Intensive care medicine
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Intensive care medicine · Oct 1999
Volume-dependent compliance in ARDS: proposal of a new diagnostic concept.
Adaptation of ventilator settings to the individual's respiratory system mechanics requires information about the pressure-volume relationship and the change of compliance which is dependent on inflated volume. Unfortunately, established methods of obtaining this information are invasive and time-consuming, and, therefore, not well suited for clinical routine. We propose a new standardized diagnostic concept based on the recently developed slice method. This multiple linear regression method (MLR) determines volume-dependent respiratory system compliance (C(SLICE)) within the tidal volume (V(T)) during ongoing mechanical ventilation. The impact of a ventilator strategy, recommended by a consensus conference, on the course of compliance within V(T) was investigated in patients with the acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). ⋯ C(SLICE) was not constant in patients with ARDS/ALI whose lungs were ventilated according to consensus conference recommendations. The proposed diagnostic concept may serve as a new tool to obtain a standardized estimation of respiratory system compliance within V(T) non-invasively without interfering with ongoing mechanical ventilation.
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Intensive care medicine · Oct 1999
Comparative StudyCardiac troponin: a new serum marker of myocardial injury in sepsis.
Echocardiogram-derived left ventricular ejection fraction (LVEF) is usually utilized to evaluate left ventricular function, including that of septic patients. However, LVEF is greatly influenced by afterload. The aim of this study was to test the hypothesis that troponin I, a serum marker of myocardial injury, may be able to detect left ventricular involvement by the septic process, being at least as sensitive an indicator of left ventricular dysfunction as LVEF in these patients. ⋯ Identification of myocardial dysfunction in septic patients has been a challenging task. Troponin I, a serum marker of myocardial injury, may be of great help in the recognition of myocardial involvement by sepsis in a noninvasive and readily available way.
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To develop a model able to determine the right time for extubation and to validate its performance. paragraph sign ⋯ VC together with the f/V(T) ratio and MEP offer accurate prediction of early extubation.
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Intensive care medicine · Oct 1999
Clinical Trial Controlled Clinical TrialInfluence of prothrombin complex concentrates on plasma coagulation in critically ill patients.
To evaluate thrombogenicity of prothrombin complex concentrates (PCCs) in critically ill patients. ⋯ Administration of PCCs induces thrombin generation. No evidence for induction of disseminated intravascular coagulation in biochemical terms could be found. When rapid correction of acquired coagulation factor disturbances is warranted, the use of PCCs seems reasonable, but the elevated risk of intravascular thrombus formation should be kept in mind.
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Intensive care medicine · Oct 1999
Review Comparative StudyAssessment of regional tissue oxygenation.