Abstract:
OBJECTIVE:To evaluate the origin of H+ ions participating in the generation of CO2 coming from sodium bicarbonate infusion during metabolic acidosis. We hypothesized that these H+ ions come from a back-titration of the main non-bicarbonate buffers present in the blood, i. e. the hemoglobin and the albumin, and thus postulated that the rate of CO2 release from a bicarbonate load is dependent on the concentration of these buffers. DESIGN:Prospective clinical and experimental study. SETTING:Surgical intensive care unit of a university hospital. PATIENTS AND MATERIAL:(1) Sixteen stable sedated and artificially ventilated critically ill patients with a mild base deficit. (2) Acidotic human blood (bicarbonate 5 mM, pH 7.0) of hematocrit 5, 10, 20 and 40% regenerated from a mixture of frozen fresh plasma and packed red blood cells. INTERVENTIONS: PATIENTS:infusion of 1.5 mmol/kg sodium bicarbonate over 5 min. Regenerated blood: 25 mM sodium bicarbonate load. MEASUREMENTS AND RESULTS: PATIENTS:continuous measurement of CO2 production (VCO2) on the expired gas using a metabolic monitor and arterial blood gas analysis before (T0), at the end (T5) and at 10, 30 and 60 min after the beginning of the bicarbonate infusion. The increase in VCO2 was 18 +/- 7% leading to a rise in PaCO2 from 39.6 +/- 2.3 at T0 to 46.2 +/- 2.7 mmHg at T5. The increases in VCO2 and in PaCO2 were significantly correlated to the albumin (r = 0.73, p < 0.005 and r = 0.70, p < 0.005, respectively) and to the hemoglobin (r = 0.51, p < 0.05 and r = 0.65, p < 0.01, respectively) concentrations. Regenerated blood: gas analysis 1 min after the bicarbonate load. The increase in PCO2 was closely related to the hematocrit (Ht) of the blood as it was 15.9 +/- 7.5 mmHg for Ht 5%, 29.0 +/- 9.6 for Ht 10%, 44.2 +/- 5.9 for Ht 20% and 71.0 +/- 3.5 for Ht 40% (n = 5 for each, p < 0.001). CONCLUSIONS:The importance of the release of CO2 from a bicarbonate load is dependent on the concentration of the blood non-bicarbonate buffers. It is therefore likely that the adverse effects of bicarbonate therapy linked to the CO2 generation are more important in patients with high blood albumin and hemoglobin concentrations.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Levraut J,Garcia P,Giunti C,Ichai C,Bouregba M,Ciebiera JP,Payan P,Grimaud Ddoi
10.1007/s001340051204keywords:
subject
Has Abstractpub_date
2000-05-01 00:00:00pages
558-64issue
5eissn
0342-4642issn
1432-1238journal_volume
26pub_type
杂志文章abstract:OBJECTIVE:Both serum levels of tumor necrosis factor-alpha (TNF alpha) and interleukin-6 (IL-6) and blood lactate levels in patients with septic shock have been shown to correlate with prognosis. The aim of the study was to define the relative predictive value of these measures. PATIENTS:38 hospitalized patients with ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01712155
更新日期:1996-05-01 00:00:00
abstract:OBJECTIVE:To evaluate the nursing time required for difficult-to-wean patients in a dedicated weaning center (WC) and to examine the correlation of the nursing time with nursing workload (NW) scores and with clinical severity and dependency. SETTING:Four-bed WC of a pulmonary rehabilitation department. INTERVENTION:N...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051249
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVES:Diagnosing persistent acute kidney injury (AKI) as opposed to transient AKI in critically ill patients may help physicians in making treatment decisions. This diagnosis relies chiefly on urinary indices, which may be of limited value or difficult to obtain. We assessed the performance of the Doppler renal re...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-2050-y
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:The most recent approach to estimate nursing resources consumption has led to the generation of the Nine Equivalents of Nursing Manpower use Score (NEMS). The objective of this prospective study was to establish a completely automatically generated calculation of the NEMS using a patient data management syste...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2239-z
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:Lung injury is a severe complication of acute pancreatitis that increases the mortality rate of the disease. The pathophysiology of acute pancreatitis has been studied in several experimental models, but the kinetics of pulmonary complications in relation to the pancreatic disease is not completely understood...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0264-9
更新日期:2006-11-01 00:00:00
abstract::A study was conducted to evaluate repeated intrathecal injections of baclofen, without artificial ventilation, in the treatment of severe tetanus. Ten patients, 5 men and 5 women, with a mean age of 34 +/- 7 years, were included in the study. The dose of baclofen injected was 1000 micrograms between the ages of 16 and...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709840
更新日期:1992-01-01 00:00:00
abstract:OBJECTIVE:Evaluation of low-level PEEP (5 cm H2O) and the two different CPAP trigger modes in the Bennett 7200a ventilator (demand-valve and flow-by trigger modes) on inspiratory work of breathing (Wi) during the weaning phase. DESIGN:Prospective controlled study. SETTING:The intensive care unit of a university hospi...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01712329
更新日期:1995-11-01 00:00:00
abstract:BACKGROUND:After resuscitation, asphyxiated neonates often develop poor cardiac function with hypotension, pulmonary hypertension and multiorgan ischemia. In a swine model of neonatal hypoxia-reoxygenation, effects of epinephrine, dobutamine and milrinone on systemic, pulmonary and regional hemodynamics and oxygen tran...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1820-x
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVES:Processed EEG monitoring has been suggested for sedation depth evaluation in intensive care unit (ICU) patients. The present study investigated the efficacy of two processed EEG monitors using SEF90% or SEF95% and BIS to differentiate between conscious (Ramsay score 4) and unconscious sedation (Ramsay score ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340000761
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVE:To investigate the effects of some acid-base abnormalities on blood capacity of transporting CO(2). DESIGN:Prospective study. SETTING:General and Cardiosurgical ICUs of a University hospital. PATIENTS:Six groups of ten patients characterized by: metabolic alkalosis; respiratory alkalosis; absence of acid-b...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1259-9
更新日期:2002-05-01 00:00:00
abstract::Plasma colloid osmotic pressure (COP) has been calculated from both serum albumin concentration and plasma total protein concentration. These values have been compared to those measured directly using a membrane-transducer oncometer in a group of normal subjects, in a group of critically-ill patients with a variety of...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00254796
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVE:Assessing pulse pressure variation (PPV) to predict fluid responsiveness in mechanically ventilated patients with tidal volume (VT) and the impact of VT and airway driving pressure (P(plat) - PEEP) on the ability of PPV for predicting fluid responsiveness. DESIGN:Prospective interventional study. SETTING:IC...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1686-y
更新日期:2010-03-01 00:00:00
abstract::There has been little research on smoking cessation after critical illness. Smokers make up a high percentage of patients admitted to intensive care (ICU) and stopping smoking is one message that should be clearly given to recovering patients. The recovery period provides an important opportunity for patients to quit ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340101051
更新日期:2001-09-01 00:00:00
abstract:PURPOSE:Sedatives administered to critically ill children should be titrated to effect, because both under- and oversedation may have negative effects. We conducted a systematic review to examine reported incidences of under-, optimal, and oversedation in critically ill children receiving intensive care. METHODS:A sys...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-013-2971-3
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVES:Controversies concerning the pivotal trial and negative results from other Drotrecogin alfa activated (DAA) trials have raised questions about its efficacy in severe sepsis patients. Based on all available evidence, our study aimed to respond to: (1) What is the current probability that DAA is not better tha...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-008-1159-8
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:Pulmonary endothelial activation caused by high pulmonary capillary pressures may be involved in the pathogenesis of cardiogenic pulmonary edema (CPE). We studied soluble selectins and soluble ICAM-1 as markers of cell activation in the systemic and pulmonary circulation of patients with respiratory failure (...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000843
更新日期:2001-03-01 00:00:00
abstract::Conventional indices of tissue perfusion after surgery involving cardiopulmonary bypass (CPB) may not accurately reflect disordered cell metabolism. Venous hypercarbia leading to an increased veno-arterial difference in CO2 tensions (V-aCO2 gradient) has been shown to reflect critical reductions in systemic and pulmon...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01716189
更新日期:1991-01-01 00:00:00
abstract:OBJECTIVE:To assess acute cardiorespiratory effects of recruitment manoeuvres in experimental acute lung injury. DESIGN:Experimental study in animal models of acute lung injury. SETTING:Experimental laboratory at a University Medical Centre. ANIMALS:Ten pigs with bronchoalveolar lavage and eight pigs with endotoxin-...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2496-x
更新日期:2005-01-01 00:00:00
abstract:PURPOSE:Although low doses of oxygen (FiO2 <0.50) are considered nontoxic, recent studies have shown that even lower doses increase pulmonary inflammatory mediators. We aimed to evaluate the acute effects of reducing FiO2 on pulmonary inflammation in mechanically ventilated patients without respiratory failure. METHOD...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2801-z
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:To evaluate the physiological effects of decannulation on breathing patterns and respiratory mechanics by comparing mouth breathing (MB) to tracheal breathing (TB) in tracheostomized patients. DESIGN AND SETTING:Prospective cross-over study in a critical and neuromuscular care unit. PATIENTS AND METHODS:Nin...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1545-6
更新日期:2002-12-01 00:00:00
abstract::Nine patients hospitalized for tetanus were studied under the same protocol which included two haemodynamic studies with a preload trial (PLT). The first being made during therapy (diazepam barbiturate association), on the sixth day of hospitalisation, and the second one after recovery. The comparison of the results s...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01700252
更新日期:1978-07-01 00:00:00
abstract:OBJECTIVE:To determine the relationship between the clinically evaluated depth of midazolam-induced sedation and the cardiac beat-to-beat variability (RR variability) in ICU patients in the intensive care unit (ICU). DESIGN:Prospective study. SETTING:ICU of a university hospital. PATIENTS:20 consecutive patients stu...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709555
更新日期:1996-12-01 00:00:00
abstract::Pulmonary artery (PA) catheterization is now a routine procedure in the care of critically ill patients. We report a case in which a pulmonary artery catheter was a major factor in the demise of a patient who developed adult respiratory distress syndrome following a septic abortion. ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00295990
更新日期:1989-01-01 00:00:00
abstract::Type III procollagen N-peptides (PIIINPs) are believed to be released in stoichiometric amounts as type III collagen molecules are secreted from cells. We hypothesized that if the human lung actively produces type III collagen a detectable transpulmonary gradient in PIIINPs would exist in normal individuals that might...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01706477
更新日期:1992-01-01 00:00:00
abstract:PURPOSE:The clinical significance of septic myocardial dysfunction is controversial, a fact that may be explained by the influence of loading conditions. Many indices may be useful to characterize cardiac function during septic shock, but their feasibility and physiological coherence in the clinical setting are unknown...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-017-4698-z
更新日期:2017-05-01 00:00:00
abstract:OBJECTIVE:To determine whether a goal-directed terlipressin infusion increases mean arterial pressure without causing a pulmonary vasopressive effect and whether this response impacts on key parameters of oxygen transport in healthy and endotoxemic sheep. DESIGN AND SETTING:Prospective controlled trial in a university...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1546-5
更新日期:2003-02-01 00:00:00
abstract:OBJECTIVE:To define the changes in middle cerebral artery flow velocity (Vmca) and the electroencephalogram (EEG) during rapid reduction in arterial carbon dioxide (PCO2) from acute hypercapnia. DESIGN. Human volunteer study. SETTING:University-affiliated hospital experimental laboratory. PARTICIPANTS:Nine healthy vo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-003-1917-6
更新日期:2003-10-01 00:00:00
abstract::Fifteen polytrauma patients with asymmetric pulmonary contusion were treated with differential lung ventilation (DLV) for a mean of 106 hours (range 24-298, median 83). The differential time constant (Tc), compliance (Ct), inspiratory and expiratory airway resistance (Rawinsp, Rawexp) and peak-airway pressure (Pawpeak...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00255602
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:Candida spp. airway colonization could promote development of ventilator-associated pneumonia (VAP) caused by Pseudomonas aeruginosa, a potentially multidrug-resistant (MDR) bacteria, and worsen the outcome of VAP regardless of pathogen. We therefore address the question of the risk of MDR bacteria isolation ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2584-2
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:To describe the beliefs and attitudes of intensive care unit (ICU) nurses toward visiting, visiting hours, and open visiting policies in critical care settings. DESIGN:A descriptive, cross-sectional, multicenter survey. SETTING:Seventeen hospitals in Flanders (Dutch-speaking Belgium), including 30 ICUs. Six...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0599-x
更新日期:2007-06-01 00:00:00