Intensive care medicine
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Intensive care medicine · Jul 2001
Dysfunction of vasomotor reactivity in severe sepsis and septic shock.
Perfusion abnormalities are an overall phenomenon in severe sepsis and septic shock, leading to organ dysfunction. We investigated whether carbon dioxide (CO2)-induced vasomotor reactivity (VMR) is impaired in septic patients, compared with values obtained outside sepsis. ⋯ In the advent of a disturbed cerebral autoregulation, critical drops in blood pressure during sepsis are transferred directly into the vascular bed, leading to cerebral hypoperfusion. This mechanism might contribute to the pathogenesis of septic encephalopathy.
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Intensive care medicine · Jul 2001
Immediate prediction of recovery of consciousness after cardiac arrest.
Short-latency somatosensory evoked potential (SSEP) monitoring has been reported to be useful in predicting neurological outcome in patients with cardiac arrest and hypoxic-ischemic encephalopathy. To obtain the immediate data of SSEP and evaluate the relationship between the presence of cortical activity and the recovery of consciousness, SSEP was recorded immediately after return of spontaneous circulation. ⋯ Even immediately following resuscitation, absence of cortical activity in SSEP indicates unlikelihood of recovering consciousness, while the preservation of such activity suggests that consciousness is improved. The result promises further accumulation of patients to validate the predictive ability of SSEP in managing postresuscitated patients.
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Intensive care medicine · Jul 2001
Clinical TrialHepato-splanchnic metabolic effects of the stable prostacyclin analogue iloprost in patients with septic shock.
To evaluate the effects of the stable prostacyclin analogue iloprost on hepato-splanchnic blood flow, oxygen exchange and metabolism in patients with septic shock. ⋯ In patients with septic shock an iloprost-induced increase in cardiac index increased splanchnic blood flow and shifted oxygen utilization from the energy requiring de novo glucose production rate to other oxygen-demanding metabolic pathways.
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Intensive care medicine · Jul 2001
Clinical Trial Controlled Clinical TrialValidity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneously breathing critically ill patients.
To test a short indirect calorimetry protocol with five stable 1-min readings (5-min steady state) against the commonly used protocol of 30 1-min readings (30-min steady state) in critically ill patients with various modes of ventilation. ⋯ Indirect calorimetry with 5-min steady state test correlated very well with the 30-min steady state test in both mechanically ventilated and spontaneously breathing patients. The time required varies depending on the mode of ventilation, and it is influenced by the level of sedation in mechanically ventilated patients. The abbreviated protocol may be more acceptable to spontaneously breathing patients.
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Intensive care medicine · Jul 2001
Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year.
To assess the prognosis of patients with acute ischemic stroke who require mechanical ventilation and to determine early factors influencing mortality. ⋯ Systematic withholding of endotracheal intubation in patients with AIS is not recommended. Careful and rigorous neurologic examination, including assessment of brain stem reflexes, might help to identify patients with a very high probability of death despite mechanical ventilation.