Abstract:
:Optimal fluid management is one of the main challenges in the care of the critically ill. However, the physiological parameters that are commonly monitored and used to guide fluid management are often inadequate and even misleading. From 1987 to 1989 we published four experimental studies which described a method for predicting the response of the cardiac output to fluid administration during mechanical ventilation. The method is based on the analysis of the variations in the arterial pressure in response to a mechanical breath, which serves as a repetitive hemodynamic challenge. Our studies showed that the systolic pressure variation and its components are able to reflect even small changes in the circulating blood volume. Moreover, these dynamic parameters provide information about the slope of the left ventricular function curve, and therefore predict the response to fluid administration better than static preload parameters. Many new dynamic parameters have been introduced since then, including the pulse pressure (PPV) and stroke volume (SVV) variations, and various echocardiographic and other parameters. Though seemingly different, all these parameters are based on measuring the response to a predefined preload-modifying maneuver. The clinical usefulness of these 'dynamic' parameters is limited by many confounding factors, the recognition of which is absolutely necessary for their proper use. With more than 20 years of hindsight we believe that our early studies helped pave the way for the recognition that fluid administration should ideally be preceded by the assessment of "fluid responsiveness". The introduction of dynamic parameters into clinical practice can therefore be viewed as a significant step towards a more rational approach to fluid management.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Perel A,Pizov R,Cotev Sdoi
10.1007/s00134-014-3285-9subject
Has Abstractpub_date
2014-06-01 00:00:00pages
798-807issue
6eissn
0342-4642issn
1432-1238journal_volume
40pub_type
杂志文章,评审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: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::We report a case of fatal septic shock, with hyperlactatemia and blood cultures positive for Streptococcus pneumoniae, in a 70-year-old patient. On two occasions (5 days, and 2 days before the patient's death), the relationship between oxygen delivery (DO2) and consumption (VO2) was examined in conjunction with two pr...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050300
更新日期:1997-01-01 00:00:00
abstract:OBJECTIVE:To compare outcome prediction using the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA), two of the systems most commonly used to evaluate organ dysfunction in the intensive care unit (ICU). DESIGN:Prospective, observational study. SETTING:Thirty-one-bed, universit...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1491-3
更新日期:2002-11-01 00:00:00
abstract:UNLABELLED:Admission of cancer patients with serious medical complications to the ICU remains controversial primarily because of the high short-term mortality rates in these patients. However, the cancer patient population is heterogeneous regarding age, underlying conditions, and curability of their disease, suggestin...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051350
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVES:To measure plasma levels and pharmacokinetics of cefpirome in critically ill septic patients with normal renal function. To use the pharmacokinetic model to simulate alternate dosing regimens and identify those that predict sustained levels. DESIGN AND SETTING:A prospective, open-label, descriptive study in...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000741
更新日期:2001-02-01 00:00:00
abstract:OBJECTIVE:Impairment of haemostasis has been described with slowly degradable medium molecular weight hydroxyethyl starch (MMW-HES), whereas rapidly degradable MMW-HES is generally considered to have no important effects on blood coagulation. This study was undertaken to investigate the effects of a rapidly degradable ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340101107
更新日期:2001-11-01 00:00:00
abstract:OBJECTIVE:To assess whether monitoring of bladder epithelial oxygen tension (BEOT) would provide an indication of regional (renal) organ perfusion in an exsanguination/fluid repletion animal model. DESIGN:Prospective non-randomized laboratory study. SETTING:Research laboratory. INTERVENTIONS:Eight anaesthetised, spo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01700454
更新日期:1996-04-01 00:00:00
abstract:OBJECTIVE:To present our observation of the development of a rare nail deformity in the prolonged course of disease of a critically ill patient with a pulmonary abscess. DESIGN:Case report. SETTING:Tertiary referral, 16-bed, level I surgical ICU in an academic hospital. PATIENT:A 48-year-old Caucasian male was treat...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000679
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVE:The study was undertaken to determine if critically ill patients under mechanical ventilation could reactivate latent cytomegalovirus (CMV) in either lung or blood. DESIGN:Prospective study in critically ill patients was performed in a multidisciplinary intensive care unit in a university hospital. PATIENTS...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709343
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:To compare available instruments for assessing delirium in critically ill adults that have undergone validity testing and provide clinicians with strategies to incorporate these instruments into clinical practice. DESIGN:Medline (1966-September 2006) was searched using the key words: delirium, cognitive dysf...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-007-0603-5
更新日期:2007-06-01 00:00:00
abstract:PURPOSE:To assess the impact of lung ultrasound (LU) on clinical decision making in mechanically ventilated critically ill patients. METHODS:One hundred and eighty-nine patients took part in this prospective study. The patients were enrolled in the study when LU was requested by the primary physician for (1) unexplain...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-013-3133-3
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the efficacy of minitracheotomy (MT) insertion for intratracheal oxygen insufflation (ITO2) on arterial blood gases and survival in patients with respiratory failure from chronic lung disease. DESIGN:Open, prospective clinical study. SETTING:A 12-bed medical intensive care unit in a non-universi...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01709545
更新日期:1996-12-01 00:00:00
abstract:PURPOSE:An International Consensus Conference proposed classifying weaning into simple, difficult, and prolonged weaning. However, the usefulness of this classification in a respiratory intensive care unit (ICU) is unknown. The aims of the study were: (1) to compare the clinical characteristics and outcomes of patients...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-011-2179-3
更新日期:2011-05-01 00:00:00
abstract::Two patients with severe hepatic and renal failure underwent emergency hepatic retransplantation (2nd and 6th day after transplantation). Continuous arteriovenous haemodialysis was begun before surgery and successfully performed, without any incident, during the retransplantation with a biospal (SCU/CAVH AN 69 S) devi...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01706360
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:To define the different types of costs incurred in the care of critically ill patients and to describe some of the most commonly used methods for measuring and allocating these costs. DESIGN:Literature review. Definitions for opportunity, direct and indirect, fixed, variable, marginal, and total costs are de...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-002-1279-5
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:We undertook this study to evaluate the influence of the inspiration:expiration (I:E) ratio on intracranial pressure and cerebral perfusion in patients with acute stroke. DESIGN:Ventilated patients with acute stroke were examined under a protocol involving variations of I:E ratio from 1:2 to 1:1 to 1:2 under...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1351-1
更新日期:2002-08-01 00:00:00
abstract::We analysed the case histories of 22 patients with life threatening asthma retrospectively. Fifteen patients needed mechanical ventilation. Three patients, all of them in cardiac arrest before or at the moment of admission, died. In five patients, halothane therapy was successfully used as a last resort. No major comp...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00260352
更新日期:1985-01-01 00:00:00
abstract::Marked respiratory insufficiency was established in 20 of 91 patients with acute pancreatitis. 16 of them died, 12 from uncontrollable hypoxaemia. At postmortem the most prominent finding was microatelectasis, the occurrence of which correlated highly with the serum amylase activity. ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01683069
更新日期:1977-08-01 00:00:00
abstract:PURPOSE:The efficacy of noninvasive continuous positive airway pressure (CPAP) to improve outcomes in severe hypoxemic acute respiratory failure (hARF) due to pneumonia has not been clearly established. The aim of this study was to compare CPAP vs. oxygen therapy to reduce the risk of meeting criteria for endotracheal ...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s00134-014-3325-5
更新日期:2014-07-01 00:00:00
abstract::This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pu...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-019-05725-8
更新日期:2019-09-01 00:00:00
abstract::The spread of a multi-resistant glucose-acidifying Acinetobacter calcoaceticus strain in a community hospital was studied. After admission of a colonized patient to the hospital the strain was found in clinical specimens from ICU patients and subsequently from several of these patients after transfer to medical wards....
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01058568
更新日期:1989-01-01 00:00:00
abstract::Myxoedema coma is a medical emergency with high mortality. In this study, clinical response and plasma variations of thyroid hormones were analysed in 7 patients, 6 presenting with myxoedema coma and one with myxoedema ileus. These patients were treated with intravenous or oral l-thyroxine (l-T4). 1000 mu l-T4 iv were...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01708403
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Trustworthy clinical practice guidelines (CPGs) require identification and careful management of conflicts of interest (COIs) among all participants in the guideline development. Furthermore, COIs are more common than anticipated. However, there are no universally accepted methods to identify and manage COIs...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-018-5367-6
更新日期:2018-10-01 00:00:00
abstract:OBJECTIVE:To assess the impact of hemodynamic variables on the outcome of critically ill patients in septic shock and to identify the optimal threshold values related to outcome with special reference to continuously monitored mean arterial pressure (MAP) and mixed venous oxygen saturation (SvO2). DESIGN AND SETTING:R...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2688-z
更新日期:2005-08-01 00:00:00
abstract:PURPOSE:Acute heart failure (AHF) causes high burden of mortality, morbidity, and repeated hospitalizations worldwide. This guidance paper describes the tailored treatment approaches of different clinical scenarios of AHF and CS, focusing on the needs of professionals working in intensive care settings. RESULTS:Tissue...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-015-4041-5
更新日期:2016-02-01 00:00:00
abstract::Extracorporeal life support (ECLS) can support gas exchange in patients with the acute respiratory distress syndrome (ARDS). During ECLS, venous blood is drained from a central vein via a cannula, pumped through a semipermeable membrane that permits diffusion of oxygen and carbon dioxide, and returned via a cannula to...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-020-06290-1
更新日期:2020-12-01 00:00:00
abstract::A cardiorespiratory monitoring system allows the measurement of FAECO2 and FECO2 in the expired air of the patient at the mouth (endtidal CO2) and in a mixing box. From these parameters, combined with the measured PACO2, the alveolo-expired (DuA = PECO2/PAECO2) and alveolar-arterial (Dua = PAECO2/PACO2) ductances whic...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01687162
更新日期:1980-08-01 00:00:00
abstract:INTRODUCTION:Most anxiolytics and sedative regimens in the intensive care unit (ICU) impair intellectual function, reducing patient autonomy, and often add to patient morbidity. Using an ICU-validated cognitive assessment tool Adapted Cognitive Exam (ACE), we performed a comparison between dexmedetomidine (DEX) and pro...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-010-1874-9
更新日期:2010-09-01 00:00:00
abstract::We studied the effect of thiopental loading during resuscitation of 53 patients following cardiopulmonary arrest and compared the outcome with that found in 54 patients treated conventionally in the 30 previous months. Thiopental therapy (10 mg/kg i.v.) was begun within 30 min of the arrest once hemodynamic stability ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF00265112
更新日期:1987-01-01 00:00:00