Intensive care medicine
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Intensive care medicine · Jan 1997
Clinical Trial Controlled Clinical TrialThe effects of low-dose dopamine on splanchnic blood flow and oxygen uptake in patients with septic shock.
To assess the effects of low-dose dopamine on splanchnic blood flow and splanchnic oxygen uptake in patients with septic shock. ⋯ Low-dose dopamine has a potential beneficial effect on splanchnic blood flow and oxygen consumption in patients with septic shock, provided the fractional splanchnic flow is not already high before treatment.
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Intensive care medicine · Jan 1997
Case ReportsIncreased lactate/pyruvate ratio with normal beta-hydroxybutyrate/acetoacetate ratio and lack of oxygen supply dependency in a patient with fatal septic shock.
We report a case of fatal septic shock, with hyperlactatemia and blood cultures positive for Streptococcus pneumoniae, in a 70-year-old patient. On two occasions (5 days, and 2 days before the patient's death), the relationship between oxygen delivery (DO2) and consumption (VO2) was examined in conjunction with two presumed markers of tissue oxygenation: the lactate/pyruvate ratio (L/P), and the beta-hydroxybutyrate acetoacetate ratio (beta OHB/AcAc). ⋯ The L/P ratio remained persistently above normal limits, thus suggesting actual organ or regional hypoxia. This case shows that during an overwhelming septic shock, the "oxygen flux test" can be negative, despite the presence of hyperlactatemia and of an increased L/P ratio suggestive of impaired tissue oxygenation.
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Intensive care medicine · Jan 1997
Effects of nebulized salbutamol on respiratory mechanics in adult respiratory distress syndrome.
To determine whether nebulized salbutamol improves the respiratory mechanics of patients with adult respiratory distress syndrome (ARDS). We also assessed the mechanisms that contribute to high respiratory system resistances during this disease. ⋯ a) Salbutamol administered through the endotracheal tube by a nebulizer device lessens respiratory system resistances and airway and alveolar pressures, and therefore could decrease the risk of barotrauma and alveolar damage; b) high respiratory system resistances in ARDS have an increased smooth muscle tone component that can be reversible with salbutamol.
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Intensive care medicine · Jan 1997
Hemodynamic and gas exchange responses to inhalation of nitric oxide in patients with the acute respiratory distress syndrome and in hypoxemic patients with chronic obstructive pulmonary disease.
Inhalation of nitric oxide (NO) can improve oxygenation and decrease mean pulmonary artery pressure (MPAP) in patients with the acute respiratory distress syndrome (ARDS). It is not known whether inhaled NO exerts a similar effect in hypoxemic patients with chronic obstructive pulmonary disease (COPD). ⋯ NO inhalation had similar effects on hemodynamics but not on gas exchange in ARDS and COPD patients, and this response probably depends on the underlying disease.
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Intensive care medicine · Jan 1997
Platelet activation with massive formation of thromboxane A2 during and after cardiopulmonary resuscitation.
Hypoxia and ischemia cause endothelial cell damage with consequent platelet activation. The hypothesis that human cardiac arrest accelerates platelet activation and the formation of prostanoids was tested. ⋯ Platelet activation with the massive formation of thromboxane A2 (TXA2) occurs in patients with out-of-hospital cardiac arrest. Successful resuscitation is not associated with the balanced production of PGI2 against the TXA2 formation.