Critical care medicine
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Critical care medicine · Mar 2005
ReviewComputed tomography scan assessment of lung volume and recruitment during high-frequency oscillatory ventilation.
This review describes how computed tomography has increased our understanding of the pathophysiology of acute respiratory distress syndrome. It summarizes current knowledge about lung volume changes and alveolar recruitment during high-frequency oscillatory ventilation (HFOV) assessed by computed tomography (CT), outlines potential problems when comparing HFOV with conventional ventilation (CV) as a result of the different pressure-time profiles, and describes future research directions. ⋯ CT is a valuable tool to quantify recruitment and overinflation during HFOV. Additional studies are needed to better characterize the specific effects of HFOV on lung volume and morphology.
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Critical care medicine · Mar 2005
ReviewSedation, analgesia, and neuromuscular blockade for high-frequency oscillatory ventilation.
To provide a comprehensive review of the issue related to the administration of sedative, analgesic, and neuromuscular blocking agents (NMBA) to patients who are receiving ventilatory support for acute respiratory distress syndrome (ARDS) with high-frequency oscillatory ventilation. ⋯ A multidisciplinary, structured approach that is based on the considerations described should help achieve optimal results in this challenging patient population.
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Critical care medicine · Mar 2005
Comparative StudyComparison between dobutamine and levosimendan for management of postresuscitation myocardial dysfunction.
To investigate the effects of levosimendan, a nonadrenergic inotropic calcium sensitizer, in comparison with adrenergic dobutamine for the management of postresuscitation myocardial dysfunction following resuscitation from prolonged cardiac arrest. ⋯ Levosimendan has the potential of improving postresuscitation myocardial function. It is likely to serve as an alternative to dobutamine as an inotropic agent for management of postresuscitation myocardial dysfunction.
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Critical care medicine · Mar 2005
Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the Anesthetic Conserving Device.
To examine ambient isoflurane pollution, scavenging efficacy, and isoflurane consumption using the Anesthetic Conserving Device (ACD) for prolonged isoflurane sedation in the intensive care unit. ⋯ In the present setting, isoflurane via the ACD is an environmentally safe method of sedation provided users follow instructions for standardizing procedures with potential spillage of isoflurane. This method of sedation requires considerably less isoflurane than with traditional vaporizer technique.
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Critical care medicine · Mar 2005
Cardiovascular response to acute normovolemic hemodilution in patients with coronary artery diseases: Assessment with transesophageal echocardiography.
Preoperative acute normovolemic hemodilution induces an increase in circulatory output that is thought to be limited in patients with cardiac diseases. Using multiple-plane transesophageal echocardiography, we investigated the mechanisms of cardiovascular adaptation during acute normovolemic hemodilution in patients with severe coronary artery disease. ⋯ In anesthetized patients with coronary artery disease, moderate acute normovolemic hemodilution did not compromise left ventricular systolic and diastolic function. Lowering blood viscosity resulted in increased stroke volume that was mainly related to increased venous return and higher cardiac preload.