Intensive care medicine
-
Intensive care medicine · Mar 2009
The relationship between the intracranial pressure-volume index and cerebral autoregulation.
The pressure-volume index (PVI) can be used to assess the cerebrospinal fluid dynamics and intracranial elastance in critically ill brain injured patients. The dependency of PVI on the state of cerebral autoregulation within the physiologic range of cerebral perfusion pressure (CPP) can be described by mathematical models that account for changes in cerebral blood volume during PVI testing. This relationship has never been verified clinically using direct PVI measurement and independent cerebral autoregulation assessment. ⋯ Cerebral autoregulation status can affect PVI estimation despite a normal CPP. PVI measurement may overestimate the tolerance of the intracranial system to volume loads in patients with disturbed cerebral autoregulation.
-
Intensive care medicine · Mar 2009
Late-onset hyperlactataemia following paediatric cardiac surgery.
To investigate the clinical significance of a late rise in blood lactate concentration, developing after PICU admission, in older children undergoing cardiac surgery. ⋯ LOH is common in older children following cardiac surgery. We found no evidence to suggest that it is associated with adverse clinical outcomes. The strong association between LOH and hyperglycaemia supports a metabolic aetiology.
-
Intensive care medicine · Mar 2009
Systemic and microcirculatory responses to progressive hemorrhage.
To compare systemic hemodynamics with microcirculatory changes at different vascular beds during progressive hemorrhage. ⋯ Alterations in sublingual, intestinal microcirculation, and arterial lactate simultaneously arose from the first step of bleeding. The microcirculatory changes were identified either by semi-quantitative flow index or by quantitative red blood cell velocity measurements.