Intensive care medicine
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Intensive care medicine · Aug 1997
Randomized Controlled Trial Clinical TrialHemofiltration increases IL-6 clearance in early systemic inflammatory response syndrome but does not alter IL-6 and TNF alpha plasma concentrations.
To test the hypothesis that continuous hemofiltration increases interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF alpha) clearances and results in decreased cytokine plasma concentrations independent of renal function in patients with early SIRS. ⋯ Continuous hemofiltration increases IL-6 plasma clearance but not TNF alpha clearance. However, hemofiltration failed to decrease plasma concentrations of TNF alpha and IL-6 and, therefore, cannot be used effectively for cytokine elimination in SIRS. Accordingly, beneficial effects occasionally reported with hemofiltration are unlikely to be expected due to elimination of IL-6 or TNF alpha.
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To determine the presence of tricuspid regurgitation (TR) in patients affected by acute lung injury (ALI) and the adult respiratory distress syndrome (ARDS) during mechanical ventilation with positive end-expiratory pressure (PEEP). ⋯ Our study demonstrated the development of TR after the use of PEEP in patients with ALI and ARDS as a consequence of pulmonary hypertension and right ventricular overloading. Since TR may randomly affect cardiac output values and derived parameters, the assessment of cardiac performance by some techniques such as thermodilution should be used with caution.
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Intensive care medicine · Aug 1997
Clinical TrialHigh survival rate in 122 ARDS patients managed according to a clinical algorithm including extracorporeal membrane oxygenation.
We investigated whether a treatment according to a clinical algorithm could improve the low survival rates in acute respiratory distress syndrome (ARDS). ⋯ We conclude that patients with ARDS can be successfully treated with the clinical algorithm and high survival rates can be achieved.
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Intensive care medicine · Aug 1997
Clinical TrialPharmacokinetics of piperacillin and tazobactam in critically ill patients with renal failure, treated with continuous veno-venous hemofiltration (CVVH).
Kinetics of piperacillin (pip), in combination with the beta-lactamase inhibitor tazobactam (taz) have been studied in volunteers and patients in relatively stable conditions. The fixed drug preparation appeared to have ideal pharmacokinetic properties if renal function was normal or slightly impaired, but no data are available for critically ill patients in anuric renal failure. This study should provide such data. PATIENTS, DESIGN: We studied the pharmacokinetics in nine patients with multiple organ failure, including anuric renal failure, treated with continuous veno-venous hemofiltration (CVVH). Patients received a standard schedule of 4 g pip and 0.5 g taz administered over 0.5 h intravenously, 8 hourly. During 2 consecutive days, the serum levels of both compounds were determined, and total clearance (CIT) was calculated from serum concentrations. ⋯ In CVVH dependent patients, pip/taz fixed drug preparations can be used initially, but the pip dosage should be increased relative to that of taz (or interval-adjusted) to prevent cumulation of taz, as compared to the active antimicrobial agent pip.
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Intensive care medicine · Aug 1997
Case ReportsSuccessful weaning from mechanical ventilation following balloon mitral commissurotomy.
Successful weaning from mechanical ventilation (MV) following percutaneous balloon mitral commissurotomy (BMC) is reported in a 59-year-old woman with severe symptomatic rheumatic mitral stenosis. The patient was admitted to the Intensive Care Unit for acute respiratory failure secondary to pulmonary edema requiring intubation and mechanical ventilation. ⋯ In spite of the reinforcement of conventional therapy (diuretics, digitalis, vasodilators), weaning attempts were unsuccessful because of persisting elevated left atrial pressure. Percutaneous BMC was performed with favorable hemodynamic results, allowing the removal of external ventilatory support 24 h later and discharge from the Intensive Care Unit the same day.