Abstract:
OBJECTIVES:To assess the markers of perfusion which best discriminate survivors from non-survivors of childhood sepsis and to compare the information derived from gastric tonometry with conventionally measured haemodynamic and laboratory parameters. DESIGN:Prospective clinical study of children with sepsis syndrome or septic shock. SETTING:Paediatric intensive care unit in a tertiary referral centre. PATIENTS:31 children with sepsis syndrome or septic shock. INTERVENTIONS:A tonometer was passed into the stomach via the orogastric route. MEASUREMENTS AND MAIN RESULTS:The following data were recorded at admission, 12, 24 and 48 h: heart rate, mean arterial pressure, arterial pH, base deficit, arterial lactate, gastric intramucosal pH (pHi) and DCO2 (intramucosal carbon dioxide tension minus arterial partial pressure of carbon dioxide). The principal outcome measure was. The secondary outcome measure was the number of organ systems failing at 48 h after admission. There were 10 deaths and 21 survivors. No variable discriminated survival from death at presentation. Blood lactate level was the earliest discriminator of survival. Using univariate logistic regression, lactate discriminated survivors from those who died at 12 and 24 h after admission, but not at 48 h (p = 0.049, 0.044 and 0.062, respectively). The area under the receiver operating characteristic (ROC) curve for lactate was 0.81, 0.88 and 0.89 at 12, 24 and 48 h, respectively. At 12 h after admission, a blood lactate level > 3 mmol/l had a positive predictive value for death of 56% and a lactate level of 3 mmol/l or less had a positive predictive value for survival of 84%. At 24 h a lactate level > 3 mmol/l had a positive predictive value for death of 71% and a level of 3 mmol/l or less had a positive predictive value for survival of 86%. No other variable identified non-survivors from survivors at 12 h. Gastric tonometry could only be done on 19 of the 31 children, of whom 8 died and 11 survived. In these 19 children, DCO2 measured at 24 h, but not at 12 or 48 h, distinguished those who died from those who survived (p = 0.045 and p = 0.20, respectively). The area under the ROC curve for DCO2 measured at 24 h as a predictor of survival was 0.71. Neither the absolute value of pHi nor the trend of change in pHi at any time in the first 48 h identified survivors in this series. The mean arterial pressure distinguished survivors from non-survivors at 24 and 48 h (area under ROC curve = 0.80 and 0.78, respectively). The base deficit and heart rate did not identify non-survivors from survivors at any time in the first 48 h. CONCLUSIONS:Blood lactate level was the earliest predictor of outcome in children with sepsis. In this group of patients, gastric tonometry added little to the clinical information that could be derived more simply by other means.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Duke TD,Butt W,South Mdoi
10.1007/s001340050394subject
Has Abstractpub_date
1997-06-01 00:00:00pages
684-92issue
6eissn
0342-4642issn
1432-1238journal_volume
23pub_type
杂志文章abstract::The oxygen cost of breathing (which is the difference in oxygen consumption measured during controlled ventilation and again during spontaneous ventilation) was measured in 30 patients between the ages of 17 and 96 years at the time of commencement of weaning from mechanical ventilation. There was a significant expone...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00254122
更新日期:1988-01-01 00:00:00
abstract:OBJECTIVE:We examined in rabbits the effects of more than 48 h of mechanical ventilation on the contractile properties and fiber type adaptations of the respiratory muscles. DESIGN AND SETTING:Experimental prospective study in a university laboratory. ANIMALS AND INTERVENTIONS:Nineteen rabbits were randomly allocated...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1548-3
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:Real-time measurement of stroke volume variation by arterial pulse contour analysis (SVV) is useful in predicting volume responsiveness and monitoring volume therapy in mechanically ventilated patients. This study investigated the influence of the depth of tidal volume (V(t)) on SVV both during the state of f...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s00134-003-1649-7
更新日期:2003-03-01 00:00:00
abstract::Arterial blood ketone body ratio, reflecting hepatic mitochondrial redox state, was measured in 26 brain-dead patients who were hypotensive but hemodynamically stable. All of them had substantially normal hepatic function. In 18 of the patients, blood ketone body ratio was maintained within the normal range in spite o...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01691432
更新日期:1991-01-01 00:00:00
abstract::Recombinant activated factor VII (rFVIIa, 'NovoSeven') is indicated for the treatment of spontaneous and surgical bleeding in patients with haemophilia A or B with antibodies to factors VIII or IX (FVIII or FIX) worldwide, and in patients with acquired haemophilia in Europe. In vitro cell models have demonstrated that...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-002-1469-1
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:To test the feasibility of the transcardiac conductance (TCC) method for continuous, on-line measurement of absolute left ventricular (LV) volume and to validate the method by comparison with biplane angiography. DESIGN AND SETTING:Prospective clinical feasibility and validation study in a cardiac catheteriz...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-004-2300-y
更新日期:2004-07-01 00:00:00
abstract:OBJECTIVE:To investigate the regional partial pressure of oxygen (PO2) and partial pressure of carbon dioxide (PCO2) of the perfluorocarbon liquid (PpfcO2, PpfcCO2) during partial liquid ventilation (PLV). DESIGN:Prospective, controlled study. SETTING:A research laboratory at a university medical center. SUBJECTS:Th...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000706
更新日期:2001-01-01 00:00:00
abstract:OBJECTIVE:Interhospital transfers of critically ill pediatric patients in The Netherlands are accompanied by referring specialists or by specialist retrieval teams. We compared the interventions before and directly after transports and the complications and the equipment available during transports in the two groups. ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-003-2066-7
更新日期:2004-02-01 00:00:00
abstract:OBJECTIVE:Fibroproliferation markers like procollagen I predict mortality in patients with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). We sought to determine whether bronchoalveolar lavage fluid (BALF) from patients with lung injury contained mediators that would activate procollagen I promo...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-004-2503-2
更新日期:2005-01-01 00:00:00
abstract::Sixteen anaesthetized rabbits were subjected to tracheostomy and lung damage produced by the instillation of 4.5 ml/kg hydrochloric acid (pH 1.5) into the trachea. Half of the animals were ventilated with a positive end-expiratory pressure (PEEP) of 3 cmH2O and half with a PEEP of 10 cmH2O for 5 h, the mean airway pre...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01705044
更新日期:1992-01-01 00:00:00
abstract:PURPOSE:Previous observational studies have inconsistently associated early hyperoxia with worse outcomes after cardiac arrest, and have methodological limitations. We tested this association using a high-resolution database controlling for multiple disease-specific markers of severity of illness and care processes. M...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-014-3555-6
更新日期:2015-01-01 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::Membranous laryngotracheobronchitis is a very serious infection which affects the larynx, trachea and bronchi, requiring aggressive therapeutic measures. It has been recently rediscovered as a cause of disease in children. However, it is a very unusual complication of measles. Two infants with measles and membranous l...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00273547
更新日期:1985-01-01 00:00:00
abstract::A randomized study of 30 patients undergoing uncomplicated surgery under spinal anesthesia was conducted to assess the influence of colloids on the kinetics of plasma fibronectin and complement. Both are opsonins of the reticuloendothelial system; moreover fibronectin is concerned with host resistance against septic c...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/BF01691428
更新日期:1991-01-01 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:BACKGROUND:Vasopressors are administered to critically ill patients with vasodilatory shock not responsive to volume resuscitation, and less often in cardiogenic shock, and hypovolemic shock. OBJECTIVES:The objectives are to review safety and efficacy of vasopressors, pathophysiology, agents that decrease vasopressor ...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-019-05801-z
更新日期:2019-11-01 00:00:00
abstract::Thirty patients with adult respiratory distress syndrome required intermittent positive pressure ventilation; 15 survived. In 25 the syndrome followed bacterial infection or multiple injuries. From the peak upper airway pressure, the oxygen gradient and the age of the patient, an index was obtained which discriminated...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00254517
更新日期:1986-01-01 00:00:00
abstract::Risk of critical illness is determined both by genetic and environmental influences, particularly those relating to infectious and cardiovascular diseases. Physiologically-based scoring systems cannot measure prior risk because they do not quantify physiological reserve independently of the acute illness. Genetic prof...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s001340051120
更新日期:2000-01-01 00:00:00
abstract:OBJECTIVE:Cytokeratin 19 (CK19) is a specific cytoskeletal structure for alveolar epithelium. We hypothesized that the levels of CK19 fragments in bronchoalveolar lavage (BAL) fluid could serve as an index of epithelial injury and as a prognosis marker in patients with acute lung injury (ALI) or acute respiratory distr...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-006-0124-7
更新日期:2006-06-01 00:00:00
abstract:PURPOSE:To assess the generalisability of published clinical risk predictive models for invasive candidiasis in ICU patients. METHODS:The performance characteristics of published clinical risk factor-only and Candida colonisation-only predictive models for invasive candidiasis were assessed in a multicentre cohort of ...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-009-1619-9
更新日期:2009-12-01 00:00:00
abstract:OBJECTIVES:To determine the effects of an intravenous bolus dose of a vasopressin analogue, terlipressin (1 mg), on systemic haemodynamic parameters and gastric mucosal perfusion (GMP) in patients with catecholamine-treated septic shock using a gastric tonometry and laser-Doppler flowmetry technique. DESIGN:Prospectiv...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-003-2094-3
更新日期:2004-04-01 00:00:00
abstract:PURPOSE:Pneumonia associated with invasive mechanical ventilation (IMV) is one of the indicator infections of the German Nosocomial Infection Surveillance System. In 2005 surveillance was extended to include pneumonia associated with noninvasive ventilation (NIV). The aim of this study was to determine the utilization ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-010-1863-z
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVES:To measure the extent of dilution of helium-oxygen (heliox) by room air when given via high concentration reservoir mask to spontaneously breathing subjects. Substantial dilution of heliox by room air under these circumstances might alter its physical properties sufficiently to negate any potential clinical ...
journal_title:Intensive care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1007/s00134-008-1064-1
更新日期:2008-08-01 00:00:00
abstract:PURPOSE:In critically ill pediatric patients, fluid overload (FO) >10% has been identified as a threshold for possible interventions, including initiation of continuous renal replacement therapy (CRRT). However, multiple definitions have been reported, and there remains no consensus method for FO calculation. The goal ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2503-6
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:To describe the syndrome of rhabdomyolysis during bacterial sepsis with regard to incidence, blood bacteriology and complications and to examine the association between hyperosmolal state and rhabdomyolysis, evaluating the relationship between plasma osmolality (Posm) and serum creatine phosphokinase (CPK) le...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050882
更新日期:1999-05-01 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 characterize N-terminal pro-brain natriuretic peptide (N-proBNP) and troponin I (TnI) profile following mitral and/or aortic valve surgery and to evaluate correlations with echocardiography measures and outcome criteria. DESIGN AND SETTING:Prospective cross-controlled study in a university children's hosp...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-008-1025-8
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVE:To describe Enterococcus faecalis colonisation and endocarditis in 5 intensive care patients after treatment with selective decontamination (SDD). SETTING:Intensive care unit (ICU) in a general hospital. PATIENTS:The patients were admitted to the ICU because of adult respiratory distress syndrome, polytraum...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01701478
更新日期:1995-03-01 00:00:00
abstract:INTRODUCTION:The purpose of a scientific paper is to communicate results and within the paper this applies especially to the presentation of data. It is the universal practice in medical journals to present statistical results using tables. Good tables are an integral part of the manuscript. To help researchers communi...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-014-3248-1
更新日期:2014-05-01 00:00:00
abstract::The process of fluidisation involves blowing warm air through small solid microspheres thus creating a liquid, without wetness. The warmth provides some important properties including reducing the metabolic rate in thermal injury which has a beneficial effect on mortality, modifying catabolism after surgery, providing...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/BF01701488
更新日期:1995-03-01 00:00:00