Intensive care medicine
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Intensive care medicine · Jun 2002
Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema.
To evaluate whether different indicators using for guiding volume expansion are valuable tools to assess edematous lung injury in patients with septic shock. ⋯ Volume variables (TEDVI, ITBVI) are more useful indicators than pressure variables (CVP, PAOP) for assessment of EVLWI in septic patients with pulmonary edema.
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Intensive care medicine · Jun 2002
Aerosolized beta(2)-adrenergic agonists achieve therapeutic levels in the pulmonary edema fluid of ventilated patients with acute respiratory failure.
Experimental studies demonstrate that beta-adrenergic agonists markedly stimulate alveolar fluid clearance if concentrations of 10(-6) M are achieved in alveolar fluid. However, no studies have determined whether aerosolized beta-adrenergic agonists are delivered to the distal air spaces of the lung in therapeutic concentrations in patients with pulmonary edema. ⋯ These results provide the first evidence that levels of beta-adrenergic agonists that are physiologically efficacious in experimental models can be achieved with conventional delivery systems in ventilated, critically ill patients with acute respiratory failure from pulmonary edema.
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Intensive care medicine · Jun 2002
Translaryngeal tracheostomy in acute respiratory distress syndrome patients.
To prevent gas exchange deterioration during translaryngeal tracheostomy (TLT) in patients with acute respiratory distress syndrome (ARDS) ventilation is maintained through a small diameter endotracheal tube (ETT; 4.0 mm i.d.) advanced beyond the tracheostoma. We report on the feasibility of uninterrupted ventilation delivered through a high-resistance ETT in ARDS patients, and relevant ventilatory adjustments and monitoring. ⋯ The high-resistance ETT allows ventilatory assistance during the whole TLT procedure. Assessment of stability in plateau pressure and PEEP(tot) by end-inspiratory and end-expiratory occlusions prevent hyperinflation and possibly barotrauma.
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Intensive care medicine · Jun 2002
High-frequency oscillatory ventilation in experimental lung injury: effects on gas exchange.
To compare ventilation-perfusion (V(A)/Q) distributions during improvement of oxygenation caused by high-frequency oscillatory ventilation (HFOV) and pressure-controlled mechanical ventilation with high PEEP levels (CMV) in experimental acute lung injury (ALI). ⋯ In this model of acute lung injury CMV and HFOV improved gas exchange due to similar changes in V(A)/Q distribution. However, mean airway pressure had to be adjusted twofold higher during HFOV then during CMV to achieve comparable improvements in gas exchange.
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Intensive care medicine · Jun 2002
Increased endogenous carbon monoxide production in severe sepsis.
A comparison was made between the endogenous carbon monoxide (CO) production in mechanically ventilated critically ill adult patients with, and those without, severe sepsis. ⋯ Endogenous CO production was significantly higher in mechanically ventilated patients suffering from severe sepsis. Further studies are required in order to determine the mechanism(s) and the functional significance of this increase.