Abstract:
OBJECTIVE:To compare the effects of continuous negative extrathoracic pressure (CNEP) and positive end-expiratory pressure (PEEP) at the same level of transpulmonary pressure. DESIGN:Prospective analysis. SETTING:Medical intensive care unit of a university hospital. PATIENTS:Nine consecutive acute lung injury patients. Patients with cardiac failure and patients with chronic lung disease were excluded from the investigation. INTERVENTIONS:The patients were sedated and paralyzed while receiving mechanical ventilation and were studied in three different conditions: a) using a PEEP of 0 cm H2O (zero end-expiratory pressure); b) using a PEEP of 15 cm H2O; c) using CNEP. CNEP was applied to the thorax and the upper abdomen and its level was chosen to obtain a transpulmonary pressure similar to the one observed at a PEEP of 15 cm H2O. All patients had an arterial catheter, a pulmonary artery catheter, and a thermistor-tip fiberoptic catheter for thermo-dye-dilution in the femoral artery. These catheters were connected to an integrated monitoring system. We also placed an esophageal catheter in each patient to detect esophageal pressure. MEASUREMENTS AND MAIN RESULTS:For each step, we assessed the hemodynamic variations by measuring intravascular pressures (via a pulmonary artery catheter), transmural pressures (computed by subtracting esophageal pressure from intravascular pressure), and blood volumes (derived from the technique of double indicator). The application of CNEP of -20+/-0.7 cm H2O produced a venous admixture and PaO2/FO2 improvement similar to that obtained with a PEEP of 15 cm H2O. This procedure is associated with a higher cardiac index (5.5+/-1.5 vs. 4.6+/-1.2 L/min/m2; p < .05) coupled with lower central venous pressure, pulmonary artery occlusion pressure, and higher transmural pressures and blood volume parameters. CONCLUSIONS:In acute lung injury patients, a CNEP of -20 cm H2O has the capability to obtain transpulmonary pressure and lung function improvement similar to a PEEP of 15 cm H2O. CNEP differs from the positive pressure by increasing the venous return and the preload of the heart, and has no negative effects on cardiac performance.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Borelli M,Benini A,Denkewitz T,Acciaro C,Foti G,Pesenti Adoi
10.1097/00003246-199806000-00021subject
Has Abstractpub_date
1998-06-01 00:00:00pages
1025-31issue
6eissn
0090-3493issn
1530-0293journal_volume
26pub_type
杂志文章abstract:OBJECTIVES:We have previously shown that remote ischemic preconditioning reduces acute kidney injury (acute kidney injury) in high-risk patients undergoing cardiopulmonary bypass and that the protective effect is confined to patients who exhibit an increased urinary tissue inhibitor of metalloproteinases-2 and insulin-...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004415
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10-15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using gr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000084856.00372.CE
更新日期:2003-09-01 00:00:00
abstract:OBJECTIVE:To determine whether treatment with patient-controlled analgesia (PCA) alone or in combination with nonsteroidal anti-inflammatory drugs can prevent postoperative pulmonary complications after cardiac surgery, when compared with conventional nurse-controlled analgesia. DESIGN:Randomized controlled trial. SE...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-199910000-00025
更新日期:1999-10-01 00:00:00
abstract::The current investigation describes the morphological and pathophysiological effects of stroma-free hemoglobin solution (SFH) on the liver and kidney. One h after a 75% blood volume exchange in animals receiving 7% SFH, hepatic morphology was normal. Animals whose blood was similarly exchanged with 7% albumin demonstr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198204000-00011
更新日期:1982-04-01 00:00:00
abstract::Sixty-four (48%) of 133 children with hematologic malignancy who were admitted to three pediatric ICUs died. Children who required management because of airway obstruction or after general anesthesia had the best outlook (mortality rate of 7% or less); those children who required major circulatory support or mechanica...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198808000-00005
更新日期:1988-08-01 00:00:00
abstract:OBJECTIVE:To evaluate whether current criteria for the diagnosis of brain death fulfill the requirement for the "irreversible cessation of all functions of the entire brain, including the brainstem." DATA SOURCES:Clinical, philosophical, legal, and public policy literature on the subject of brain death. DATA EXTRACTI...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199212000-00018
更新日期:1992-12-01 00:00:00
abstract:OBJECTIVE:Procalcitonin, the precursor peptide of calcitonin, has been shown to be a serum marker of the severity and mortality of several systemic inflammatory response syndromes. This study addressed the correlation of serum procalcitonin with the course of classic (nonexertional) heatstroke. DESIGN:Serum samples we...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199708000-00024
更新日期:1997-08-01 00:00:00
abstract:OBJECTIVE:We investigated whether serum levels of neuron-specific enolase (NSE) and S-100beta protein could be used to evaluate cerebral injury and to predict outcome in severe sepsis and severe septic shock. DESIGN:Prospective study. SETTING:University hospital. PATIENTS AND MEASUREMENTS:In 170 consecutively enroll...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000217218.51381.49
更新日期:2006-07-01 00:00:00
abstract:OBJECTIVE:Citrate anticoagulation is an excellent alternative to heparin anticoagulation for critically ill patients requiring continuous renal replacement therapy. In this article, we provide a safe and an easy-to-handle citrate anticoagulation protocol with variable treatment doses and excellent control of the acid-b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a00a92
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:To determine how top loads with different doses of carbon monoxide (CO)-saturated saline solutions (CO-saline) affect microvascular and systemic hemodynamics and to delineate the corresponding biochemical mechanisms. DESIGN:Prospective study. SETTING:University research laboratory. SUBJECTS:Male Golden Syr...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000259533.84180.C7
更新日期:2007-04-01 00:00:00
abstract:OBJECTIVE:To describe three female patients of one family with different phenotypes of the same mutation of the ornithine transcarbamylase gene. X-linked inherited ornithine transcarbamylase deficiency is the most frequent urea cycle disorder. Many of the hemizygous males die during the neonatal period. Women, who are ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200201000-00035
更新日期:2002-01-01 00:00:00
abstract::Nineteen patients with acute anterior myocardial infarction who were hypertensive (systolic BP greater than or equal to 170 mm Hg and/or diastolic BP greater than or equal to 100 mm Hg) at the time of admission were treated with continuous infusion of sodium nitroprusside (NP). The administration of NP resulted in a s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198310000-00010
更新日期:1983-10-01 00:00:00
abstract:OBJECTIVE:High-frequency oscillation has been proposed for use in adult acute respiratory distress syndrome. However, limited data are available on the effect of pressure amplitude and rate (Hz) on tidal volumes delivered during high-frequency oscillation in adults. DESIGN:Prospective, animal model, lung injury study....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200301000-00035
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVE:Heatstroke is characterized by hyperthermia, vasoplegic shock, and cerebral ischemia and hypoxia. Hyperbaric oxygen (HBO) has been shown to reduce brain ischemia and behavioral dysfunction during cerebral artery occlusion. The efficacy of HBO therapy for resuscitation from heatstroke remains to be determined ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000159193.42628.e8
更新日期:2005-04-01 00:00:00
abstract::Factors responsible for determining the position of the oxyhemoglobin equilibrium curve during the neonatal period are briefly reviewed and the clinical implications of these changes are examined. Two clinical trials employing exchange transfusions as an adjunct to conventional therapy of the severe respiratory distre...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197909000-00013
更新日期:1979-09-01 00:00:00
abstract:OBJECTIVES:To determine the proportion of patients with documented bacterial aspiration pneumonia among comatose ICU patients with symptoms suggesting either bacterial aspiration pneumonia or non-bacterial aspiration pneumonitis. DESIGN:Prospective observational study. SETTING:University-affiliated 30-bed ICU. PATIE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002525
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVES:The objectives of this article are to introduce and explore a novel paradigm based on complex nonlinear systems, and to evaluate its application to critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS). DATA SOURCES:Published original work, review article...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200007000-00003
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVES:Thrombotic microangiopathy syndromes are a heterogeneous group of severe diseases that often require ICU admission. Prompt initiation of targeted therapies is required for atypical hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, whereas there is no specific consensus therapy for Shiga toxi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003292
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVE:This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. DESIGN:Forty advanced life-support providers leading a cardiac arrest team in a standardi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182591fda
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Septic shock represents the major cause of infection-associated mortality in the intensive care unit. The possibility that combination antibiotic therapy of bacterial septic shock improves outcome is controversial. Current guidelines do not recommend combination therapy except for the express purpose of broa...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181eb3ccd
更新日期:2010-09-01 00:00:00
abstract:OBJECTIVES:A recent post hoc analysis suggested that driving pressure may be more important than traditional ventilatory variables in determining outcome in mechanically ventilated patients with acute respiratory distress syndrome. We conducted a systematic review and meta-analysis to summarize the risk of mortality fo...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/CCM.0000000000002838
更新日期:2018-02-01 00:00:00
abstract:OBJECTIVE:To improve control of blood glucose concentrations in critically ill patients through use of a bedside, nurse-managed, intravenous insulin nomogram. DESIGN:Retrospective, before-after cohort study. SETTING:Fifteen-bed mixed medical/surgical intensive care unit in a tertiary, teaching hospital. PATIENTS:A t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200109000-00010
更新日期:2001-09-01 00:00:00
abstract::The effect of halothane on electrodes covered with polypropylene and FEP teflon membranes, used for monitoring transcutaneous oxygen tension, was compared in vitro and in patients anesthetized with halothane. In vitro experiments with halothane showed a false increase in PO2 measured by the electrode covered with poly...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198308000-00006
更新日期:1983-08-01 00:00:00
abstract:OBJECTIVE:To assess the value of soluble triggering receptor expressed on myeloid cells-1 as a biomarker of infection in patients with neutropenic fever comparing with procalcitonin and C-reactive protein. DESIGN:Prospective, comparative, single-center study. SETTING:Hematology ward at a university hospital. SUBJECT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31820a92dc
更新日期:2011-05-01 00:00:00
abstract:OBJECTIVE:Insulin reduces morbidity and mortality among critically ill patients, but the molecular mechanisms of its effect remain unknown. Insulin is a well-known inhibitor of glycogen synthase kinase-3, which may play an important role in systemic inflammation and shock. Here we investigate the role of blood glucose ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000215457.83953.E3
更新日期:2006-05-01 00:00:00
abstract:OBJECTIVES:To define a curriculum that outlines the core knowledge residents should possess upon completion of graduate training in order to be able to formulate and initiate a treatment plan for the critically ill patient. DATA SOURCES:Requirements for training program certification as outlined by the Accreditation C...
journal_title:Critical care medicine
pub_type: 指南,杂志文章
doi:10.1097/00003246-199511000-00020
更新日期:1995-11-01 00:00:00
abstract:OBJECTIVE:Inadequate nutrition is common in critical illness due in part to gastric stasis. However, recent data suggest that altered small intestinal mucosal function may be a contributing factor. The aim of this study was to examine the effects of critical illness on sucrose absorption, permeability, and mucosal morp...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31827ca2fa
更新日期:2013-05-01 00:00:00
abstract:OBJECTIVE:Transarterial chemoembolization is a widely used therapy for the treatment of hepatocellular carcinoma. A rare adverse event is acute respiratory distress syndrome from pulmonary embolization of Lipiodol, an iodinated oil commonly used during the procedure. The objective of this report is to describe an atypi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000307
更新日期:2014-06-01 00:00:00
abstract:BACKGROUND:We have previously described a method for the precise delivery of inhaled nitric oxide (iNO) via a conventional, continuous-flow, pressure-limited, time-cycled ventilator. Because of the augmented effect of iNO decreasing pulmonary vascular resistance with high-frequency oscillatory ventilation (HFOV), we de...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00038
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:To test the hypothesis that nebulized nitroprusside and inhaled nitric oxide would not differ in producing selective pulmonary vasodilation during hypoxia-induced pulmonary hypertension in piglets. SETTING:University laboratory. SUBJECTS:Five piglets. INTERVENTIONS:Piglets (n = 5) were anesthetized and ins...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200211000-00026
更新日期:2002-11-01 00:00:00