Intensive care medicine
-
Intensive care medicine · Nov 1999
Clinical TrialDoes indocyanine green accurately measure plasma volume independently of its disappearance rate from plasma in critically ill patients?
To determine whether plasma volume determined by the indocyanine green (ICG) dilution method (PV-ICG) is equally accurate independently of its disappearance rate from plasma in the critically ill. ⋯ The results suggest that the measurement of the PV-ICG can be equally accurate independently of its disappearance rate from plasma unless there is generalized protein capillary leakage.
-
Intensive care medicine · Nov 1999
Case ReportsAcute neuromuscular respiratory failure after ICU discharge. Report of five patients.
To describe a syndrome of acute neuromuscular respiratory failure (NM-ARF) caused by ICU-acquired acute myopathy and neuropathy. ⋯ Critically ill patients with prolonged ICU stay, sepsis and MOF are at great risk of developing CRIMYNE, which in turn may be responsible for NM-ARF. This latter complication may arise after resolution of the respiratory and cardiac dysfunctions and successful weaning from the ventilator. As NM-ARF may cause unplanned ICU readmission or even unexpected death, strict clinical surveillance and monitoring of respiratory muscle function is recommended after discharge to the general ward of patients with proven NM-ARF. Early intensive chest physiotherapy can resolve the condition.
-
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.
-
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.