Critical care medicine
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Critical care medicine · Nov 2009
Comparative StudyContinuous right ventricular volumetry by fast-response thermodilution during right ventricular ischemia: head-to-head comparison with conductance catheter measurements.
To evaluate the accuracy of right ventricular ejection fraction and right ventricular end-diastolic volume obtained by volumetric pulmonary artery catheter, using the conductance catheter as reference method. ⋯ Accuracy of volumetric pulmonary artery catheter in conditions of right ventricular ischemia is low and inadequate for diagnosis of right ventricular ischemia and failure.
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Critical care medicine · Nov 2009
Patient flow variability and unplanned readmissions to an intensive care unit.
To determine whether high patient inflow volumes to an intensive care unit are associated with unplanned readmissions to the unit. ⋯ Days of high patient inflow volumes to the unit were associated significantly with subsequent unplanned readmissions to the unit. Furthermore, the data indicate a possible dose-response relationship between intensive care unit inflow and patient outcomes. Further research is needed to understand how to defend against this risk for readmission.
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Critical care medicine · Nov 2009
Infection-induced lung injury is worsened after renal buffering of hypercapnic acidosis.
Prolonged hypercapnia is commonly encountered during the treatment of acute respiratory distress syndrome and acute respiratory failure attributable to other causes with protective ventilation strategies. In these circumstances, compensatory renal buffering returns pH to normal establishing a condition of buffered hypercapnia. It is also common intensive care practice to correct the pH more rapidly using bicarbonate infusions. Although it is well-established that hypercapnic acidosis has potent anti-inflammatory and protective effects, the effect of buffered hypercapnia on acute lung injury and acute respiratory distress syndrome is unknown. We therefore wished to determine the effects of buffered hypercapnia on acute lung injury induced by endotoxin or Escherichia coli infection in vivo. ⋯ Our results demonstrate that infection-induced injury in vivo is worsened after renal buffering of hypercapnic acidosis independently of any changes in tidal volume. These findings have important implications for our understanding of the pathogenesis of infection-induced lung injury during the use protective ventilation strategies that permits buffered hypercapnia and during infective exacerbations of chronic lung diseases associated with sustained hypercapnia.
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Critical care medicine · Nov 2009
Evaluation of sublingual and gut mucosal microcirculation in sepsis: a quantitative analysis.
To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion. ⋯ The severity and the time course of microcirculatory changes were similar in the sublingual and in the gut region in this clinically relevant model of severe sepsis. These findings support the sublingual region as an appropriate region to monitor the microcirculation in sepsis.