The open critical care medicine journal最新文献

{"title":"Hyperosmolar Solutions Effects on Cerebral Oxygenation and Metabolism","authors":"Petrikov Ss, Krylov Vv, Solodov Aa, U. V. Titova, H. Guseinova, L. T. Khamidova, A. Polupan","doi":"10.2174/1874828700902010018","DOIUrl":"https://doi.org/10.2174/1874828700902010018","url":null,"abstract":"Purpose: To estimate the dynamics of cerebral oxygenation and metabolism during intracranial pressure (ICP) correction with 15% Mannitol and 7,2% saline in 6% HES 200/0,5. Methods: We analyzed 39 episodes of ICP correction with 15% Mannitol or 7,2% NaCl in 6% HES 200/0,5 (\"Hyper- HAES\") in 9 patients with intracranial hemorrhage (GCS 4-8). Monitoring of ICP, systemic hemodynamics, SvjO2 and cerebral microdialysis was used in all patients. Brain temperature (Tbr) and brain oxygen tension (PbrO2) were investi- gated in 5 patients. ICP > 20 mmHg was the indication for treatment. Results: The duration of ICP reduction below 20 mmHg was 121 ± 58 min for 15% Mannitol and 258 ± 122 min for \"Hy- perHAES\" (p<0,001). Administration of the investigated solutions was associated with slight PbrO2 increase. 15% Manni- tol infusion did not change brain metabolism in \"intact\" and \"lesioned\" tissue. HyperHAES administration was accompa- nied with significant increase of glucose and pyruvate concentration in \"intact\" and \"lesioned\" brain tissue. We observed the same dynamics of cerebral oxygenation and metabolism in patients with traumatic and nontraumatic intracerebral hemorrhage. Infusion of investigated solutions was not accompanied by significant dynamics of cardiac preload and func- tion. Conclusions: \"HyperHAES\" infusion results in prolong ICP reduction than 15% Mannitol and is accompanied with slight increase of PbrO2 and significant improvement of cerebral metabolism. 15% Mannitol administration does not influence cerebral oxygenation and metabolism. 15% Mannitol and \"HyperHAES\" infusion does not influence systemic hemody- namics in normovolemic patients. Brain lesion, caused by intracranial hemorrhage may be accompanied by mitochondrial dysfunction, characterized by reduction and even enlargement of lactate/pyruvate ratio in condition of sufficient oxygen and glucose delivery to the brain.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"13 1","pages":"18-27"},"PeriodicalIF":0.0,"publicationDate":"2009-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85110762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperammonemia from a Urea Cycle Disorder Presenting in Adulthood","authors":"Tiffany C. Priester, T. Khoo, E. Fernández-Pérez, K. Regner, J. Tracy, S. Mitchell, M. Summar, D. Babovic‐Vuksanovic","doi":"10.2174/1874828700902010009","DOIUrl":"https://doi.org/10.2174/1874828700902010009","url":null,"abstract":"OBJECTIVE: The aim of this report is to describe a patient with late presentation of carbamyl phosphate syn- thetase I (CPS-I, EC 6.3.4.16) deficiency, a rare urea cycle deficiency, and to facilitate recognition and treatment of pa- tients presenting with encephalopathy and hyperammonemia in a critical care setting. DESIGN: Case Report. SETTING: Intensive care unit of Saint Mary's Hospital, Mayo Clinic, Rochester, Minnesota. PATIENT: A 65-year-old woman ad- mitted with progressive encephalopathy. INTERVENTIONS: Intubation and mechanical ventilation, protein-restricted parenteral nutrition, intravenous arginine, hemodiafiltration, and intravenous antibiotic therapy. MEASUREMENTS AND MAIN RESULTS: Serum ammonia and glutamine levels were elevated, but other laboratory and imaging investigations were unremarkable. Despite the above interventions, her mental status deteriorated. She developed ventilator associated pneumonia, which worsened despite antibiotic treatment. The family decided to withdraw care and the patient expired on hospital day 10. A postmortem enzyme assay on fresh-frozen liver tissue showed severely diminished CPS-I activity. CONCLUSIONS: To our knowledge, this is the oldest reported age at presentation of CPS-I deficiency. Urea cycle disor- ders should be part of the differential diagnosis of hyperammonemia regardless of age as early treatment may ameliorate mortality and morbidity in these patients.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"27 1","pages":"9-12"},"PeriodicalIF":0.0,"publicationDate":"2009-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81615172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Sigmoidal Equations To Describe the Pulmonary Pressure- Volume Curve in Acute Respiratory Distress Syndrome~!2008-09-18~!2008-10-27~!2008-12-05~!","authors":"S. Orfao, N. Hochhausen, R. Kuhlen, D. Henzler","doi":"10.2174/1874828700801010054","DOIUrl":"https://doi.org/10.2174/1874828700801010054","url":null,"abstract":"Pulmonary pressure-volume curves (P-V curves) of patients with acute lung injury are commonly analyzed us- ing a parametric algorithm with symmetrical properties. Some of the aspects observed after performing nonlinear regres- sion for two models capable of fitting symmetric, respectively asymmetric data are discussed. One analyzed aspect was the algebraic complexity of the asymmetric model that does not allow for an estimation of the boundaries of the zone of maximal compliance directly from the parameter estimates in contrast to the symmetric model. Moreover, mathematical evidence is provided. Using a sigmoid equation for analysis of P-V curves a systematic deviation caused by asymmetrical distribution was en- countered, leading to non-robust definitions of lower and upper inflection points. Increasing the number of parameters to fit asymmetric data does not increase physiological expression. We conclude that some of the drawbacks in using P-V curves may be attributed to imprecise analysis tools. To increase the value of P-V curves other forms of mathematical analysis should be investigated.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"9 1","pages":"54-62"},"PeriodicalIF":0.0,"publicationDate":"2008-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81084705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety in Bariatric Patient Transfers","authors":"E. Vieira, D. Dyer, L. Richardson, J. Raso","doi":"10.2174/1874828700801010048","DOIUrl":"https://doi.org/10.2174/1874828700801010048","url":null,"abstract":"Background: Bariatric patients are being seen more frequently in health care. Transferring these patients is a challenging and risky task. Objectives: To analyze safety and reduce risks for the musculoskeletal system of bariatric patients and health care workers during transfers from bed to wheelchair and back. Methods: Clinical intervention study of patient transfers using portable and ceiling lifts. The study was conducted in the largest freestanding rehabilitation center in North America. Forty transfers from bed to wheelchair and back involving eight bariatric patients (age: 46-62y, BMI: 42-48kg/m 2 ) were observed systematically, and four were video-recorded to il- lustrate the analysis. Two proactive risk assessments were performed and compared using a scoring system to evaluate the risks during the processes of transfers using portable and ceiling lifts. Results: The bariatric patient transfer system using portable lifts was replaced by installing and using ceiling lifts. The safety of the processes involving the two systems was compared in relation to risk of injuries to staff and patients. Using of ceiling lifts as opposed to portable lifts resulted in 28% reduction of low detectability incidents, 26% reduction of mod- erate effect incidents, and decreased both high and moderate probability incidents (22% and 30% reduction, respectively). Finally, it resulted in approximately 25% reduction on the sum of risk scores for the failure modes and causes requiring action. Conclusions: The results suggest that using ceiling lifts is safer than using portable lifts for bariatric patient transfers. The remaining risks were alleviated by training the staff and elaborating standardized procedures to perform these transfers.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"17 1","pages":"48-53"},"PeriodicalIF":0.0,"publicationDate":"2008-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90923075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uncovering Hypercoagulability in Sepsis Using ROTEM® Thromboelastometry: A Case Series","authors":"G. Luckner, V. Mayr, D. Fries, P. Innerhofer, S. Jochberger, W. Hasibeder, M. Dünser","doi":"10.2174/1874828700801010001","DOIUrl":"https://doi.org/10.2174/1874828700801010001","url":null,"abstract":"This case series presents three patients with sepsis/septic shock in whom standard coagulation tests (interna- tional normalized ratio, activated partial thromboplastin time, fibrinogen, antithrombin, thrombocytes) and ROTEM ® thromboelastometry (InTEM, ExTEM, FibTEM) were simultaneously performed. Although all patients showed signifi- cantly prolonged plasmatic coagulation times with a putatively increased risk of bleeding, ROTEM ® thromboelastometry revealed normal clotting times and even signs of hypercoagulability. Therefore, no coagulation active therapy was per- formed in any patient, not even before invasive procedures or major surgical interventions. No bleeding occurred in any study patient during surgery or the subsequent stay on the intensive care unit. These observations suggest that some criti- cally ill patients with sepsis and abnormal standard coagulation tests may in fact have hypercoagulability. ROTEM ® thromboelastometry can add important information in these patients and enable that blood products are used targeted and only for substitution of relevant deficencies. Future studies are necessary to validate these preliminary findings.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"111 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"2008-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73970605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Exercise Rehabilitation for Survivors of Intensive Care: Protocol for a Single Blind Randomised Controlled Trial","authors":"L. Denehy, S. Berney, E. Skinner, L. Edbrooke, S. Warrillow, G. Hawthorne, M. Morris","doi":"10.2174/1874828700801010039","DOIUrl":"https://doi.org/10.2174/1874828700801010039","url":null,"abstract":"Introduction: Intensive care (ICU) survivors have poor quality of life (QoL) and physical outcomes compared to people of the same age and sex (1). Although rehabilitation of patients in ICU is now advocated as routine clinical prac- tice (2) there are few randomised controlled trials (RCTs) examining patient outcomes. The primary aim of this single blind randomised controlled trial is to investigate the efficacy of a comprehensive rehabilitation intervention begun in ICU compared to standard care on health related quality of life (HRQoL) and physical function. Method: Participants who have been in one tertiary ICU for � 5 days, aged � 18 years, who can understand written and spoken English, will be randomly allocated to receive either standard care or a comprehensive physiotherapy rehabilita- tion program beginning in ICU and continuing upon discharge to the ward and as an out patient (OP). Blinded assessment of the primary outcome measures physical function, health status and HRQoL will be performed at baseline, 3, 6 and 12 months after discharge. Physical function measures will be obtained at ICU and hospital discharge and for the intervention group, pre and post OP classes. The intervention will include individualised exercises prescribed by physiotherapists in ICU and on the ward and given by an exercise physiologist and physiotherapist in OP. Results: We aim to enrol 200 participants over two years. The study will determine whether comprehensive physiotherapy rehabilitation from ICU to discharge and OP attendance will improve physical functioning, health status and quality of life in critical care survivors. The cost utility (CUA) and cost effectiveness of such a program will also be evaluated using util- ity scores and a purpose designed economics questionnaire. Secondary outcomes related to proxy and subject HRQoL comparisons, mechanical ventilation, critical illness neuromyopathy, ICU readmission and discharge destination will also be examined. Conclusion: The outcomes measured are of significance to critical care patients. The CUA of the intervention will be of interest to health service providers. The results will enable development of clinical practice guidelines for the appropriate exercises in survivors of ICU. Registered with the Australian and New Zealand Clinical Trials Network (ACTRN 12605000776606).","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"60 1","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2008-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78169047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expression and Localization of Pituitary Adenylate Cyclase-Activating Polypeptide-Specific Receptor (PAC1R) After Traumatic Brain Injury in Mice","authors":"K. Morikawa, K. Dohi, S. Yofu, Y. Mihara, T. Nakamachi, H. Ohtaki, S. Shioda, T. Aruga","doi":"10.1007/978-4-431-99039-0_19","DOIUrl":"https://doi.org/10.1007/978-4-431-99039-0_19","url":null,"abstract":"","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"27 1","pages":"207-210"},"PeriodicalIF":0.0,"publicationDate":"2008-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74214445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral Oxygen Desaturation with Normal ICP and CPP in Severe TBI","authors":"S. Palmer, M. K. Bader","doi":"10.2174/1874828700801010028","DOIUrl":"https://doi.org/10.2174/1874828700801010028","url":null,"abstract":"Introduction: Standard monitoring of severe traumatic brain injury patients (TBI) by intracranial pressure (ICP) and cerebral perfusion pressure (CPP) monitoring fails to recognize episodes of cerebral oxygen desaturation. We found and characterized frequent episodes of desaturation of jugular venous oxygen (SjO2) in the face of normal ICP and CPP. Methods: Fifty six patients with severe TBI had SjO2 and ICP monitors placed. The charts were retrospectively reviewed and all episodes of desaturation were recorded and characterized. Results: Nineteen patients had episodes of desaturation with normal ICP and CPP. The average GCS score was 5.8. 63% of desaturations occurred in the first 24 hours, 17% of desaturations occurred in 24-48 hours, and 20% occurred in 48-72 hours. The depth of desaturation was 50-54% in 50% of instances, 45-49% in 37% of instances, and 40-44% in 13% of in- stances. The duration of the desaturation episodes was less than 10 minutes in 47%, 10-30 minutes in 17%, 30-60 minutes in 23%, and greater than 50 minutes in 13%. Treatment of the desaturation was elevation of FIO2 in all patients, elevation of pCO2 in 15 patients, volume expansion in 9 patients, pressors in 9 patients, and Propofol in 5 patients. Conclusions: The monitoring of severe TBI patients with ICP and CPP alone is insufficient to recognize cerebral oxygen de- saturation episodes in 34% of patients. The monitoring of SjO2 facilitates the recognition and treatment of these episodes.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"82 1","pages":"28-32"},"PeriodicalIF":0.0,"publicationDate":"2008-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79334651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Mechanical Ventilation on Intestinal Permeability in Preterm Infants: A Retrospective Cohort Study~!2008-03-27~!2008-05-30~!2008-06-11~!","authors":"Martine F. Kruse-Ruijter, F. Plötz, J. Twisk, C. Bunkers, W. Fetter, R. M. Elburg","doi":"10.2174/1874828700801010024","DOIUrl":"https://doi.org/10.2174/1874828700801010024","url":null,"abstract":"Mechanical ventilation (MV) and ventilator strategies can induce or aggravate lung injury and may contribute to the development of distant organ failure, including the gastrointestinal tract. A retrospective cohort study was per- formed among 61 preterm infants, with a gestational age of 25-36 weeks, admitted at a neonatal intensive care unit. Intes- tinal permeability was measured by the sugar absorption test (SAT). Mechanically ventilated preterm infants were com- pared to not mechanically ventilated preterm infants. To analyze the effect of parameters of MV on intestinal permeabil- ity, we calculated the oxygenation index (OI). Intestinal permeability was not different in ventilated and not ventilated preterm infants within 48hr after birth. Although OI was < 10 in most of the infants, OI was positively correlated with the SAT, suggesting that the degree of MV was correlated with intestinal permeability.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"73 1","pages":"24-27"},"PeriodicalIF":0.0,"publicationDate":"2008-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84293113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation Between Markers of TH2-Oriented Response and SOFA Score in Sepsis","authors":"L. P. Fabbri, V. Santarlasci, M. Nucera, F. Liotta, C. Becchi, L. Cosmi, M. A. Malyan, E. Maggi, S. Boncinelli, F. Annunziato","doi":"10.2174/1874828700801010017","DOIUrl":"https://doi.org/10.2174/1874828700801010017","url":null,"abstract":"A shift from Th1- to Th2-type cell immune response has been suggested to occur during sepsis, contributing to cell-mediated immunity suppression and to poor prognosis. The aim was to study the relationship between old and new Th2 markers and the clinical outcome of sepsis. 30 critically ill patients with sepsis for � 48 hours were enrolled in a pro- spective clinical study. Blood samples were collected at the enrolment, at the 5 th and 10 th day. Serum levels of total IgE and soluble chemokines related to Th1- and Th2 responses were evaluated. The percentages and absolute number of CD4+ and CD8+Tcells as well as CRTH2+Tcell subsets were detected by flow cytometry. Sepsis severity was assessed with SOFA score. The mean values of total IgE in septic patients were significantly higher than in controls(p<0.01). Moreover, IgE levels of septic patients who died were higher than those of survived patients(p<0.05). It has been found that IgE levels directly and RANTES inversely correlated with SOFA score at different time points(p<0.01). A significant correlation between the percentages of CRTH2+/CD4+(but not CRTH2+/CD8+)T cells and SOFA at different time points was observed(p<0.05). The direct correlation between total IgE, the percentages of circulating CRTh2+CD4+T cells and the clinical outcome suggests that clinical worsening of sepsis is closely linked to the shift towards a predominant less protective Th2 phenotype. Although these are preliminary results, the longitudinal analysis of these parameters during the disease could be proposed as useful prognostic tools in sepsis.","PeriodicalId":88750,"journal":{"name":"The open critical care medicine journal","volume":"8 1","pages":"17-23"},"PeriodicalIF":0.0,"publicationDate":"2008-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87736160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}