Annals of intensive care
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Annals of intensive care · Dec 2016
The passive leg raising test to guide fluid removal in critically ill patients.
To investigate whether haemodynamic intolerance to fluid removal during intermittent renal replacement therapy (RRT) in critically ill patients can be predicted by a passive leg raising (PLR) test performed before RRT. ⋯ The presence of preload dependence, as assessed by a positive PLR test before starting RRT with fluid removal, predicts that RRT will induce haemodynamic intolerance.
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Annals of intensive care · Dec 2016
Ratios of central venous-to-arterial carbon dioxide content or tension to arteriovenous oxygen content are better markers of global anaerobic metabolism than lactate in septic shock patients.
To evaluate the ability of the central venous-to-arterial CO2 content and tension differences to arteriovenous oxygen content difference ratios (∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2, respectively), blood lactate concentration, and central venous oxygen saturation (ScvO2) to detect the presence of global anaerobic metabolism through the increase in oxygen consumption (VO2) after an acute increase in oxygen supply (DO2) induced by volume expansion (VO2/DO2 dependence). ⋯ ∆ContCO2/∆ContO2 and ∆PCO2/∆ContO2 ratios are more reliable markers of global anaerobic metabolism than lactate. ScvO2 failed to predict the presence of global tissue hypoxia.
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Annals of intensive care · Dec 2016
Effect of external PEEP in patients under controlled mechanical ventilation with an auto-PEEP of 5 cmH2O or higher.
In some patients with auto-positive end-expiratory pressure (auto-PEEP), application of PEEP lower than auto-PEEP maintains a constant total PEEP, therefore reducing the inspiratory threshold load without detrimental cardiovascular or respiratory effects. We refer to these patients as "complete PEEP-absorbers." Conversely, adverse effects of PEEP application could occur in patients with auto-PEEP when the total PEEP rises as a consequence. From a pathophysiological perspective, all subjects with flow limitation are expected to be "complete PEEP-absorbers," whereas PEEP should increase total PEEP in all other patients. This study aimed to empirically assess the extent to which flow limitation alone explains a "complete PEEP-absorber" behavior (i.e., absence of further hyperinflation with PEEP), and to identify other factors associated with it. ⋯ Expiratory flow limitation was associated with both high and complete "PEEP-absorber" behavior, but setting a relatively high respiratory rate on the ventilator can prevent from observing complete "PEEP-absorption." Therefore, the effect of PEEP application in patients with auto-PEEP can be accurately predicted at the bedside by measuring the respiratory rate and observing the flow-volume loop during manual compression of the abdomen.
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Annals of intensive care · Dec 2016
End-tidal carbon dioxide variation after a 100- and a 500-ml fluid challenge to assess fluid responsiveness.
EtCO2 variation has been advocated replacing cardiac output measurements to evaluate fluid responsiveness (FR) during sepsis. The ability of EtCO2 variation after a fluid challenge to detect FR in the context of general anaesthesia has not been investigated. Forty patients were prospectively studied. They underwent general anaesthesia for major surgeries. CO was measured by transoesophageal Doppler, and EtCO2 was recorded as well as other haemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), pulse pressure (PP)] at baseline, after 100-ml fluid load over 1 min, and at the end of the 500-ml fluid load. We measured the variation of EtCO2 at 100 (ΔEtCO2100) and 500 ml (ΔEtCO2500), and ROC curves were generated. A threshold for ΔEtCO2 to predict FR was determined with receiver operating curves (ROC) analysis. The primary end point was the ability of EtCO2 variation after a 500-ml fluid load to diagnose FR. ⋯ During surgery, when alveolar ventilation and CO2 production are constant, ΔEtCO2500 is fairly reliable to assess FR. When the variation of EtCO2 is >5.8 %, all patients were responders, but no conclusion could be done when this variation was <5.8 %. ΔEtCO2100 failed to predict FR. Trial registration CPP Lyon Sud Est III ref: 2013-027 B, Number ID RCB: 2013-A00729-36 delivered by the ANSM).
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Annals of intensive care · Dec 2016
Combination of C-reactive protein, procalcitonin and sepsis-related organ failure score for the diagnosis of sepsis in critical patients.
To measure the ability of a new bioscore to diagnose sepsis in a general critical care population. ⋯ This bioscore using CRP, PCT and SOFA score may potentially be used in the future to help identify septic patients earlier, improving their access to timely treatment modalities.