Critical care medicine
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Critical care medicine · Mar 2014
Comparative StudyAgitated Saline Bubble-Enhanced Transthoracic Echocardiography: A Novel Method to Visualize the Position of Central Venous Catheter.
The purpose of this study is to describe a novel method to visualize the position of central venous catheters, which is safe, expeditious, and less expensive than the routine postprocedural chest radiograph. ⋯ The results revealed that the accuracy of agitated saline bubble-enhanced transthoracic echocardiography is equivalent to the chest radiograph. It offers a safe, cost-effective, expeditious alternative to routine chest radiograph for position controls of central venous catheters.
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Critical care medicine · Mar 2014
Comparative StudyTrauma-Hemorrhagic Shock Induces a CD36-Dependent RBC Endothelial-Adhesive Phenotype.
Microvascular dysfunction is a key element in the development of the multiple organ dysfunction syndrome. Although the mechanisms for this response are unclear, RBC adhesion to endothelium may initiate intravascular occlusion leading to ischemic tissue injury. Thus, we tested the hypothesis that trauma-hemorrhage induces RBC-endothelial cell adhesion. ⋯ 1) Trauma-hemorrhagic shock induces rapid RBC adhesion to endothelial cells in patients and animals. 2) Increased RBC CD36 expression characterizes the RBC-adhesive phenotype. 3) The RBC phenotypic and functional changes were induced by gut-derived humoral factors. These novel findings may explain the microvascular dysfunction occurring after trauma-hemorrhagic shock, sepsis, and other stress states.
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Critical care medicine · Mar 2014
Extracorporeal Gas Exchange and Spontaneous Breathing for the Treatment of Acute Respiratory Distress Syndrome: An Alternative to Mechanical Ventilation?
Venovenous extracorporeal gas exchange is increasingly used in awake, spontaneously breathing patients as a bridge to lung transplantation. Limited data are available on a similar use of extracorporeal gas exchange in patients with acute respiratory distress syndrome. The aim of this study was to investigate the use of extracorporeal gas exchange in awake, spontaneously breathing sheep with healthy lungs and with acute respiratory distress syndrome and describe the interactions between the native lung (healthy and diseased) and the artificial lung (extracorporeal gas exchange) in this setting. ⋯ Spontaneous ventilation of both healthy sheep and sheep with acute respiratory distress syndrome can be controlled via extracorporeal gas exchange. If this holds true in humans, extracorporeal gas exchange could be used in awake, spontaneously breathing patients with acute respiratory distress syndrome to support gas exchange. A deeper understanding of the pathophysiology of spontaneous breathing during acute respiratory distress syndrome is however warranted in order to be able to propose extracorporeal gas exchange as a safe and valuable alternative to mechanical ventilation for the treatment of patients with acute respiratory distress syndrome.