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| 3. |
- Bellander, B M, et al.
(författare)
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Consensus meeting on microdialysis in neurointensive care
- 2004
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 30, s. 2166-2169
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Tidskriftsartikel (refereegranskat)abstract
- Background: Microdialysis is used in many European neurointensive care units to monitor brain chemistry in patients suffering subarachnoid hemorrhage (SAH) or traumatic brain injury (TBI). Discussion: We present a consensus agreement achieved at a meeting in Stockholm by a group of experienced users of microdialysis in neurointensive care, defining the use of microdialysis, placement of catheters, unreliable values, chemical markers, and clinical use in SAH and in TBI. Conclusions: As microdialysis is maturing into a clinically useful technique for early detection of cerebral ischemia and secondary brain damage, there is a need to following such definition regarding when and how to use microdialysis after SAH and TBI.
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| 5. |
- Beydon, L, et al.
(författare)
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Effects of positive end-expiratory pressure on dead space and its partitions in acute lung injury
- 2002
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 28:9, s. 1239-1245
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Tidskriftsartikel (refereegranskat)abstract
- Objective: A large tidal volume (VT) and lung collapse and re-expansion may cause ventilator-induced lung injury (VILI) in acute lung injury (ALI). A low VT and a positive end-expiratory pressure (PEEP) can prevent VILI, but the more VT is reduced, the more dead space (VD) compromises gas exchange. We investigated how physiological, airway and alveolar VD varied with PEEP and analysed possible links to respiratory mechanics. Setting: Medical and surgical intensive care unit (ICU) in a university hospital. Design: Prospective, non-randomised comparative trial. Patients: Ten consecutive ALI patients. Intervention: Stepwise increases in PEEP from zero to 15 cmH(2)O. Measurements and results: Lung mechanics and VD were measured at each PEEP level. Physiological VD was 41-64% of VT at zero PEEP and increased slightly with PEEP due to a rise in airway VD. Alveolar VD was 11-38% of VT and did not vary systematically with PEEP. However, in individual patients a decrease and increase of alveolar VD paralleled a positive or negative response to PEEP with respect to oxygenation (shunt), respectively. VD fractions were independent of respiratory resistance and compliance. Conclusions: Alveolar VD is large and does not vary systematically with PEEP in patients with various degrees of ALI. Individual measurements show a diverse response to PEEP. Respiratory mechanics were of no help in optimising PEEP with regard to gas exchange.
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| 6. |
- Bitzén, Ulrika, et al.
(författare)
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Dynamic elastic pressure-volume loops in healthy pigs recorded with inspiratory and expiratory sinusoidal flow modulationRelationship to static pressure-volume loops.
- 2004
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 30:3, s. 481-488
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The objective was to analyse relationships between inspiratory and expiratory static and dynamic elastic pressure-volume (P-el/V) curves in healthy pigs. Design: The modulated low flow method was developed to allow studies also of the expiratory P-el/V curves. Static P-el/V (P-el,P-st/V) and dynamic P-el/V (P-el,P-dyn/V) loops were studied in healthy pigs. Setting: Animal research laboratory in a university hospital. Material: Ten healthy anaesthetised and paralysed pigs. Interventions and measurements: A computer controlled a Servo Ventilator 900C with respect to respiratory rate, inspiratory flow and expiratory pressure to achieve a sinusoidal modulation of inspiration and expiration for determination of P-el,P-dyn/V loops from zero end-expiratory pressure (ZEEP) and from a positive end-expiratory pressure (PEEP) of 6 cmH(2)O to 20, 35 and 50 cmH(2)O. The same system was used for studies of P-el,P-st/V loops with the flow-interruption method from ZEEP and PEEP to 35 cmH(2)O. Recordings were analysed with an iterative technique. Results: The feasibility of automated determination of P-el,P-dyn/V loops was demonstrated. Differences between P-el,P-dyn/V and P-el,P-st/V loops were explained by viscoelastic behaviour. P-el,P-st/V loops recorded from PEEP to 35 cmH(2)O showed no significant hysteresis, indicating a non-significant surface tension hysteresis. P-el,P-dyn/V loops from PEEP and both P-el,P-st/V and P-el,P-dyn/V loops from ZEEP to 35 cmH(2)O showed hysteresis. This indicates that lung collapse/re-expansion caused P-el/V loop hysteresis which, in P-el,P-dyn/V loops, was augmented by viscoelastic behaviour. Conclusions: Viscoelasticity influences P-el,P-dyn/V curves. Hysteresis caused by surface tension merits re-evaluation. Lung collapse and re-expansion may be indicated by hysteresis of P-el/V loops.
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| 7. |
- Bäckman, Carl G, et al.
(författare)
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Use of a personal diary written on the ICU during critical illness
- 2001
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Ingår i: Intensive Care Medicine. - : SpringerLink. - 0342-4642 .- 1432-1238. ; 27:2, s. 426-9
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the use of a diary as an aid in debriefing patients and relatives following critical illness. Design: Observation study. Setting: Intensive care unit of a 500-bed hospital. Patients and participants: Fifty-one critically ill patients and their relatives. Method: A daily account of the patient's progress was written in everyday language by nursing staff, photographs were added as necessary. The booklet was given to the patient or a relative at a follow-up appointment 2 weeks after discharge from the unit. A standard questionnaire was mailed 6 months later, responses were analyzed by an independent observer. Measurements and results: All diaries had been read by survivors (n=41) or relatives (n=10), 51% of the diaries had been read more than 10 times. Comments in the questionnaires were graded as very positive (39%), positive (28%) and neutral (33%). Conclusions: A detailed narrative of the patient's stay is a useful tool in the debriefing process following intensive care.
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- Cox, Peter N., et al.
(författare)
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Fluorocarbons facilitate lung recruitment
- 2003
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 29, s. 2297-2302
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Tidskriftsartikel (refereegranskat)abstract
- Objective: "Open the lung and keep it open" is increasingly accepted as a fundamental principle for mechanical ventilation. However, it is sometimes very difficult, or impossible, to recruit the diseased lung. We questioned whether one could facilitate recruitment by using a low dose of fluorocarbon in a model previously shown to be non-recruitable by conventional sustained inflation maneuvers. Design and setting: Experimental prospective study in a university laboratory. Animals and interventions: Nine saline-lavaged rabbits subjected to prolonged large tidal volume mechanical ventilation to establish significant lung injury were randomly allocated to two groups: control [High Frequency Oscillation (HFO) alone: n=4] or 1 ml/kg fluorocarbon (FC) treated (HFO/FC: n=5) for 2+1 h (experiment 1). An additional four similarly prepared animals were treated by single-lung instillation of 0.5 ml/kg dose of fluorocarbon and underwent serial computerized tomography scans at a series of predetermined step-wise pressure increase in both lungs (experiment 2). Measurements and results: In experiment 1 there was a very significant improvement in oxygenation in HFO/FC group (PaO2 increased from 108 mmHg to 424±81 mmHg; P<0.05) while there was no significant change in the control group. In experiment 2 lung volumes were determined using three-dimensional reconstruction. The lung having fluorocarbon showed a 2.4-fold increase in lung volume at inflation pressure of 15 cmH 2O compared to the lung without fluorocarbon. Conclusions: We propose that the low equilibrium surface tension and positive spreading coefficient of fluorocarbon facilitates lung recruitment by ungluing adherent surfaces in this model of lung injury.
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| 12. |
- De Robertis, E, et al.
(författare)
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Aspiration of dead space allows isocapnic low tidal volume ventilation in acute lung injury. Relationships to gas exchange and mechanics
- 2001
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 27:9, s. 1496-1503
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: In acute lung injury (ALI) mechanical ventilation damages lungs. We hypothesised that aspiration and replacement of dead space during expiration (ASPIDS) allows normocapnic ventilation at higher end-expiratory pressure (PEEP) and reduced tidal volume (V(T)), peak and plateau pressures (Paw(peak), Paw(plat)), thus avoiding lung damage. SETTING: University Hospital. PATIENTS: Seven consecutive sedated and paralysed ALI patients were studied. Interventions and measurements: Single breath test for CO(2) and multiple elastic pressure volume (Pel/V) curves recorded from different end-expiratory pressures guided ventilatory setting at ASPIDS. ASPIDS was studied at respiratory rate (RR) of 14 min(-1) and then 20 min(-1) with minute ventilation maintaining stable CO(2) elimination. RESULTS: Alveolar and airway dead spaces were 24.3% and 31.3% of V(T), respectively. Multiple Pel/V curves showed a shift towards lower volume at decreasing PEEP, thus indicating that patients required a higher PEEP. At ASPIDS, PEEP was increased from 8.9 cmH(2)O to 12.6 cmH(2)O and VT reduced from 11 ml/kg to 8.9 ml/kg at RR 14 min(-1) and to 6.9 ml/kg at RR 20 min(-1). A significant decrease in Paw(peak) (36.7 vs 32 at RR 14 min(-1) and 28.7 at RR 20 min(-1)) and Paw(plat) (29.9 vs 27.3 at RR 14 min-1 and 24.1 at RR 20 min-1) were observed. PaCO(2) remained stable. No intrinsic PEEP developed. No side effects were noticed. CONCLUSIONS: ASPIDS allowed the use of higher PEEP at lower V(T) and inflation pressure and constant PaCO(2). Multiple Pel/V curves gave insight into the tendency of lungs to collapse.
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| 13. |
- Diaz-Parejo, P, et al.
(författare)
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Cerebral energy metabolism during transient hyperglycemia in patients with severe brain trauma
- 2003
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 29:4, s. 544-550
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study whether transient hyperglycemia adversely affects cerebral energy metabolism in patients with severe traumatic brain lesions. Design and setting: Prospective, nonrandomized study in the neurosurgical intensive care unit of a university hospital. Patients: 108 patients treated for severe traumatic brain lesions. Interventions: All patients were treated according to neurosurgical intensive care routine including monitoring of, intracranial pressure. One microdialysis catheter was inserted via a burr hole frontally to that used for the intraventricular catheter ("better" position). In patients with focal lesions one or more catheters were inserted into cerebral cortex surrounding an evacuated focal contusion or underlying an evacuated hematoma ("worse" position). Perfusion rate was 0.3 mul/min and samples were taken every. 30 or 60 min. The levels of glucose, pyruvate, lactate, glutamate, and glycerol were analyzed and displayed bedside. Measurements and results: There were 18 episodes of moderate (12-15 mmol/1) and 6 episodes of pronounced (>15 mmol/1) hyperglycemia. Moderate hyperglycemia did not change intracerebral levels of lactate, pyruvate, glutamate, glycerol, or lactate/pyruvate ratio. Lactate concentrations increased during pronounced hyperglycemia. Pronounced cerebral lactic acidosis and a moderate increase in interstitial glycerol concentration indicating cell membrane degradation was observed in a single patient with pronounced, long-lasting hyperglycemia. Conclusions: Cerebral energy metabolism was affected by transient hyperglycemia only at blood glucose concentration above 15 mmol/l as shown by a moderate increase in interstitial lactate level.
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| 19. |
- Lethvall, Sven, 1967, et al.
(författare)
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Tracheal double-lumen ventilation attenuates hypercapnia and respiratory acidosis in lung injured pigs.
- 2004
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Ingår i: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 30:4, s. 686-92
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Evaluation of ventilatory and circulatory effects with coaxial double-lumen tube ventilation for dead-space reduction as compared with standard endotracheal tube ventilation. DESIGN: Experimental study in a pig model of lung lavage induced acute lung injury. SETTING: University research laboratory. MEASUREMENTS AND RESULTS: Tidal volumes of 6, 8 and 10 ml/kg body weight with a set respiratory rate of 20 breaths per minute were used in a random order with both double-lumen ventilation and standard endotracheal tube ventilation. Measurements of ventilatory and circulatory parameters were obtained after steady state at each experimental stage. With a tidal volume of 6 ml/kg, PaCO(2) was reduced from 10.9 kPa (95% CI 9.0-12.9) with a standard endotracheal tube to 8.2 kPa (95% CI 7.0-9.4) with double-lumen ventilation. This corresponds to a reduction in carbon dioxide levels by 25%. At 6 ml/kg, pH increased from 7.17 (95% CI 7.09-7.24) with a standard endotracheal tube to 7.27 (95% CI 7.21-7.32) with double-lumen ventilation. Tracheal pressure was monitored continuously and no difference between single- or double-lumen ventilation was noted at corresponding levels of ventilation. There was no formation of auto-PEEP. Partial tube obstruction due to secretions was not observed during the experiments. CONCLUSIONS: Coaxial double-lumen tube ventilation is an effective adjunct to reduce technical dead space. It attenuates hypercapnia and respiratory acidosis in a lung injury pig model.
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| 20. |
- Linde, Torbjörn, et al.
(författare)
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Improved hemorheological properties during infusion of a lipid emulsion(Intralipid) in healthy subjects
- 2000
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Ingår i: Intensive Care Medicine. - 0342-4642 .- 1432-1238. ; 26:10, s. 1462-1465
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Lipid emulsions are commonly used for nutrition in critically ill patients. In these patients interventions resulting in deteriorated blood rheology and thereby an impaired microcirculation may be deleterious. This study examined the acute hemorrheological effects of the lipid emulsion Intralipid. We have recently shown that hyperinsulinemia exerts a negative effect on erythrocyte deformability, and here the effect of hyperinsulinemia combined with Intralipid was studied. SUBJECTS AND INTERVENTIONS: Eleven healthy subjects received Intralipid (200 mg/ml) intravenously as a bolus injection (0.5 ml/kg) over 10 min and thereafter as a continuous intravenous infusion (90 ml/h) for 4 h combined with heparin (200 U/h) to stimulate lipolysis. During the final 2 h an euglycemic hyperinsulinemic clamp was added. Five subjects underwent the same protocol with the exception that saline was given instead of Intralipid and heparin. MEASUREMENTS AND RESULTS: Whole blood viscosity, plasma viscosity, erythrocyte aggregation tendency and fluidity were measured by rotational viscometry. Compared with basal and control values the Intralipid infusion caused greater erythrocyte fluidity (p < 0.05) and less aggregation tendency (p < 0.05). Whole blood and plasma viscosity remained unchanged. Hyperinsulinemia had no significant effect on the hemorrheological variables measured. CONCLUSIONS: Intralipid has no deleterious effects on blood rheology in healthy subjects. Instead, it leads to improved erythrocyte aggregation tendency and fluidity. If the emulsion exerts the same effects in patients with impaired circulation, the use of Intralipid may be beneficial in these patients.
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| 23. |
- Lindgren, Sophie, 1971, et al.
(författare)
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Effectiveness and side effects of closed and open suctioning: an experimental evaluation.
- 2004
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Ingår i: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 30:8, s. 1630-7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the effectiveness of closed system suctioning (CSS) and open system suctioning (OSS) and the side effects on gas exchange and haemodynamics, during pressure-controlled ventilation (PCV) or continuous positive airway pressure (CPAP). DESIGN: Bench test and porcine lung injury model. PARTICIPANTS: Twelve bronchoalveolar saline-lavaged pigs. SETTING: Research laboratory in a university hospital. INTERVENTIONS: In a mechanical lung, the efficacy of OSS and CSS with 12 and 14 Fr catheters were compared during volume-control ventilation, PCV, CPAP 0 or 10 cmH(2)O by weighing the suction system before and after aspirating gel in a transparent trachea. Side effects were evaluated in the animals with the same ventilator settings during suctioning of 5, 10 or 20 s duration. MEASUREMENTS AND RESULTS: Suctioning with 12 and 14 Fr catheters was significantly more efficient with OSS (1.9+/-0.1, 2.8+/-0.9 g) and with CSS during CPAP 0 cmH(2)O (1.8+/-0.2, 4.2+/-0.5 g) as compared to CSS during PCV (0.2+/-0.2, 0.8+/-0.3 g) or CPAP 10 cmH(2)O (0.0+/-0.1, 0.7+/-0.4 g), p<0.01 (means +/- SD). OSS and CSS at CPAP 0 cmH(2)O resulted in a marked decrease in SpO(2), mixed venous oxygen saturation and tracheal pressure, p<0.001, but the side effects were considerably fewer during CSS with PCV and CPAP 10 cmH(2)O, p<0.05. CONCLUSIONS: Irrespective of catheter size, OSS and CSS during CPAP 0 cmH(2)O were markedly more effective than CSS during PCV and CPAP 10 cmH(2)O but had worse side effects. However, the side effects lasted less than 5 min in this animal model. Suctioning should be performed effectively when absolutely indicated and the side effects handled adequately.
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| 24. |
- Lonnqvist, PA
(författare)
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How continuous are continuous drug infusions?
- 2000
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Ingår i: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 26:6, s. 660-661
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 25. |
- Luhr, O R, et al.
(författare)
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The impact of respiratory variables on mortality in non-ARDS and ARDS patients requiring mechanical ventilation.
- 2000
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Ingår i: Intensive care medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 26:5, s. 508-17
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Tidskriftsartikel (refereegranskat)abstract
- Primarily, to determine if respiratory variables, assessed on a daily basis on days 1-6 after ICU admission, were associated with mortality in non-ARDS and ARDS patients with respiratory failure requiring mechanical ventilation. Secondarily, to determine non-respiratory factors associated with mortality in ARDS and non-ARDS patients.Prospective multicentre clinical study.Seventy-eight intensive care units in Sweden and Iceland.Five hundred twenty non-ARDS and 95 ARDS patients.Potentially prognostic factors present at inclusion were tested against 90-day mortality using a Cox regression model. Respiratory variables (PaO2/FIO2, PEEP, mean airway pressure (MAP) and base excess (BE)) were tested against mortality using the model. Primary aim: in non-ARDS a low PaO2/FIO2 on day 1, RR (risk ratio) = 1.17, CI (95% confidence interval) (1.00; 1.36), day 4, 1.24 (1.02; 1.50), day 5, 1.25 (1.02; 1.53) and a low MAP at baseline, 1.18 (1.00; 1.39), day 2, 1.24 (1.02; 1.52), day 3, 1.33 (1.06; 1.67), day 6, 2.38 (1.11; 5.73) were significantly associated with 90-day death. Secondary aim: in non-ARDS a low age, RR = 0.77 (0.67; 0.89), female gender, 0.85 (0.74; 0.98), and low APS (acute physiologic score), 0.85 (0.73; 0.99), were associated with survival; chronic disease, 1.31 (1.12; 1.52), and non-pulmonary origin to the respiratory failure, 1.27 (1.10; 1.47), with death. In ARDS low age, RR = 0.65 CI (0.46; 0.91), and low APS, 0.65 (0.46; 0.90), were associated with survival.No independent significant association was seen between 90-day mortality and degree of hypoxaemia, PEEP, MAP or BE for the first full week of ICU care in either ARDS or non-ARDS. In a sub-group of non-ARDS a lower PaO2/FIO2 and MAP tended to influence mortality where a significant association was seen for 3 of 7 study days. Age, gender, APS, presence of a chronic disease and a pulmonary/non-pulmonary reason for the respiratory failure were associated with mortality in non-ARDS, while only age and APS showed a similar association in ARDS.
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