Intensive care medicine
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Intensive care medicine · Jul 1996
Haemodynamic changes in neurogenic pulmonary oedema: effect of dobutamine.
The haemodynamic and gas exchange abnormalities occurring in neurogenic pulmonary oedema (NPO) were examined retrospectively in 20 patients admitted to the Intensive Therapy Unit (ITU) over a 45-month period (February 1992 to November 1995). In 12 patients, where vasoactive therapy with dobutamine was employed, its effect on haemodynamics was examined. Cardiac index (CI median 2.2 l min-1 m-2) and left ventricular stroke work index (LVSWI 20 g.m.m-2) were markedly depressed, while pulmonary artery wedge pressure (PAWP 17 mmHg), mean pulmonary artery pressure (MPAP 30.5 mmHg), systemic vascular resistance index (SVRI 2852 dyne.s.cm-5.m2) and pulmonary vascular resistance index (PVRI 393 dyne.s.cm-5.m2) were substantially elevated above normal values. ⋯ Patients treated with dobutamine showed significant increases in CI and LVSWI and significant falls in SVRI and PAWP at 2 and 6 h after institution of therapy, and there was a significant rise in PaO2/fiO2 ratio to 27.8 kPa at 6 h. NPO was generally associated with severe depression of myocardial function and elevation of pulmonary vascular pressures. This dysfunction was readily reversed by dobutamine.
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Intensive care medicine · Jul 1996
Clinical TrialAutomated infusion of nitroglycerin to control arterial hypertension during cardiac surgery.
To evaluate the feasibility of closed-loop blood pressure control during cardiac surgery. ⋯ The controller provided fast and stable control in all patients. The expert knowledge implemented through the supervisory computer program enabled the controller to respond adequately to the rapid changes in arterial pressures commonly associated with cardiac surgery. We conclude that closed-loop control of arterial pressure is feasible not only in the cardiac surgical care unit but also during cardiac surgery.
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Intensive care medicine · Jul 1996
Effects of extreme lateral posture on hemodynamics and plasma atrial natriuretic peptide levels in critically ill patients.
To quantify the hemodynamic effects of turning critically ill, mechanically ventilated patients to the extreme left and right lateral postures. ⋯ Extreme lateral posture affects the cardiovascular system in critically ill, mechanically ventilated patients: in the left dependent position a "hyperdynamic state" is reinforced, while the right decubitus position impairs right ventricular preload and predisposes to hypotension. Echocardiography and changes in plasma atrial natriuretic peptide values indicate that these findings are due to altered distensibility of the right ventricle caused by regional intrathoracic gravitational changes. We conclude that the duration and the angle of lateral posture should be restricted in hemodynamically unstable patients.
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Intensive care medicine · Jul 1996
Case ReportsInorganic fluoride concentration after long-term sedation with isoflurane.
We report on five patients in whom long-term sedation with isoflurane for up to 7 days was used successfully. Serum inorganic fluoride concentrations were measured daily. ⋯ These were well below the described renal toxic level of 50 mmol l-1. There was no deterioration in renal function attributable to the use of isoflurane.