Abstract:
OBJECTIVES:To compare the effects of norepinephrine and dobutamine to epinephrine on hemodynamics, lactate metabolism, and gastric tonometric variables in hyperdynamic dopamine-resistant septic shock. DESIGN:A prospective, intervention, randomized clinical trial. SETTING:Adult medical/surgical intensive care unit in a university hospital. PATIENTS:30 patients with a cardiac index (CI) > 3.51 x min(-1) x m(-2) and a mean arterial pressure (MAP) < or = 60 mmHg after volume loading and dopamine 20 microg/kg per min and either oliguria or hyperlactatemia. INTERVENTIONS:Patients were randomized to receive an infusion of either norepinephrine-dobutamine or epinephrine titrated to obtain an MAP greater than 80 mmHg with a stable or increased CI. MEASUREMENTS AND MAIN RESULTS:Baseline measurements included: hemodynamic and tonometric parameters, arterial and mixed venous gases, and lactate and pyruvate blood levels. These measurements were repeated after 1, 6, 12, and 24 h. All the patients fulfilled the therapeutic goals. No statistical difference was found between epinephrine and norepinephrine-dobutamine for systemic hemodynamic measurements. Considering metabolic and tonometric measurements and compared to baseline values, after 6 h, epinephrine infusion was associated with an increase in lactate levels (from 3.1 +/- 1.5 to 5.9 +/- 1.0 mmol/l;p < 0.01), while lactate levels decreased in the norepinephrine-dobutamine group (from 3.1 +/- 1.5 to 2.7 +/- 1.0 mmol/l). The lactate/pyruvate ratio increased in the epinephrine group (from 15.5 +/- 5.4 to 21 +/- 5.8; p < 0.01) and did not change in the norepinephrine-dobutamine group (13.8 +/- 5 to 14 +/- 5.0). Gastric mucosal pH (pHi) decreased (from 7.29 +/- 0.11 to 7.16 +/- 0.07; p < 0.01) and the partial pressure of carbon dioxide (PCO2) gap (tonometer PCO2-arterial PCO2) increased (from 10 +/- 2.7 to 14 +/- 2.7 mmHg; p < 0.01) in the epinephrine group. In the norepinephrine-dobutamine group pHi (from 7.30 +/- 0.11 to 7.35 +/- 0.07) and the PCO2 gap (from 10 +/- 3.0 to 4 +/- 2.0 mmHg) were normalized within 6 h (p < 0.01). The decrease in pHi and the increase in the lactate/pyruvate ratio in the epinephrine group was transient, since it returned to normal within 24 h. CONCLUSIONS:Considering the global hemodynamic effects, epinephrine is as effective as norepinephrine-dobutamine. Nevertheless, gastric mucosal acidosis and global metabolic changes observed in epinephrine-treated patients are consistent with a markedly inadequate, although transient, splanchnic oxygen utilization. The metabolic and splanchnic effects of the combination of norepinephrine and dobutamine in hyperdynamic dopamine-resistant septic shock appeared to be more predictable and more appropriate to the current goals of septic shock therapy than those of epinephrine alone.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Levy B,Bollaert PE,Charpentier C,Nace L,Audibert G,Bauer P,Nabet P,Larcan Adoi
10.1007/s001340050329subject
Has Abstractpub_date
1997-03-01 00:00:00pages
282-7issue
3eissn
0342-4642issn
1432-1238journal_volume
23pub_type
临床试验,杂志文章,随机对照试验abstract:OBJECTIVE:To describe a real-time ultrasound sign, the visualization of the cavity and the walls of the maxillary sinus ("sinusogram"), and to assess its correlation with total opacity of the sinus. DESIGN:Prospective clinical study. SETTING:The medical ICU of a university-affiliated hospital. PATIENTS:The significa...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050716
更新日期:1998-10-01 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
abstract:OBJECTIVE:To evaluate various treatment strategies in critically ill patients with ischaemic acute renal failure, there is a need for reliable bedside measurements of total renal blood flow (RBF), glomerular filtration rate (GFR) and renal oxygen consumption without the need for urine collection. DESIGN:The continuous...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-004-2380-8
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVE:Definition of the changes in the activators of plasminogen, u-PA and t-PA, and examination of the possible generation of plasmin in the circulation in overwhelming sepsis. DESIGN:Serial blood analysis starting 4 h after development of symptoms of toxic shock syndrome. SETTING:Intensive care unit. PATIENT:A...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050561
更新日期:1998-03-01 00:00:00
abstract:PURPOSE:To assess the ability of quantitative pupillometry [using the Neurological Pupil index (NPi)] to predict an unfavorable neurological outcome after cardiac arrest (CA). METHODS:We performed a prospective international multicenter study (10 centers) in adult comatose CA patients. Quantitative NPi and standard ma...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-018-5448-6
更新日期:2018-12-01 00:00:00
abstract::The side effects of positive pressure ventilation on cardiovascular function are well known. However, in most clinical studies its influence on left ventricular function was examined. In the present study right ventricular (RV) performance was studied in 13 patients undergoing coronary artery bypass grafting during me...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00256962
更新日期:1988-01-01 00:00:00
abstract::The effect of plasma exchange (PE) was evaluated in 4 patients with rhabdomyolysis. A single 21 PE produced a transient fall of creatinine phosphokinase and did not prevent renal failure. Theoretically PE would need to be performed very frequently to remove toxins in appropriate amounts. Since renal failure in myoglob...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00273565
更新日期:1989-01-01 00:00:00
abstract::Acetazolamide (Diamox) induced carbonic anhydrase inhibition is an efficient means of eliminating surplus water and bicarbonate in the overhydrated and alkalotic patient. Previous studies have demonstrated an unexpected and unexplained increase in arterial and venous oxygenation during acute carbonic anhydrase inhibit...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00255787
更新日期:1987-01-01 00:00:00
abstract:INTRODUCTION:Microcirculatory abnormalities are frequently observed in patients with severe heart failure and correlate to worse outcomes. We tested the hypothesis that nitroglycerin dose-dependently improves perfusion in severe heart failure and that this could be monitored by measuring central-peripheral temperature ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1591-4
更新日期:2009-11-01 00:00:00
abstract:: ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-018-5280-z
更新日期:2018-12-01 00:00:00
abstract::Neuromuscular blocking agents (NMBAs) inhibit patient-initiated active breath and the risk of high tidal volumes and consequent high transpulmonary pressure swings, and minimize patient/ ventilator asynchrony in acute respiratory distress syndrome (ARDS). Minimization of volutrauma and ventilator-induced lung injury (...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-020-06297-8
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:An instrument able to estimate the direct costs of stays in Intensive Care Units (ICUs) simply would be very useful for resource allocation inside a hospital, through a global budget system. The aim of this study was to propose such a tool. DESIGN:Since 1991, a region-wide common data base has collected stan...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050619
更新日期:1998-06-01 00:00:00
abstract::The case of an 11-year-old boy who suffered second and third degree burns to 78% of his body is reported. The large doses of morphine used as analgesia resulted in severe side effects: ventilatory dependence, impairment of gastrointestinal function and psychological disturbance. Intravenous lignocaine was added withou...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01712245
更新日期:1996-03-01 00:00:00
abstract::We compare two patients admitted after near drowning. Both presented a severe metabolic acidosis, but only one of them developed an acute pulmonary edema with hypoxemia. An increase of lipid peroxides associated with a reduction of vitamin E concentration has been observed in this later patient. Lipid peroxidation, on...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00254776
更新日期:1985-01-01 00:00:00
abstract::Owing to an oversight by the authors, Figure 2 in this article was not the version intended for publication. The correct Figure 2, reproduced here, features footnote symbols and Figure 2b includes three studies as described in the main text. ...
journal_title:Intensive care medicine
pub_type: 杂志文章,已发布勘误
doi:10.1007/s00134-018-5055-6
更新日期:2018-02-01 00:00:00
abstract:PURPOSE:To provide evidence-based guidelines for early enteral nutrition (EEN) during critical illness. METHODS:We aimed to compare EEN vs. early parenteral nutrition (PN) and vs. delayed EN. We defined "early" EN as EN started within 48 h independent of type or amount. We listed, a priori, conditions in which EN is o...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,实务指引,评审
doi:10.1007/s00134-016-4665-0
更新日期:2017-03-01 00:00:00
abstract:OBJECTIVE:To determine: (1) the proportion of small (<5 mm) or thrombosed internal jugular veins (IJV) and femoral veins (FV) in which catheter placement would be difficult without ultrasound guidance; (2) which position increases central vein sizes and may facilitate cannulation of these vessels. DESIGN:Prospective s...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0875-9
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:Brain death may induce cardiac dysfunction. In potential organ donors measurements of N-terminal pro-brain natriuretic peptide (NT-proBNP) and circulating cardiac troponins T and I (cTnT and cTnI), alone or in combination, are performed to investigate the accuracy of these biomarkers for early diagnosis of le...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0601-7
更新日期:2007-06-01 00:00:00
abstract:OBJECTIVE:To determine the steady-state trough serum and epithelial lining fluid (ELF) concentrations of teicoplanin 12 mg/kg per day in critically ill patients with ventilator associated pneumonia. DESIGN AND SETTING:Prospective, pharmacokinetic study in the surgical intensive care unit in a university hospital. PAT...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0136-3
更新日期:2006-05-01 00:00:00
abstract:PURPOSE:To determine the global metabolomic profile as measured in circulating plasma from surviving and non-surviving patients with community-acquired pneumonia (CAP) and sepsis. METHODS:Random, outcome-stratified case-control sample from a prospective study of 1,895 patients hospitalized with CAP and sepsis. Cases (...
journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-013-2935-7
更新日期:2013-08-01 00:00:00
abstract::A young woman with long-standing systemic lupus erythematosus and rheumatic fever presented with deteriorating renal function. She had severe gastritis treated with cimetidine and received methylprednisolone when her blood cultures were repeatedly negative. She developed spontaneous bruising and bleeding from venepunc...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01724803
更新日期:1990-01-01 00:00:00
abstract:PURPOSE:Ventricular-arterial (V-A) decoupling decreases myocardial efficiency and is exacerbated by tachycardia that increases static arterial elastance (Ea). We thus investigated the effects of heart rate (HR) reduction on Ea in septic shock patients using the beta-blocker esmolol. We hypothesized that esmolol improve...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-016-4351-2
更新日期:2016-10-01 00:00:00
abstract:OBJECTIVE:Inhalation of nitric oxide (NO) can improve oxygenation and decrease mean pulmonary artery pressure (MPAP) in patients with the acute respiratory distress syndrome (ARDS). It is not known whether inhaled NO exerts a similar effect in hypoxemic patients with chronic obstructive pulmonary disease (COPD). DESIG...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050290
更新日期:1997-01-01 00:00:00
abstract::A hypertensive crisis with an arterial blood pressure of 280/180 mmHg developed immediately after an apparently successful removal of a phaeochromocytoma. The blood pressure could not be lowered by phentolamine and not until the administration of dihydralazine and furosemide was the systemic pressure normalized. In ad...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00315379
更新日期:1986-01-01 00:00:00
abstract:OBJECTIVE:To investigate the involvement of intestinal angiotensin II type 2 receptors in the outcome of acute severe hypovolemia as well as systemic and regional mesenteric hemodynamics and intestinal mucosal functions in anesthetized pigs. DESIGN AND SETTING:Prospective, interventional animal study in a university r...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-005-2686-1
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVE:To determine the relation of malnutrition and underlying diagnosis to the length of stay in the Intensive Care Unit (ICU) and to mortality after lung transplantation (LTX). DESIGN:Retrospective ICU chart review. SETTING:Cardiothoracic ICU in a University hospital. PATIENTS:Fifty-one consecutive patients wh...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01709333
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:We perform an ethical analysis of European Union Directive 2001/20/EC on the simplification and harmonization of guidelines regarding good clinical practice in the conduct of clinical trials involving drugs. BACKGROUND:The Directive provides guidance on protecting incapacitated subjects who participate in dr...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2367-5
更新日期:2004-09-01 00:00:00
abstract:OBJECTIVE:Our study aimed to determine the efficacy and safety of colistin in the treatment of ventilator-associated pneumonia (VAP) caused by pan-drug-resistant Pseudomonas aeruginosa or Acinetobacter baumanii. DESIGN:Pairwise, retrospective exposed-unexposed study. SETTING:Combined medical and surgical intensive ca...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0675-2
更新日期:2007-07-01 00:00:00
abstract:PURPOSE:To evaluate the diagnostic accuracy of ultrasonography of optic nerve sheath diameter (ONSD) for assessment of intracranial hypertension. METHODS:Systematic review without language restriction based on electronic databases, with manual review of literature and conference proceedings until July 2010. Studies we...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00134-011-2224-2
更新日期:2011-07-01 00:00:00
abstract::Status epilepticus is one of the most frequent neurological emergencies in the intensive care unit. Standard treatment includes intravenous barbiturates, benzodiazepines and phenytoin. However, drug coma is sometimes necessary to control refractory status epilepticus. We report such a case, successfully treated by int...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01707672
更新日期:1994-01-01 00:00:00