonary hypertension...
April 2018: Circulation. Heart Failure
https://www.readbyqxmd.com/read/29608456/the-pulmonary-artery-catheter-is-it-still-alive
#16
Daniel De Backer, Jean-Louis Vincent
PURPOSE OF REVIEW: The present review discusses the current role of the pulmonary artery catheter (PAC) in the hemodynamic monitoring of critically ill patients. RECENT FINDINGS: The PAC has an important role in the characterization and management of hemodynamic alterations in critically ill patients. Use of the PAC has decreased in the last 30 years because of recent advances in less invasive hemodynamic monitoring techniques, in particular transpulmonary thermodilution and echocardiography, combined with the publication of the results of several randomized trials that failed to show improvements in outcome with the use of the PAC in various settings...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29608455/extravascular-lung-water-measurements-in-acute-respiratory-distress-syndrome-why-how-and-when
#17
Takashi Tagami, Marcus Eng Hock Ong
PURPOSE OF REVIEW: Increase in pulmonary vascular permeability accompanied with accumulation of excess extravascular lung water (EVLW) is the hallmark of acute respiratory distress syndrome (ARDS). Currently, EVLW and pulmonary vascular permeability index (PVPI) can be quantitatively measured using the transpulmonary thermodilution (TPTD) technique. We will clarify why, how, and when EVLW and PVPI measurements should be performed. RECENT FINDINGS: Although the Berlin criteria of ARDS are simple and widely used, several criticisms of them have been published...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29601320/esophageal-pressure-monitoring-why-when-and-how
#18
Takeshi Yoshida, Laurent Brochard
PURPOSE OF REVIEW: Esophageal manometry has shown its usefulness to estimate transpulmonary pressure, that is lung stress, and the intensity of spontaneous effort in patients with acute respiratory distress syndrome. However, clinical uptake of esophageal manometry in ICU is still low. Thus, the purpose of review is to describe technical tips to adequately measure esophageal pressure at the bedside, and then update the most important clinical applications of esophageal manometry in ICU...
March 29, 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29596015/continuous-negative-abdominal-pressure-mechanism-of-action-and-comparison-with-prone-position
#19
Takeshi Yoshida, Doreen Engelberts, Gail Otulakowski, Bhushan Katira, Niall D Ferguson, Laurent Brochard, Marcelo B P Amato, Brian P Kavanagh
We recently reported that continuous negative abdominal pressure (CNAP) could recruit dorsal atelectasis in experimental lung injury, and that oxygenation improved at different transpulmonary pressure values compared with increases in airway pressure (31). The mechanism of recruitment with CNAP is uncertain; and, its impact compared with a commonly proposed alternative approach to recruitment -prone positioning- is not known. We hypothesized that CNAP recruits lung by decreasing the vertical Ppl gradient (i...
March 29, 2018: Journal of Applied Physiology
https://www.readbyqxmd.com/read/29576127/evaluation-of-lung-and-chest-wall-mechanics-during-anaesthesia-using-the-peep-step-method
#20
P Persson, O Stenqvist, S Lundin
BACKGROUND: Postoperative pulmonary complications are common. Between patients there are differences in lung and chest wall mechanics. Individualised mechanical ventilation based on measurement of transpulmonary pressures would be a step forward. A previously described method evaluates lung and chest wall mechanics from a change of ΔPEEP and calculation of change in end-expiratory lung volume (ΔEELV). The aim of the present study was to validate this PEEP-step method (PSM) during general anaesthesia by comparing it with the conventional method using oesophageal pressure (PES) measurements...
April 2018: British Journal of Anaesthesia
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