Critical care medicine
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Critical care medicine · Oct 2008
Comparative StudyEffect of tidal volume, sampling duration, and cardiac contractility on pulse pressure and stroke volume variation during positive-pressure ventilation.
Both pulse pressure variation and stroke volume variation during intermittent positive-pressure ventilation predict preload responsiveness. However, because ventilatory and cardiac frequencies are not the same, increasing the number of breaths sampled may increase calculated pulse pressure variation and stroke volume variation because larger (max) and smaller (min) pulse pressure and stroke volume may occur. Tidal volume and contractility may also alter pulse pressure variation and stroke volume variation. We hypothesized that the magnitude of pulse pressure variation would increase with sampling duration, and that both tidal volume and contractility would independently alter pulse pressure variation and stroke volume variation. ⋯ Sampling duration, tidal volume, and beta-adrenergic blockade differentially alters pulse pressure variation and stroke volume variation during intermittent positive-pressure ventilation. Thus, separate validation is required to define threshold pulse pressure variation and stroke volume variation values used to drive resuscitation algorithms.
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Critical care medicine · Oct 2008
Hemoglobin-based oxygen carrying compound-201 as salvage therapy for severe neuro- and polytrauma (Injury Severity Score = 27-41).
A prehospital trial in trauma patients has been proposed to evaluate Hemopure (hemoglobin glutamer-250 [bovine], hemoglobin-based oxygen carrying compound [HBOC]-201, Biopure). We tested the hypothesis that HBOC-201 would improve cerebrovascular resuscitation in a unique polytrauma model. ⋯ 1) A single bolus of HBOC-201 at initial resuscitation rapidly restored cerebral perfusion pressure and stabilized hemodynamics with improved intracranial pressure and brain oxygen for the first 8 hrs; and 2) HBOC-201 could be an effective salvage therapy after severe neurotrauma or as a temporizing measure during prolonged transport of a polytrauma patient.
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Critical care medicine · Oct 2008
Comparative StudyEffects of colloid solutions on ischemia-reperfusion-induced periosteal microcirculatory and inflammatory reactions: comparison of dextran, gelatin, and hydroxyethyl starch.
To compare the microhemodynamics and possible anti-inflammatory reactions of colloid resuscitation with 4% gelatin, 6% dextran, or 6% hydroxyethyl starch 130/0.4 solutions. ⋯ When compared with gelatin or dextran solutions, hydroxyethyl starch provided a therapeutic advantage in this setting by exerting an inhibitory effect on the ischemia-reperfusion-induced local and systemic leukocyte reactions and the postischemic periosteal microvascular dysfunction.