Canales de SAEI.ORG
Intensive Care Medicine
Titulares
Resúmenes
Abstract
Purpose Ineffective respiratory efforts during expiration (IEE) are a problem during mechanical ventilation (MV). The goal of this
study is to validate mathematical algorithms that automatically detect IEE in a computerized (Better Care®) system that obtains and processes data from intensive care unit (ICU) ventilators in real time.
Methods The Better Care® system, integrated with ICU health information systems, synchronizes and processes data from bedside technology. Algorithms
were developed to analyze airflow waveforms during expiration to determine IEE. Data from 2,608,800 breaths from eight patients
were recorded. From these breaths 1,024 were randomly selected. Five experts independently analyzed the selected breaths and
classified them as IEE or not IEE. Better Care® evaluated the same 1,024 breaths and assigned a score to each one. The IEE score cutoff point was determined based on the
experts' analysis. The IEE algorithm was subsequently validated using the electrical activity of the diaphragm (EAdi) signal
to analyze 9,600 breaths in eight additional patients.
Results Optimal sensitivity and specificity were achieved by setting the cutoff point for IEE by Better Care® at 42%. A score >42% was classified as an IEE with 91.5% sensitivity, 91.7% specificity, 80.3% positive predictive value
(PPV), 96.7% negative predictive value (NPV), and 79.7% Kappa index [confidence interval (CI) (95%) = (75.6%; 83.8%)]. Compared
with the EAdi, the IEE algorithm had 65.2% sensitivity, 99.3% specificity, 90.8% PPV, 96.5% NPV, and 73.9% Kappa index [CI
(95%) = (71.3%; 76.3%)].
Conclusions In this pilot, Better Care® classified breaths as IEE in close agreement with experts and the EAdi signal.
Content Type: Journal ArticleCategory OriginalPages 1-9DOI 10.1007/s00134-012-2493-4
Authors
Lluis Blanch, Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, SpainBernat Sales, CIBER Enfermedades Respiratorias, ISCiii, Madrid, SpainJaume Montanya, Fundació Parc Tauli, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, SpainUmberto Lucangelo, Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, ItalyOscar Garcia-Esquirol, Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, SpainAna Villagra, Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, SpainEncarna Chacon, Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, SpainAnna Estruga, Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, SpainMassimo Borelli, Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara Hospital, Trieste University, Trieste, ItalyMa Jose Burgueño, Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, SpainJoan C. Oliva, Fundació Parc Tauli, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, SpainRafael Fernandez, CIBER Enfermedades Respiratorias, ISCiii, Madrid, SpainJesus Villar, CIBER Enfermedades Respiratorias, ISCiii, Madrid, SpainRobert Kacmarek, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USAGastón Murias, Clínica Bazterrica y Clínica Santa Isabel, Buenos Aires, Argentina
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Ineffective efforts during mechanical ventilation: the brain wants, the machine declines
Content Type: Journal ArticleCategory EditorialPages 1-3DOI 10.1007/s00134-012-2497-0
Authors
Dimitris Georgopoulos, Department of Intensive Care Medicine, University Hospital of Heraklion, Medical School, University of Crete, Heraklion, Crete, Greece
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Selective decontamination in European intensive care patients
Content Type: Journal ArticleCategory EditorialPages 1-6DOI 10.1007/s00134-012-2488-1
Authors
Evelien A. N. Oostdijk, Department of Medical Microbiology, University Medical Center Utrecht, G04.614, PO box 85500, 3508 GA Utrecht, The NetherlandsBastiaan H. J. Wittekamp, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The NetherlandsChristian Brun-Buisson, INSERM U955, Université Paris Est-Créteil, Créteil, FranceMarc J. M. Bonten, Department of Medical Microbiology, University Medical Center Utrecht, G04.614, PO box 85500, 3508 GA Utrecht, The Netherlands
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose To determine whether fever is associated with an increased or decreased risk of death in patients admitted to an intensive
care unit (ICU) with infection.
Methods We evaluated the independent association between peak temperature in the first 24 h after ICU admission and in-hospital mortality
according to whether there was an admission diagnosis of infection using a database of admissions to 129 ICUs in Australia
and New Zealand (ANZ) (n = 269,078). Subsequently, we sought to confirm or refute the ANZ database findings using a validation cohort of admissions
to 201 ICUs in the UK (n = 366,973).
Results A total of 29,083/269,078 (10.8%) ANZ patients and 103,191/366,973 (28.1%) of UK patients were categorised as having an infection.
In the ANZ cohort, adjusted in-hospital mortality risk progressively decreased with increasing peak temperature in patients
with infection. Relative to the risk at 36.5 – 36.9°C, the lowest risk was at 39 – 39.4°C (adjusted OR 0.56; 95% CI 0.48 – 0.66).
In patients without infection, the adjusted mortality risk progressively increased above 39.0°C (adjusted OR 2.07 at 40.0°C
or above; 95% CI 1.68 – 2.55). In the UK cohort, findings were similar with adjusted odds ratios at corresponding temperatures
of 0.77 (95% CI 0.71 – 0.85) and 1.94 (95% CI 1.60 – 2.34) for infection and non-infection groups, respectively.
Conclusions Elevated peak temperature in the first 24 h in ICU is associated with decreased in-hospital mortality in critically ill patients
with an infection; randomised trials are needed to determine whether controlling fever increases mortality in such patients.
Content Type: Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-012-2478-3
Authors
Paul Jeffrey Young, Medical Research Institute of New Zealand, Intensive Care Research, Wellington Regional Hospital, Intensive Care Unit, Wellington, New ZealandManoj Saxena, St George Clinical School, University of New South Wales, Sydney, NSW, AustraliaRichard Beasley, Medical Research Institute of New Zealand, Wellington, New ZealandRinaldo Bellomo, Austin Hospital, Intensive Care Unit, Melbourne, VIC, AustraliaMichael Bailey, Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, AustraliaDavid Pilcher, Intensive Care Unit, Alfred Hospital, Melbourne, VIC, AustraliaSimon Finfer, Division of Critical Care and Trauma, George Institute for Global Health, Sydney, NSW, AustraliaDavid Harrison, Intensive Care National Audit and Research Centre, London, UKJohn Myburgh, St George Clinical School, University of New South Wales, Sydney, NSW, AustraliaKathryn Rowan, Intensive Care National Audit and Research Centre, London, UK
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Properly regulated circadian rhythm supports physical and immunologic function. This rhythm is disrupted in patients with
critical illness. We assessed the association between ambient light and circadian melatonin release, measured by urinary 6-sulfatoxymelatonin
(6-SMT), in medical intensive care unit (MICU) patients with severe sepsis.
Methods After excluding patients for renal failure or hepatic failure, blindness, and intracranial disease, seven patients were studied.
No environmental manipulation was performed. Urinary 6-SMT specimens were obtained every 4 h. Light was measured in 1-min
epochs for two sequential 24-h periods and compared to 6-SMT levels.
Results No significant differences among urinary 6-SMT levels were found across 4-h time periods or between the 2 days (range 1,190.26 ± 1,040.81 – 4,738.57 ± 5,543.08 ng,
4-h period p = 0.09, 24-h day p = 0.50). Light levels were low and differed among 4-h periods, but not 24-h averages (minimum 2.32 ± 3.65 lux/min 00:01 – 04:00,
maximum 70.11 ± 79.12 lux/min from 12:01 – 16:00, 4 h period p = <0.001, 24 h period p = 0.53). There was no relationship between light levels and 6-SMT excretion.
Conclusions Circadian rhythm was disrupted in patients with severe sepsis, as reflected by disordered diurnal variation of urinary 6-SMT
excretion. Light levels were low, exhibited limited diurnal variation, and did not entrain circadian rhythms in these patients.
Content Type: Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-012-2494-3
Authors
Avelino C. Verceles, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USALeann Silhan, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USAMichael Terrin, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USAGiora Netzer, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USACarl Shanholtz, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USASteven M. Scharf, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, 110 S. Paca St, Second Floor, Baltimore, MD 21201, USA
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Objectives To define a set of indicators that could be used to improve quality in intensive care medicine.
Methodology An European Society of Intensive Care Medicine Task Force on Quality and Safety identified all commonly used key quality indicators.
This international Task Force consisted of 18 experts, all with a self-proclaimed interest in the area. Through a modified
Delphi process seeking greater than 90% consensual agreement from this nominal group, the indicators were then refined through
a series of iterative processes.
Results A total of 111 indicators of quality were initially found, and these were consolidated into 102 separate items. After five
discrete rounds of debate, these indicators were reduced to a subset of nine that all had greater than 90% agreement from
the nominal group. These indicators can be used to describe the structures (3), processes (2) and outcomes (4) of intensive
care. Across this international group, it was much more difficult to obtain consensual agreement on the indicators describing
processes of care than on the structures and outcomes.
Conclusion This document contains nine indicators, all of which have a high level of consensual agreement from an international Task
Force, which could be used to improve quality in routine intensive care practice.
Content Type: Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-011-2462-3
Authors
A. Rhodes, Department of Intensive Care Medicine, St George's Healthcare NHS Trust and St George's University of London, London, SW17 0QT UKR. P. Moreno, Unidade de Cuidados Intensivos Polivalente, Hospital de St. António Dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E, Lisbon, PortugalE. Azoulay, Service de Réanimation Médicale, Hôpital Saint-Louis, Université Paris 7, 1 Avenue Claude Vellefaux, 75010 Paris, FranceM. Capuzzo, Section of Anaesthesiology and Intensive Care, Department of Surgical, Anaesthetic and Radiological Sciences, University Hospital of Ferrara, Corso Giovecca 203, 44100 Ferrara, ItalyJ. D. Chiche, Réanimation Médicale-Hôpital Cochin, 27 Rue Du Faubourg St Jacques, 75679 Paris Cedex 14, FranceJ. Eddleston, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, Oxford Road, Manchester, M13 9WL UKR. Endacott, Faculty of Health, University of Plymouth, 8 Portland Villas, Drake Circus, Plymouth, PL4 8AA UKP. Ferdinande, Surgical and Transplantation ICU, University Hospital Gasthuisberg, Leuven, BelgiumH. Flaatten, Haukeland University Hospital, Bergen, NorwayB. Guidet, Service de réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Paris, 75012 FranceR. Kuhlen, HELIOS Kliniken GmbH, Geschäftsführer Medizin, Friedrichstrasse 136, 10117 Berlin, GermanyC. León-Gil, Servicio de Cuidados Críticos y Urgencias, Hospital Universitario de Valme, Ctra. Cádiz, Sevilla, SpainM. C. Martin Delgado, Hospital de Torrejón, C /Mateo Inurria, s/n, 28850 Torrejón de Ardoz, Madrid, SpainP. G. Metnitz, Department of Anesthesia and General Intensive Care, AKH Wien Medical University of Vienna, Vienna, AustriaM. Soares, IDOR – D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30-3º andar, Botafogo, Rio de Janeiro, RJ CEP 22281-100, BrazilC. L. Sprung, General Intensive Care Unit, Hadassah Hebrew University Medical Center, PO Box 12000, 91120 Jerusalem, IsraelJ. F. Timsit, Responsable Médical Clinique Réanimation Médicale (PMAC), Teaching Hospital Albert Michallon, University Grenoble 1, PO Box 217, 38043 Grenoble Cedex 9, FranceA. Valentin, General and Medical ICU, Rudolfstiftung Hospital, Juchgasse 25, 1030 Vienna, Austria
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Response to fluid challenge is often defined as an increase in cardiac index (CI) of more than 10 – 15%. However, in clinical
practice CI values are often not available. We evaluated whether changes in mean arterial pressure (MAP) correlate with changes
in CI after fluid challenge in patients with septic shock.
Methods This was an observational study in which we reviewed prospectively collected data from 51 septic shock patients in whom complete
hemodynamic measurements had been obtained before and after a fluid challenge with 1,000 ml crystalloid (Hartman's solution)
or 500 ml colloid (hydroxyethyl starch 6%). CI was measured using thermodilution. Patients were divided into two groups (responders
and non-responders) according to their change in CI (responders: %CI >10%) after the fluid challenge. Statistical analysis
was performed using a two-way analysis of variance test followed by a Student's t test with adjustment for multiple comparisons. Pearson's correlation and receiver operating characteristic curve analysis
were also used.
Results Mean patient age was 67 ± 17 years and mean Sequential Organ Failure Assessment (SOFA) upon admittance to the intensive care
unit was 10 ± 3. In the 25 responders, MAP increased from 69 ± 9 to 77 ± 9 mmHg, pulse pressure (PP) increased from 59 ± 15
to 67 ± 16, and CI increased from 2.8 ± 0.8 to 3.4 ± 0.9 L/min/m2 (all p < 0.001). There were no significant correlations between the changes in MAP, PP, and CI.
Conclusions Changes in MAP do not reliably track changes in CI after fluid challenge in patients with septic shock and, consequently,
should be interpreted carefully when evaluating the response to fluid challenge in such patients.
Content Type: Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-011-2457-0
Authors
Charalampos Pierrakos, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, BelgiumDimitrios Velissaris, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, BelgiumSabino Scolletta, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, BelgiumSarah Heenen, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, BelgiumDaniel De Backer, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, BelgiumJean-Louis Vincent, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose This study investigates whether positron emission tomography (PET) can be used to monitor the inflammatory response and its
correlation with the later fibroproliferative phase in an experimental model of acute lung injury.
Methods Hydrochloric acid (0.1 N, pH 1, 1.5 ml/kg) was instilled into the right bronchus of mice. A group of mice underwent a micro-computed
tomography (CT) scan 1 h after lung injury and a series of 2-[18F]fluorine-2-deoxy-d-glucose (FDG)-PET scans (6, 24 and 48 h and 7 days after surgery). After 21 days respiratory static compliance was assessed
and lung tissue was collected in order to measure the hydroxy (OH)-proline content. Other groups of mice underwent micro-CT
and micro-PET scans at the same time points, and then were immediately killed to assess arterial blood gases and histology.
Results Histological analysis showed the recruitment of neutrophils and macrophages into the damaged lung, reaching the peak at 24
and 48 h, respectively. The time course of the [18F]FDG signal, used as a marker of inflammation, correlated with that of recruited inflammatory cells. In mice killed 21 days
after the surgery, a correlation was found between reduced respiratory static compliance and high PET signal 7 days after
lung injury. The PET signal also correlated with the OH-proline content.
Conclusions This study demonstrated that PET imaging is a valid means of tracking the inflammatory response, also in longitudinal studies.
Moreover, a correlation was found between persistence of the inflammatory response and fibrotic evolution of the injury.
Content Type: Journal ArticleCategory ExperimentalPages 1-8DOI 10.1007/s00134-011-2456-1
Authors
Vanessa Zambelli, Department of Experimental Medicine (DIMS), University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, ItalyGiuseppe Di Grigoli, Tecnomed Foundation, Foundation of University of Milano-Bicocca, Milan, MI, ItalyMargherita Scanziani, Department of Experimental Medicine (DIMS), University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, ItalySilvia Valtorta, Tecnomed Foundation, Foundation of University of Milano-Bicocca, Milan, MI, ItalyMaria Amigoni, Department of Experimental Medicine (DIMS), University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, ItalySara Belloli, IBFM, CNR, Milan, ItalyCristina Messa, Tecnomed Foundation, Foundation of University of Milano-Bicocca, Milan, MI, ItalyAntonio Pesenti, Department of Experimental Medicine (DIMS), University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, ItalyFerruccio Fazio, Tecnomed Foundation, Foundation of University of Milano-Bicocca, Milan, MI, ItalyGiacomo Bellani, Department of Experimental Medicine (DIMS), University of Milan-Bicocca, Via Cadore 48, 20900 Monza, MB, ItalyRosa Maria Moresco, Tecnomed Foundation, Foundation of University of Milano-Bicocca, Milan, MI, Italy
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
An atypical case of Guillain – Barré syndrome: acute intermittent porphyria
Content Type: Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-012-2464-9
Authors
É. Cuquemelle, Réanimation Médicale, AP-HP, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceS. Ehrmann, Réanimation Médicale, AP-HP, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceK. Razazi, Réanimation Médicale, AP-HP, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceJ. C. Deybach, Centre Français des Porphyries, INSERM U773, AP-HP, Hôpital Louis Mourier, Colombes, FranceC. Brun-Buisson, Réanimation Médicale, AP-HP, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, FranceA. W. Thille, Réanimation Médicale, AP-HP, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Background Low socioeconomic status (SES) is associated with increased mortality from cardiovascular disease, cancer and trauma. However,
individual-level prospective data on SES in relation to health outcomes among critically ill patients admitted to intensive
care units (ICU) are unavailable.
Methods In a cohort of 1,006 patients at a 24-bed surgical ICU of an academic tertiary care facility in Germany, we examined levels
of SES in relation to disease severity at admission, time period of mechanical ventilation, length of stay and frequency of
phone calls and visits by next-of-kin.
Findings Patients with low SES had higher risk for Sequential Organ Failure Assessment (SOFA) score greater or equal to 5 [multivariate-adjusted
odds ratio (OR) 1.49; 95% confidence interval (CI) 0.95 – 2.33; p = 0.029] and a trend for higher risk for Simplified Acute Physiology Score (SAPS II) greater or equal to 31 (OR 1.28; 95%
CI 0.80 – 2.05; p = 0.086) at admission as compared with patients with high SES. When compared with men with high SES, those with low SES had
greater risk for ICU treatment =5 days (multivariate-adjusted OR 1.99; 95% CI 1.06 – 3.74; p = 0.036) and showed a trend for a low number of visits from next-of-kin (<0.5 visits per day) (OR 1.85; 95% CI 0.79 – 4.30;
p = 0.054). In women such associations could not be demonstrated.
Interpretation Socioeconomic status is inversely related to severity of disease at admission and to length of stay in ICU, and positively
associated with the level of care by next-of-kin. Whether relations differ by gender requires further examination.
Content Type: Journal ArticleCategory OriginalPages 1-8DOI 10.1007/s00134-012-2463-x
Authors
Thomas Bein, Department of Anaesthesiology and Critical Care, University Hospital, 93042 Regensburg, GermanyKathrin Hackner, Department of Anaesthesiology and Critical Care, University Hospital, 93042 Regensburg, GermanyTianya Zou, Department of Epidemiology and Preventive Medicine, University Hospital, Regensburg, GermanySybille Schultes, Department of Anaesthesiology and Critical Care, University Hospital, 93042 Regensburg, GermanyTeresa Bösch, Department of Anaesthesiology and Critical Care, University Hospital, 93042 Regensburg, GermanyHans Jürgen Schlitt, Department of Surgery, University Hospital, Regensburg, GermanyBernhard M. Graf, Department of Anaesthesiology and Critical Care, University Hospital, 93042 Regensburg, GermanyMatthias Olden, Department of Epidemiology and Preventive Medicine, University Hospital, Regensburg, GermanyMichael Leitzmann, Department of Epidemiology and Preventive Medicine, University Hospital, Regensburg, Germany
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Epidemiology of contrast-associated acute kidney injury in ICU patients: reply to Valette and du Cheyron
Content Type: Journal ArticleCategory CorrespondencePages 1-1DOI 10.1007/s00134-012-2471-x
Authors
Eric Hoste, Ghent University Hospital-Intensive Care Medicine, De Pintelaan 185, 9000 Ghent, BelgiumSeverine Doom, Ghent University Hospital-Intensive Care Medicine, De Pintelaan 185, 9000 Ghent, BelgiumJan De Waele, Ghent University Hospital-Intensive Care Medicine, De Pintelaan 185, 9000 Ghent, BelgiumLouke Delrue, Ghent University Hospital-Intensive Care Medicine, De Pintelaan 185, 9000 Ghent, BelgiumLuc Defreyne, Ghent University Hospital-Intensive Care Medicine, De Pintelaan 185, 9000 Ghent, BelgiumDominique Benoit, Ghent University Hospital-Intensive Care Medicine, De Pintelaan 185, 9000 Ghent, BelgiumJohan Decruyenaere, Ghent University Hospital-Intensive Care Medicine, De Pintelaan 185, 9000 Ghent, Belgium
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Contrast 'induced' versus 'associated' acute kidney injury: take care with the definition
Content Type: Journal ArticleCategory CorrespondencePages 1-1DOI 10.1007/s00134-012-2470-y
Authors
Xavier Valette, Medical Intensive Care Unit, University Hospital of Caen, Av Côte de Nacre, 14000 Caen, FranceDamien du Cheyron, Medical Intensive Care Unit, University Hospital of Caen, Av Côte de Nacre, 14000 Caen, France
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Objective Severe forms of Kawasaki disease (KD) associated with shock have recently been reported in which a greater number of coronary
artery abnormalities (CAA) were observed. In this study, we analyzed organ involvement not restricted to cardiovascular aspects
in severe KD and assessed whether their outcome is different than in common forms.
Design Retrospective study.
Setting A 12-bed pediatric intensive care unit (PICU) in a university hospital setting.
Patients All patients managed in the PICU with a diagnosis of KD from 1 January 2001 to 30 April 2009.
Results Eleven patients were admitted because of moderate febrile shock without initial KD diagnosis. Median age was 75 months (6 – 175)
with a male:female ratio of 1.4. KD was diagnosed and treated after a delay of 1 day (0 – 2), for a total of 7 days (5 – 9) after
fever onset. Seven patients (63%) developed CAA after 21 days (6 – 30) with complete regression within a delay of 120 days (18 – 240).
Nonspecific encephalopathy (n = 6) as well as acute kidney injury (n = 10) were also observed. Multiple organ dysfunction syndrome (MODS) occurred in eight patients. Although predicted mortality
according to the PELOD score [21 (10 – 43)] ranged from 20% to up to 50%, all 11 children survived with no sequelae.
Conclusion Moderate shock is the main reason for PICU admission in children suffering from KD. These forms can be associated with surprising
MODS. Despite the severity of symptoms, all patients survived without any sequelae, hence the need for proper diagnosis and
rapid treatment of these unusual severe forms.
Content Type: Journal ArticleCategory Pediatric OriginalPages 1-7DOI 10.1007/s00134-012-2473-8
Authors
Pauline Gatterre, Service de Réanimation Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, FranceMehdi Oualha, Service de Réanimation Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, FranceLaurent Dupic, Service de Réanimation Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, FranceFranck Iserin, Service de Cardiologie Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, FranceChristine Bodemer, Service de Dermatologie Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, FranceFabrice Lesage, Service de Réanimation Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, FrancePhilippe Hubert, Service de Réanimation Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, France
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Large infusion of crystalloids may induce acid-base alterations according to their strong ion difference ([SID]). We wanted
to prove in vivo, at constant PCO2, that if the [SID] of the infused crystalloid is equal to baseline plasma bicarbonate, the arterial pH remains unchanged,
if lower it decreases, and if higher it increases.
Methods In 12 pigs, anesthetized and mechanically ventilated at PCO2 ˜40 mmHg, 2.2 l of crystalloids with a [SID] similar to (lactated Ringer's 28.3 mEq/l), lower than (normal saline 0 mEq/l),
and greater than (rehydrating III 55 mEq/l) baseline bicarbonate (29.22 ± 2.72 mEq/l) were infused for 120 min in randomized
sequence. Four hours of wash-out were allowed between the infusions. Every 30 min up to minute 120 we measured blood gases,
plasma electrolytes, urinary volume, pH, and electrolytes. Albumin, hemoglobin, and phosphates were measured at time 0 and
120 min.
Results Lactated Ringer's maintained arterial pH unchanged (from 7.47 ± 0.06 to 7.47 ± 0.03) despite a plasma dilution around 12%.
Normal saline caused a reduction in pH (from 7.49 ± 0.03 to 7.42 ± 0.04) and rehydrating III induced an increase in pH (from
7.46 ± 0.05 to 7.49 ± 0.04). The kidney reacted to the infusion, minimizing the acid-base alterations, by increasing/decreasing
the urinary anion gap, primarily by changing sodium and chloride concentrations. Lower urine volume after normal saline infusion
was possibly due to its greater osmolarity and chloride concentration as compared to the other solutions.
Conclusions Results support the hypothesis that at constant PCO2, pH changes are predictable from the difference between the [SID] of the infused solution and baseline plasma bicarbonate
concentration.
Content Type: Journal ArticleCategory ExperimentalPages 1-8DOI 10.1007/s00134-011-2455-2
Authors
T. Langer, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyE. Carlesso, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyA. Protti, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyM. Monti, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyB. Comini, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyL. Zani, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyD. T. Andreis, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyG. E. Iapichino, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyD. Dondossola, Centro di Ricerche Chirurgiche Precliniche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, ItalyP. Caironi, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, ItalyS. Gatti, Centro di Ricerche Chirurgiche Precliniche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, ItalyL. Gattinoni, Dipartimento di Anestesiologia, Terapia Intensiva e Scienze Dermatologiche, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Università degli Studi, Via Francesco Sforza, 35 20122 Milano, Italy
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Work of breathing to optimize noninvasive ventilation in bronchiolitis obliterans
Content Type: Journal ArticleCategory CorrespondencePages 1-3DOI 10.1007/s00134-012-2469-4
Authors
Lisa Giovannini-Chami, Pediatric Pulmonary Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, 06200 Nice, FranceSonia Khirani, Pediatric Pulmonary Unit, National Reference Center for Rare Lung Diseases, INSERM UMR S-938, AP-HP, Hôpital Armand-Trousseau, Université Pierre et Marie Curie-Paris 6, 28 avenue du Docteur Arnold Netter, 75012 Paris, FranceGuillaume Thouvenin, Pediatric Pulmonary Unit, National Reference Center for Rare Lung Diseases, INSERM UMR S-938, AP-HP, Hôpital Armand-Trousseau, Université Pierre et Marie Curie-Paris 6, 28 avenue du Docteur Arnold Netter, 75012 Paris, FranceAdriana Ramirez, Pediatric Pulmonary Unit, National Reference Center for Rare Lung Diseases, INSERM UMR S-938, AP-HP, Hôpital Armand-Trousseau, Université Pierre et Marie Curie-Paris 6, 28 avenue du Docteur Arnold Netter, 75012 Paris, FranceBrigitte Fauroux, Pediatric Pulmonary Unit, National Reference Center for Rare Lung Diseases, INSERM UMR S-938, AP-HP, Hôpital Armand-Trousseau, Université Pierre et Marie Curie-Paris 6, 28 avenue du Docteur Arnold Netter, 75012 Paris, France
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Objective The Pediatric Index of Mortality 2 (PIM2), one of the key mortality prediction models for children in intensive care units,
has not been validated in Japan. The purpose of this study was to validate the performance of PIM2 in a population of patients
admitted to one pediatric intensive care unit (PICU) in Japan.
Methods This was a prospective cohort study involving consecutive patients admitted to the largest multidisciplinary PICU in Japan
between 1 January 2008 and 31 December 2010. There were no interventions.
Results A total of 2,536 patients were included in this study of whom 67 (2.6%) died. Discrimination between survival and death assessed
by the area under the receiver operating characteristic curve was 0.92 [95% confidence interval (CI) 0.89 – 0.96]. Calibration
across the five risk intervals according to the Hosmer – Lemeshow goodness-of-fit test showed a chi-square value of 4.8 (df = 5, p = 0.44). The standardized mortality ratio for the whole population was 0.77 (95% CI 0.59 – 0.96).
Conclusions At the largest PICU center in Japan, the PIM2 was found to have excellent discriminatory power and good calibration, although
it over-predicted deaths. Based on these results, PIM2 can be used as a good prediction model for pediatric mortality, which
is a tool used to assess the overall quality of care in a PICU.
Content Type: Journal ArticleCategory OriginalPages 1-6DOI 10.1007/s00134-011-2460-5
Authors
Toshihiro Imamura, Division of Critical Care Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535 JapanSatoshi Nakagawa, Division of Critical Care Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535 JapanRan D. Goldman, The Pediatric Research in Emergency Therapeutics (PRETx) Program, Division of Pediatric Emergency Medicine, BC Children's Hospital, Child and Family Research Institute, University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 3N1, CanadaTakeo Fujiwara, Department of Social Medicine, National Research Institute for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Hypercapnic acidosis often occurs in critically ill patients and during protective mechanical ventilation; however, the effect
of hypercapnic acidosis on endogenous nitric oxide (NO) production and hypoxic pulmonary vasoconstriction (HPV) presents conflicting
results. The aim of this study is to test the hypothesis that hypercapnic acidosis augments HPV without changing endogenous
NO production in both hyperoxic and hypoxic lung regions in pigs.
Methods Sixteen healthy anesthetized pigs were separately ventilated with hypoxic gas to the left lower lobe (LLL) and hyperoxic gas
to the rest of the lung. Eight pigs received 10% carbon dioxide (CO2) inhalation to both lung regions (hypercapnia group), and eight pigs formed the control group. NO concentration in exhaled
air (ENO), nitric oxide synthase (NOS) activity, cyclic guanosine monophosphate (cGMP) in lung tissue, and regional pulmonary
blood flow were measured.
Results There were no differences between the groups for ENO, Ca2+-independent or Ca2+-dependent NOS activity, or cGMP in hypoxic or hyperoxic lung regions. Relative perfusion to LLL (Q
LLL/Q
T) was reduced similarly in both groups when LLL hypoxia was induced. During the first 90 min of hypercapnia, Q
LLL/Q
T increased from 6% (1%) [mean (standard deviation, SD)] to 9% (2%) (p < 0.01), and then decreased to the same level as the control group, where Q
LLL/Q
T remained unchanged. Cardiac output increased during hypercapnia (p < 0.01), resulting in increased oxygen delivery (p < 0.01), despite decreased PaO2 (p < 0.01).
Conclusions Hypercapnic acidosis does not potentiate HPV, but rather transiently weakens HPV, and does not affect endogenous NO production
in either hypoxic or hyperoxic lung regions.
Content Type: Journal ArticleCategory ExperimentalPages 1-9DOI 10.1007/s00134-012-2482-7
Authors
Manja C. A. Nilsson, Department of Anesthesiology and Intensive Care, Uppsala University, Uppsala, SwedenFilip Fredén, Department of Anesthesiology and Intensive Care, Uppsala University, Uppsala, SwedenAnders Larsson, Department of Anesthesiology and Intensive Care, Uppsala University, Uppsala, SwedenPeter Wiklund, Department of Urology, Karolinska University Hospital, Stockholm, SwedenMaria Bergquist, Hedenstierna Laboratory, Uppsala University, Uppsala, SwedenKristina Hambraeus-Jonzon, Department of Anesthesiology Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Stockholm, Sweden
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Year in review in Intensive Care Medicine 2011. II. Cardiovascular, infections, pneumonia and sepsis, critical care organization and outcome, education, ultrasonography, metabolism and coagulation
Content Type: Journal ArticleCategory Year in Review 2011Pages 1-14DOI 10.1007/s00134-012-2467-6
Authors
Massimo Antonelli, Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, ItalyMarc Bonten, Department of Medical Microbiology, Julius Center for Health Sciences, Primary Care University Medical Center, Utrecht, The NetherlandsJean Chastre, Reanimation medicale, Hopital Pitié Salpétrière, Paris, FranceGiuseppe Citerio, Neurointensive Care Unit, Ospedale S. Gerardo, Monza, ItalyGiorgio Conti, Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, ItalyJ. Randall Curtis, Division of Pulmonary and Critical Care, University of Washington, Seattle, WA, USADaniel De Backer, Service des Soins Intensifs, Erasme Hospital, Brussels, BelgiumGoran Hedenstierna, Department of Clinical Physiology, Uppsala University, Uppsala, SwedenMichael Joannidis, Department of Internal Medicine, Medical University of Innsbruck, Innsbruck, AustriaDuncan Macrae, Pediatric Intensive Care Unit, Royal Brompton Hospital, London, UKJordi Mancebo, Intensive Care Medicine Unit, Hospital Sant Pau, Barcelona, SpainSalvatore M. Maggiore, Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168 Rome, ItalyAlexandre Mebazaa, Department of Anesthesiology and Critical Care Medicine, Lariboisière Hospital, Paris, FranceJean-Charles Preiser, Department of Intensive Care, Erasme University Hospital, Brussels, BelgiumPatricia Rocco, Laboratory of Pulmonary Investigation, Centro de Ciências da Saúde, Rio de Janeiro, BrazilJean-François Timsit, Intensive Care Medicine Unit, Hôpital A. Michallon, Grenoble, FranceJan Wernerman, Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital, Stockholm, SwedenHaibo Zhang, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Effect of do-not-resuscitate orders on the penumbra of care
Content Type: Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-011-2461-4
Authors
Angélique M. E. Spoelstra-de Man, Department of Intensive Care, Tergooiziekenhuizen, Van Riebeeckweg 212, 1213 XZ Hilversum, The NetherlandsJohannes G. van der Hoeven, Department of Intensive Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The NetherlandsLeo M. A. Heunks, Department of Intensive Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Infections after pediatric cardiac surgery are a common complication, occurring in up to 30% of cases. The purpose of this
study was to develop a bedside prediction rule to estimate the risk of a postoperative infection.
Methods All consecutive pediatric cardiac surgery procedures between April 2006 and May 2009 were retrospectively analyzed. The primary
outcome variable was any postoperative infection, as defined by the Center of Disease Control (2008). All variables known
to the clinician at the bedside at 48 h post cardiac surgery were included in the primary analysis, and multivariable logistic
regression was used to construct a prediction rule.
Results A total of 412 procedures were included, of which 102 (25%) were followed by an infection. Most infections were surgical site
infections (26% of all infections) and bloodstream infections (25%). Three variables proved to be most predictive of an infection:
age less than 6 months, postoperative pediatric intensive care unit (PICU) stay longer than 48 h, and open sternum for longer
than 48 h. Translation into prediction rule points yielded 1, 4, and 1 point for each variable, respectively. Patients with
a score of 0 had 6.6% risk of an infection, whereas those with a maximal score of 6 had a risk of 57%. The area under the
receiver operating characteristic curve was 0.78 (95% confidence interval 0.72 – 0.83).
Conclusions A simple bedside prediction rule designed for use at 48 h post cardiac surgery can discriminate between children at high and
low risk for a subsequent infection.
Content Type: Journal ArticleCategory Pediatric OriginalPages 1-8DOI 10.1007/s00134-011-2454-3
Authors
Selma O. Algra, Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The NetherlandsMieke M. P. Driessen, Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The NetherlandsAlvin W. L. Schadenberg, Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The NetherlandsAntonius N. J. Schouten, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The NetherlandsFelix Haas, Department of Pediatric Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The NetherlandsCasper W. Bollen, Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The NetherlandsMichiel L. Houben, Department of General Pediatrics, University Medical Center Utrecht, Utrecht, The NetherlandsNicolaas J. G. Jansen, Department of Pediatric Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose To evaluate whether an in-line filter inserted in the syringe pump infusion line assembly influences start-up times and flow
irregularities during vertical pump displacement at low infusion rates.
Methods Fluid delivery after syringe pump start-up and after vertical displacement of the syringe pump by -50 cm was determined gravimetrically
at flow rates of 0.5, 1.0 and 2.0 ml h-1. Measurements were repeated for each flow rate four times with two different syringe pumps with and without an in-line filter
incorporated. Data are shown as median and range.
Results Start-up times were reduced by an in-line filter at 0.5 ml h-1 flow rate from 355.5 s (0 – 660) to 115 s (0 – 320), whereas the effect was attenuated at higher flow rates. Pooling of fluid
into the infusion system after lowering the infusion syringe pump was halved in all flow rates tested. Amount of infusion
bolus after elevating the syringe pump by 50 cm was not affected by an in-line filter.
Conclusion In the evaluated model in-line filters help to reduce flow irregularities and delay in drug delivery of syringe pumps at low
flow rates and represent an option to optimize continuous administration of highly concentrated short-acting drugs at very
small infusion rates.
Content Type: Journal ArticleCategory Physiological and Technical NotesPages 1-5DOI 10.1007/s00134-011-2452-5
Authors
B. Brotschi, Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Steinwiesstr. 75, 8032 Zurich, SwitzerlandB. Grass, Department of Neonatology, University Hospital Zurich, Frauenklinikstr. 10, 8091 Zurich, SwitzerlandM. Weiss, Department of Anaesthesia, University Children's Hospital Zurich, Steinwiesstr. 75, 8032 Zurich, SwitzerlandC. Doell, Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Steinwiesstr. 75, 8032 Zurich, SwitzerlandV. Bernet, Department of Neonatology and Intensive Care, University Children's Hospital Zurich, Steinwiesstr. 75, 8032 Zurich, Switzerland
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Objective A significant fraction of patients with acute liver failure (ALF) suffer from a concomitant acute kidney injury (AKI), the
mechanism of which is probably multifactorial. Cadmium (Cd) is a widespread environmental pollutant and a tubulotoxic metal
that accumulates in the liver. We tested the hypothesis that a release of Cd during ALF may cause a redistribution of Cd from
the liver to the kidneys and play a role in the occurrence of ALF-associated AKI.
Methods Twenty patients with ALF (ALF-patients), 20 patients from the ICU with no liver damage at admission (ICU-controls) and 20
healthy controls were recruited to compare the 24-h urinary excretion rate of Cd with that of lead (Pb), a nephrotoxic metal
that does not accumulate in the liver, and zinc (Zn), a non-nephrotoxic element found in high amounts in the liver. The excretion
rates of the low-molecular-weight proteins (LMWPs) were monitored.
Results ALF-patients excreted markedly more Cd than the healthy controls and ICU-controls. In ALF-patients, the four urinary LMWPs
(RBP, ß2-MG, CC16 and a1-MG) increased as a function of Cd excretion, with high correlation coefficients. The prevalence of
patients excreting a high amount of LMWPs also increased with increasing Cd excretion. No relationship was found between the
other elements investigated and the LMWPs, with the exception of copper, which shares close toxicokinetic similarities with
Cd.
Conclusions This study shows a strong association between urinary Cd levels and the excretion rates of LMWPs in patients with ALF. A causal
relationship is possible but could not be fully demonstrated in this study.
Content Type: Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-011-2449-0
Authors
Perrine Hoet, Louvain Centre for Toxicology and Applied Pharmacology, Brussels, BelgiumVincent Haufroid, Louvain Centre for Toxicology and Applied Pharmacology, Brussels, BelgiumGladys Deumer, Louvain Centre for Toxicology and Applied Pharmacology, Brussels, BelgiumXavier Dumont, Louvain Centre for Toxicology and Applied Pharmacology, Brussels, BelgiumDominique Lison, Louvain Centre for Toxicology and Applied Pharmacology, Brussels, BelgiumPhilippe Hantson, Louvain Centre for Toxicology and Applied Pharmacology, Brussels, Belgium
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose We hypothesized that: (1) intraabdominal hypertension increases pulmonary inflammatory and fibrogenic responses in acute lung
injury (ALI); (2) in the presence of intraabdominal hypertension, higher tidal volume reduces lung damage in extrapulmonary
ALI, but not in pulmonary ALI.
Methods Wistar rats were randomly allocated to receive Escherichia coli lipopolysaccharide intratracheally (pulmonary ALI) or intraperitoneally (extrapulmonary ALI). After 24 h, animals were randomized
into subgroups without or with intraabdominal hypertension (15 mmHg) and ventilated with positive end expiratory pressure = 5 cmH2O and tidal volume of 6 or 10 ml/kg during 1 h. Lung and chest wall mechanics, arterial blood gases, lung and distal organ
histology, and interleukin (IL)-1ß, IL-6, caspase-3 and type III procollagen (PCIII) mRNA expressions in lung tissue were
analyzed.
Results With intraabdominal hypertension, (1) chest-wall static elastance increased, and PCIII, IL-1ß, IL-6, and caspase-3 expressions
were more pronounced than in animals with normal intraabdominal pressure in both ALI groups; (2) in extrapulmonary ALI, higher
tidal volume was associated with decreased atelectasis, and lower IL-6 and caspase-3 expressions; (3) in pulmonary ALI, higher
tidal volume led to higher IL-6 expression; and (4) in pulmonary ALI, liver, kidney, and villi cell apoptosis was increased,
but not affected by tidal volume.
Conclusions Intraabdominal hypertension increased inflammation and fibrogenesis in the lung independent of ALI etiology. In extrapulmonary
ALI associated with intraabdominal hypertension, higher tidal volume improved lung morphometry with lower inflammation in
lung tissue. Conversely, in pulmonary ALI associated with intraabdominal hypertension, higher tidal volume increased IL-6
expression.
Content Type: Journal ArticleCategory ExperimentalPages 1-10DOI 10.1007/s00134-011-2451-6
Authors
Cíntia L. Santos, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilLillian Moraes, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilRaquel S. Santos, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilMariana G. Oliveira, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilJohnatas D. Silva, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilTatiana Maron-Gutierrez, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilDébora S. Ornellas, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilMarcelo M. Morales, Laboratory of Cellular and Molecular Physiology, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, BrazilVera L. Capelozzi, Department of Pathology, School of Medicine, University of São Paulo, São Paulo, BrazilNelson Jamel, Department of Surgery, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, BrazilPaolo Pelosi, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, ItalyPatricia R. M. Rocco, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, BrazilCristiane S. N. B. Garcia, Laboratório de Investigação Pulmonar, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, Brazil
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose To assess coagulation status and factor Xa inhibition in surgical intensive care unit (ICU) patients administered prophylactic
unfractionated heparin for venous thromboembolism (VTE) prophylaxis.
Methods We conducted a randomized, single-blind study at a tertiary academic medical center. Included were patients 18 years and older
admitted to the surgical ICU directly after major abdominal surgery. Exclusion criteria included significant bleeding risk,
preoperative anticoagulation, or history of heparin-induced thrombocytopenia. Patients were randomized to two regimens for
VTE prophylaxis: standard of care unfractionated heparin, 5,000 units subcutaneously three times daily (SQH) versus unfractionated
heparin via intravenous infusion, titrated to an activated partial thromboplastin time of 40 – 45 s (IVH). Blood samples were
taken prior to surgical incision on day 0 and daily for 5 days after surgery. Samples were analyzed for factor Xa inhibition
and viscoelastic whole blood clotting parameters (Sonoclot analyzer).
Results A total of 50 patients were randomized to either SQH or IVH. The majority of patients had cancer. Patients in the SQH group
had no detectable peak anti-factor Xa (aFXa) activity for 5 days after surgery, while patients in the IVH group had statistically
elevated levels compared to the SQH group on days 3 – 5. SQH patients demonstrated a hypercoagulable profile on Sonoclot, while
IVH patients displayed a normal profile.
Conclusions Standard of care subcutaneous dosing of unfractionated heparin for VTE prophylaxis in surgical ICU patients leads to subtherapeutic
levels of factor Xa inhibition.
Content Type: Journal ArticleCategory OriginalPages 1-7DOI 10.1007/s00134-011-2453-4
Authors
Sara S. Cheng, Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B113, 12401 E. 17th Avenue, Aurora, CO 80045, USAKristen Nordenholz, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USADavid Matero, Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, USANathan Pearlman, Department of Surgery, University of Colorado School of Medicine, Aurora, USAMartin McCarter, Department of Surgery, University of Colorado School of Medicine, Aurora, USACsaba Gajdos, Department of Surgery, University of Colorado School of Medicine, Aurora, USAChristine Hamiel, Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B113, 12401 E. 17th Avenue, Aurora, CO 80045, USAAngela Baer, Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B113, 12401 E. 17th Avenue, Aurora, CO 80045, USAElizabeth Luzier, Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B113, 12401 E. 17th Avenue, Aurora, CO 80045, USAZung Vu Tran, Department of Preventive Medicine and Biometrics, University of Colorado School of Medicine, Aurora, USATimothy Olson, Department of Medicine, University of Colorado School of Medicine, Aurora, USAKelly Queensland, Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B113, 12401 E. 17th Avenue, Aurora, CO 80045, USARyan Lutz, Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B113, 12401 E. 17th Avenue, Aurora, CO 80045, USAPaul Wischmeyer, Department of Anesthesiology, University of Colorado School of Medicine, Mail Stop B113, 12401 E. 17th Avenue, Aurora, CO 80045, USA
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Background Expiratory muscle activity may cause the end-expiratory central venous pressure (CVP) to greatly overestimate right atrial
transmural pressure.
Methods We recorded CVP and expiratory change in intra-abdominal pressure (?IAP) in 39 patients who had a respiratory excursion in
CVP from end-expiration to end-inspiration (CVPee – CVPei) =8 mmHg. Uncorrected CVP was measured at end-expiration, and corrected CVP was calculated as uncorrected CVP-?IAP. In 13
patients measurements were repeated during relaxed breathing.
Results The CVPee – CVPei was 15.2 ± 6.3 mmHg (range 8 – 34 mmHg), and ?IAP was 7.4 ± 6.0 mmHg (range 0 – 30 mmHg). Uncorrected CVP was 18.3 ± 6.1 mmHg,
and corrected CVP was 10.9 ± 3.9 mmHg. There was a significant positive correlation between CVPee – CVPei and ?IAP (r = 0.814). However, some patients with a large CVPee – CVPei had negligible ?IAP. In a subset of 13 patients with active expiration who had a relaxed CVP tracing available for comparison,
the difference between uncorrected CVP and relaxed CVP was much greater than the difference between corrected CVP and relaxed
CVP (7.3 ± 3.0 vs. 1.1 ± 0.7 mmHg, p < 0.001).
Conclusion Patients with large respiratory excursions in CVP often have significant expiratory muscle activity that will cause their
CVP to overestimate transmural right atrial pressure. The magnitude of expiratory muscle activity can be assessed by measuring
?IAP. Subtracting ?IAP from the end-expiratory CVP usually provides a reasonable estimate of the CVP that would be obtained
if exhalation were passive.
Content Type: Journal ArticleCategory OriginalPages 1-5DOI 10.1007/s00134-011-2450-7
Authors
James W. Leatherman, Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, USAChristina Bastin-DeJong, Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, USARobert S. Shapiro, Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, USARamiro Saavedra-Romero, Division of Pulmonary and Critical Care Medicine, Hennepin County Medical Center, Minneapolis, USA
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Physicians just need to be better trained to provide the best care at the end-of-life
Content Type: Journal ArticleCategory EditorialPages 1-3DOI 10.1007/s00134-011-2432-9
Authors
Márcio Soares, D'Or Institute for Research and Education, Rua Diniz Cordeiro, 30-3º andar, Rio de Janeiro, RJ CEP 22281-100, BrazilJefferson P. Piva, Department of Pediatrics, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose This study investigated the association between physician education in EOL and variability in EOL practice, as well as the
differences between beliefs and practices regarding EOL in the ICU.
Methods Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family
or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational
characteristics.
Results The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 ± 8 years, with a mean of 14 ± 7 years since
graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than
those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356 – 0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs.
46/83, OR = 4.1959 (1.271 – 13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians
who would apply 'full code' had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012 – 0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122 – 0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what
they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns
were the leading cause for this dichotomy.
Conclusions Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ
from what physicians believe is best for the patient.
Content Type: Journal ArticleCategory OriginalPages 1-9DOI 10.1007/s00134-011-2400-4
Authors
Daniel Neves Forte, Intensive Care Unit, Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, BrazilJean Louis Vincent, Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, BelgiumIrineu Tadeu Velasco, Intensive Care Unit, Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, BrazilMarcelo Park, Intensive Care Unit, Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, Brazil
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Human metapneumovirus in bronchoalveolar lavage fluid of critically ill patients with suspected pneumonia
Content Type: Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-011-2446-3
Authors
Marijke J. Vanspauwen, Department of Medical Microbiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The NetherlandsWalther N. van Mook, Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The NetherlandsCathrien A. Bruggeman, Department of Medical Microbiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The NetherlandsDennis C. J. J. Bergmans, Department of Intensive Care Medicine, Maastricht University Medical Centre, Maastricht, The NetherlandsCatharina F. M. Linssen, Department of Medical Microbiology, School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, The Netherlands
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Screening pediatric delirium with an adapted version of the Sophia Observation withdrawal Symptoms scale (SOS)
Content Type: Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-011-2434-7
Authors
Monique van Dijk, Intensive Care, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The NetherlandsHennie Knoester, Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam Medical Center, Amsterdam, The NetherlandsBabette S. van Beusekom, Department of Child and Adolescent Psychiatry, Erasmus MC-Sophia Children's Hospital, Rotterdam, The NetherlandsErwin Ista, Intensive Care, Erasmus MC-Sophia Children's Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Dobutamine is recommended for patients with severe heart failure; however uncertainty exists as to its effect on mortality.
This study aims to critically review the literature to evaluate whether dobutamine, compared with placebo or standard care,
is associated with lower mortality and a range of secondary outcomes, in patients with severe heart failure.
Methods A systematic review and meta-analysis of randomised controlled trials was performed. PubMed, EMBASE, the Cochrane Central
Trials Registry, the metaRegister of Controlled Trials and bibliographies of retrieved articles were searched. Randomised
trials comparing dobutamine with placebo or standard care, in human, adult patients with severe heart failure, were included
if they reported at least one outcome of interest. Data regarding trial validity, methodological processes and clinical outcomes
were extracted, and a meta-analysis was performed.
Results Fourteen studies, with 673 participants, met the inclusion criteria and were included; 13 studies reported mortality. There
was minimal heterogeneity (I
2 = 4.5%). The estimate of the odds ratio for mortality for patients with severe heart failure treated with dobutamine compared
with standard care or placebo was 1.47 (95% confidence interval 0.98 – 2.21, p = 0.06).
Conclusions This meta-analysis showed that dobutamine is not associated with improved mortality in patients with heart failure, and there
is a suggestion of increased mortality associated with its use, although this did not reach the conventional level of statistical
significance. Further research to define the role of dobutamine in treatment of severe heart failure should be a priority.
Content Type: Journal ArticleCategory Systematic ReviewPages 1-9DOI 10.1007/s00134-011-2435-6
Authors
Catherine L. Tacon, Intensive Care Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, AustraliaJohn McCaffrey, Department of Anaesthesia and Critical Care, Belfast City Hospital, Belfast, Northern IrelandAnthony Delaney, Intensive Care Unit, Royal North Shore Hospital, St Leonards, Sydney, NSW, Australia
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
'The beach position': crossed legs as a marker for a favourable clinical course in neurological intensive care unit patients
Content Type: Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-011-2443-6
Authors
Ulf C. Schneider, Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, GermanyPeter Vajkoczy, Department of Neurosurgery, Charité Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Diffuse digestive bezoar: a rare and severe complication of enteral nutrition in the intensive care unit (ICU)
Content Type: Journal ArticleCategory CorrespondencePages 1-2DOI 10.1007/s00134-011-2428-5
Authors
Jean-Paul Bouwyn, Department of Intensive Care, Dieppe Hospital, Dieppe, FranceThomas Clavier, Department of Intensive Care, Dieppe Hospital, Dieppe, FranceJean-Pierre Eraldi, Department of Intensive Care, Dieppe Hospital, Dieppe, FranceFrançois Bougerol, Department of Intensive Care, Dieppe Hospital, Dieppe, FranceJean-Philippe Rigaud, Department of Intensive Care, Dieppe Hospital, Dieppe, FranceIgor Auriant, Department of Intensive Care, Dieppe Hospital, Dieppe, FranceNicolas Devos, Department of Intensive Care, Dieppe Hospital, Dieppe, France
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Asphyxia-related intestinal injury in neonates may present similar to necrotizing enterocolitis (NEC) and is partially associated
with hypoxia-reoxygenation injury. Cyclosporine has been shown to reduce myocardial cell death following ischemia – reperfusion.
We hypothesize that cyclosporine treatment may attenuate NEC-like intestinal injury in asphyxiated newborn piglets during
reoxygenation.
Methods Twenty piglets (1 – 4 days old) were acutely anesthetized and instrumented for continuous monitoring of systemic hemodynamics
and superior mesenteric arterial (SMA) flow. After stabilization, normocapnic alveolar hypoxia (10 – 15% oxygen) was instituted
for 2 h followed by reoxygenation with 100% oxygen for 0.5 h, then 21% for 3.5 h. The piglets were blindly block-randomized
to receive cyclosporine (10 mg/kg) or placebo (normal saline) boluses at 5 min of reoxygenation (n = 8/group). A sham-operated group was included (n = 4) and received no hypoxia-reoxygenation. Intestinal samples were collected for tissue lactate and histological assessment
(Park's criteria).
Results At 2 h of hypoxia, piglets had cardiogenic shock (cardiac output 45% of baseline), hypotension (mean arterial pressure 30 mmHg),
acidosis (pH 7.04), and decreased superior mesenteric perfusion (all P < 0.05 vs. sham-operated group, ANOVA). Cyclosporine treatment increased SMA flow (114 ± 6 vs. 78 ± 19% of baseline of controls,
respectively) with improved SMA oxygen delivery and intestinal tissue lactate (all P < 0.05). Some control piglets had NEC-like injuries including pneumatosis intestinalis, which were attenuated in cyclosporine-treated
piglets (P < 0.05 vs. controls).
Conclusions This is the first study to demonstrate that post-resuscitation administration of cyclosporine improves mesenteric perfusion
and attenuates NEC-like intestinal injury in newborn piglets following asphyxia-reoxygenation.
Content Type: Journal ArticleCategory Pediatric OriginalPages 1-9DOI 10.1007/s00134-011-2436-5
Authors
Richdeep S. Gill, Department of Surgery, University of Alberta, Edmonton, AB, CanadaNamdar Manouchehri, Department of Surgery, University of Alberta, Edmonton, AB, CanadaTze-Fun Lee, Department of Pediatrics, University of Alberta, Edmonton, AB, CanadaWoo Jung Cho, Department of Molecular Biology, Princeton University, Princeton, NJ, USAAducio Thiesen, Department of Pathology and Laboratory Medicine, University of Alberta, Edmonton, AB, CanadaThomas Churchill, Department of Surgery, University of Alberta, Edmonton, AB, CanadaDavid L. Bigam, Department of Surgery, University of Alberta, Edmonton, AB, CanadaPo-Yin Cheung, Department of Surgery, University of Alberta, Edmonton, AB, Canada
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose Hypoxia and reoxygenation (H-R) contributes to multi-organ failure in neonates, including cardiac and systemic complications.
Use of vasopressin, an endogenous vasoconstrictive hormone commonly used to treat refractory hypotension in adults, in neonates
with shock remains limited and not yet fully studied. We hypothesize that vasopressin will improve mean arterial pressure
(MAP), without compromising cardiac, mesenteric, or carotid hemodynamics using a swine model of neonatal asphyxia.
Methods Anesthetized piglets (1 – 4 days old, 1.4 – 2.5 kg, n = 33) were instrumented for continuous monitoring of cardiac index (CI), MAP, and regional arterial [common carotid (CA),
superior mesenteric (SMA)] flow. The animals underwent hypoxia at 10 – 15% oxygen (2 h) followed by reoxygenation at 100% (0.5 h)
and 21% (3.5 h) oxygen. Vasopressin infusion was initiated after 2 h reoxygenation at 0.005, 0.01, or 0.02 units/kg/h i.v.
for 2 h (n = 7/group). H-R control (saline infusion) and sham-operated (non-asphyxiated) groups were also included. Intermittent blood
gases and plasma lactate were determined as well as tissue lactate levels. Statistical significance was determined using ANOVA.
Results All H-R piglets had hypotension (36 – 49% decrease in MAP) and decreased regional blood flows (CA -28 to -34%, SMA -12 to +32%
of baseline) at 2 h reoxygenation. Vasopressin infusion dose-dependently increased MAP (14% at 0.02 units/kg/h, P < 0.05) without significant detrimental effects in CI, regional blood flows, and intestinal or cerebral tissue lactate levels.
Conclusions Vasopressin treatment causes a dose-dependent baro-specific effect, while preserving cardiac function and cerebral and mesenteric
hemodynamics in newborn piglets following H-R.
Content Type: Journal ArticleCategory ExperimentalPages 1-8DOI 10.1007/s00134-011-2437-4
Authors
Douglas C. Cheung, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, CanadaRichdeep S. Gill, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, CanadaJiang-Qin Liu, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, CanadaNamdar Manouchehri, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, CanadaConsolato Sergi, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, CanadaDavid Bigam, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, CanadaPo-Yin Cheung, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, CanadaBryan J. Dicken, Faculty of Medicine and Dentistry, University of Alberta, 2C3.44 Walter MacKenzie Center, 8440 – 112St, Edmonton, AB T6G 2B7, Canada
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
Abstract
Purpose To investigate the in vivo effects of cardiopulmonary bypass (CPB) and perioperative hemodilution on human skeletal muscle
oxygen delivery and metabolism and to determine the dilution state at which these effects arise.
Methods We conducted this observational study in adult patients undergoing CPB surgery. Microcirculatory data were obtained by near-infrared
spectroscopy from the brachioradial muscle in 20 consecutive patients undergoing hemodilution for CPB. Outcome variables included
tissue oxy- and deoxyhemoglobin concentration ([HbO2], [HHb]), oxygen content, blood flow, oxygen delivery, and oxygen consumption.
Results Although CPB left tissue blood flow and oxygen delivery unchanged, both microcirculatory variables correlated significantly
and inversely with hematocrit (Hct) (r = -0.39, p < 0.001; r = -0.50, p < 0.001). CPB also left muscle oxygen consumption (mVO2) unchanged and this variable correlated with the tissue hemoglobin concentration and tissue oxygen delivery (r = 0.40, p = 0.001; r = 0.35, p = 0.005). During CPB most of the systemic cardiovascular variables remained unchanged. Conversely at Hct lower than 30%,
mean arterial pressure and pH decreased and lactate values increased twofold, whereas microvascular blood volume and oxygen
delivery increased. At Hct lower than 20% blood flow and oxygen delivery increased, whereas hemoglobin and oxygen content
variables decreased.
Conclusions CPB leaves skeletal muscle oxygen delivery and metabolism as measured by near-infrared spectroscopy unchanged. The only factor
that correlates directly with the oxygen content variables and inversely with blood flow, and induces significant changes
in tissue hemoglobin content and oxygen delivery, is hemodilution.
Content Type: Journal ArticleCategory OriginalPages 1-9DOI 10.1007/s00134-011-2404-0
Authors
R. A. De Blasi, Department of Medical-Surgical, Techno-Biomedical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University 'La Sapienza', Rome, ItalyE. Tonelli, Department of Medical-Surgical, Techno-Biomedical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University 'La Sapienza', Rome, ItalyR. Arcioni, Department of Medical-Surgical, Techno-Biomedical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University 'La Sapienza', Rome, ItalyM. Mercieri, Department of Medical-Surgical, Techno-Biomedical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University 'La Sapienza', Rome, ItalyL. Cigognetti, Department of Medical-Surgical, Techno-Biomedical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University 'La Sapienza', Rome, ItalyR. Romano, Department of Medical-Surgical, Techno-Biomedical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University 'La Sapienza', Rome, ItalyG. Pinto, Department of Medical-Surgical, Techno-Biomedical Sciences and Translational Medicine, Faculty of Medicine and Psychology, University 'La Sapienza', Rome, Italy
Intensive Care MedicineOnline ISSN: 1432-1238Print ISSN: 0342-4642
