Resuscitation
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To investigate the relationship between tissue oxygen saturation during a vascular occlusion test with systemic hemodynamics, central and peripheral skin temperature in patients resuscitated from cardiac arrest. ⋯ We found that peripheral skin temperature in post-arrest critically ill patients undergoing TH strongly influences tissue oxygen desaturation and reoxygenation rates. In additional, changes in NIRS derived variables were independent of measures of shock, vasopressor use or illness severity.
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Historical Article
From clinical judgment to odds: a history of prognostication in anoxic-ischemic coma.
Persistent coma from a major anoxic-ischemic injury to the brain may indicate there is less chance for full recovery. The tools of prognostication to assess comatose survivors of cardiopulmonary resuscitation have developed over several decades. Physicians would initially base their judgment on experience and data on outcome in these patients in the early years were merely on awakening not on disability. ⋯ The impetus for this study was the result of Plum and Jennet's collaboration. In 1981--for the first time--complex statistics were used to improve the accuracy of prognosis and became known as the "Levy algorithms." These early seminal studies shaped the prediction models and implied that clinical information alone could assist physicians in making a prediction. Later, probabilistic methods became more commonplace.
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New volumetric variables of preload, such as total end-diastolic volume index (TEDVI) and active circulation volume index (ACVI) and central blood volume index (CBVI), may represent good indicators of preload and predictors of fluid responsiveness. During acute changes of intravascular volume these variables would allow a more accurate intervention. ⋯ In this animal model, TEDVI and ACVI were superior to CBVI in consistently reflecting hemorrhage. TEDVI but not ACVI and CBVI correlated with volume-induced changes in SVI. NE administration did not affect this correlation.
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To investigate the predictors of adverse outcomes of extracorporeal life support (ECLS) in rescuing adult non-postcardiotomy cardiogenic shock or cardiac arrest (non-PC CS/CA). ⋯ ECLS was effective in bridging adults with non-PC CS/CA to definite treatments. Their prognosis depended on the cause of collapse and the severity of the post-cardiac arrest syndrome.
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Vasoconstriction is a side effect that may prevent the use of haemoglobin based oxygen carrier (HBOC) as blood substitute. Therefore, we tested the hypothesis that the NO donor, sodium nitroprusside (SNP), would mitigate systemic and pulmonary hypertension associated with HBOC-201 in a simple controlled haemorrhage swine model. ⋯ In swine with haemorrhagic shock, co-administration of the NO donor, SNP, effectively and safely reduces HBOC-201-related systemic but not pulmonary vasoactivity. Interestingly, co-administration of the vasodilator SNP with HEX had no deleterious effects in comparison with HEX alone.