Abstract:
OBJECTIVES:Inhaled nitric oxide is being utilized as a selective pulmonary vasodilator in the treatment of persistent pulmonary hypertension of the newborn. However, the effects of inhaled nitric oxide on cerebral hemodynamics and distribution of left ventricular output in newborn subjects have not been studied. This study was designed to measure quantitatively the effect of inhaled nitric oxide on the distribution of left ventricular output and on cerebral hemodynamics in a perinatal animal model. DESIGN:Prospective, controlled, experimental study. SETTING:Research laboratory. SUBJECTS:Eight fetal sheep. INTERVENTIONS:Each animal was exposed to three separate study periods: a) mechanical ventilation with low FIO2 (maintaining fetal levels of PaO2); b) inhalation of nitric oxide (20 parts per million) during mechanical ventilation and low FIO2; and c) mechanical ventilation with an FIO2 of 1.0. MEASUREMENTS AND MAIN RESULTS:Left ventricular output and cerebral blood flow were measured with radiolabeled microspheres. Cerebral oxygen delivery and consumption variables were calculated using measurements of arterial and cerebral venous (sagittal sinus) oxygen content. Total left ventricular output did not differ among the three treatment groups: 235 +/- 16 mL/min/kg with hypoxic ventilation; 283 +/- 13 mL/min/kg with nitric oxide inhalation; and 242 +/- 17 mL/min/kg with an FIO2 of 1.0. Lung blood flow increased 2.7-fold with inhaled nitric oxide and 1.6-fold during mechanical ventilation with an FIO2 of 1.0. With a left ventricle microsphere injection, increased lung blood flow is indicative of increased systemic-to-pulmonary shunt across the ductus arteriosus. Whole brain blood flow did not differ between the three groups: 49.6 +/- 6.7 mL/min/100 g with hypoxic ventilation; 46.4 +/- 7.4 mL/min/100 g with nitric oxide inhalation; and 36.4 +/- 3.8 mL/min/100 g with an FIO2 of 1.0. Cerebral oxygen delivery increased during inhalation of an FIO2 of 1.0 when compared with nitric oxide inhalation (p < .007); fractional extraction of oxygen decreased (p < .004 compared with hypoxic ventilation, p < .0005 compared with nitric oxide inhalation). Cerebral oxygen consumption did not differ between the three groups (1.11 +/- 0.12 microns/min/100 g with hypoxic ventilation, 0.95 +/- 0.12 microns/min/100 g with nitric oxide inhalation, and 0.96 +/- 0.08 microns/min/100 g with an FIO2 of 1.0). CONCLUSION:Acute pulmonary vasodilation caused by inhalation of nitric oxide does not change left ventricular output, cerebral blood flow, or cerebral oxygen consumption, despite an increased systemic-to-pulmonary shunt across the ductus arteriosus.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Rosenberg AA,Kinsella JP,Abman SHdoi
10.1097/00003246-199508000-00013subject
Has Abstractpub_date
1995-08-01 00:00:00pages
1391-7issue
8eissn
0090-3493issn
1530-0293journal_volume
23pub_type
杂志文章abstract:OBJECTIVE:The beneficial effects of hypertonic saline on neuronal survival and on cerebral blood flow have been shown in several animal models of global and focal brain ischemia. Because of the potential benefits of hypertonic solutions, it is hypothesized that hydroxyethyl starch enhances cerebral blood flow and impro...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31824e6750
更新日期:2012-07-01 00:00:00
abstract::To understand better the incidence and meaning of hyperamylasemia in the intensive care setting, cellulose acetate membrane electrophoresis was used to measure the isoenzymes of serum amylase in 192 patients with a variety of critical illnesses. Seventy of these patients had elevated serum amylase levels, but none had...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198507000-00003
更新日期:1985-07-01 00:00:00
abstract:OBJECTIVE:To quantify the therapeutic efficacy of loop diuretics in acute renal failure using Bayesian evidence synthesis, because despite widespread use, the role of diuretics is controversial. DATA SOURCE:Randomized controlled trials or nonrandomized studies, 1966 to January 2007, identified from MEDLINE and EMBASE ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000284503.88148.6f
更新日期:2007-11-01 00:00:00
abstract::The definition of sepsis has been recently modified to accommodate emerging knowledge in the field, while at the same time being recognized as challenging, if not impossible, to define. Here, we seek to clarify the current understanding of sepsis as one that has been typically framed as a disorder of inflammation to o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002172
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:To systematically investigate the effect of altering release time during airway pressure release ventilation in a neonatal animal model before and after oleic acid-induced acute lung injury. DESIGN:Prospective, nonrandomized, controlled study with repeated measures. SETTING:University research laboratory. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199403000-00020
更新日期:1994-03-01 00:00:00
abstract:OBJECTIVES:To determine plasma aluminum concentrations and 24-hr urine aluminum excretion rate in long-term mechanically ventilated patients treated with 6 g of sucralfate daily for stress ulcer prophylaxis. DESIGN:Prospective study in long-term mechanically ventilated critically ill patients. SETTING:A surgical inte...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:
更新日期:1994-11-01 00:00:00
abstract::We developed a method to measure accurately pressures at the airway opening (Pao) and in the trachea (Ptr) in neonates during high frequency oscillatory ventilation (HFOV) from 15-30 Hz. All component parts of the pressure-measuring system were tested as a unit against a reference transducer in a closed chamber in whi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198401000-00011
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVES:Extracorporeal membrane oxygenation is increasingly used in the management of severe acute respiratory distress syndrome. With extracorporeal membrane oxygenation, select patients with acute respiratory distress syndrome can be managed without mechanical ventilation, sedation, or neuromuscular blockade. Publ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003354
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:Leucine-rich repeat and immunoglobulin domain-containing protein (LINGO)-1 is expressed in neural stem cells, and its neutralization results in sustained neuronal immaturity. Thus, targeted inhibition of LINGO-1 via RNA interference may enhance transplanted neural stem cell survival and neuronal differentiati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001351
更新日期:2016-03-01 00:00:00
abstract::In the pathogenesis of sepsis, inflammation and coagulation play a pivotal role. Increasing evidence points to an extensive cross-talk between these two systems, whereby inflammation leads to activation of coagulation, and coagulation also considerably affects inflammatory activity. Molecular pathways that contribute ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181c98d21
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:The Sequential Organ Failure Assessment (SOFA) score was developed to quantify the severity of patients' illness, based on the degree of organ dysfunction. This study aimed to evaluate the accuracy and the reliability of SOFA scoring. DESIGN:Prospective study. SETTING:Adult intensive care unit (ICU) in a te...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000178178.02574.ab
更新日期:2005-09-01 00:00:00
abstract:OBJECTIVE:To assess the possibility that acute respiratory distress syndrome (ARDS) of pulmonary and nonpulmonary origins represent two distinct syndromes. DESIGN:Analysis of data collected prospectively from an inception cohort of 117 patients with ARDS. SETTING:Adult intensive care unit (ICU), university/postgradua...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200103000-00016
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:To determine if intracranial pressure monitor placement in patients with acute liver failure is associated with significant clinical outcomes. DESIGN:Retrospective multicenter cohort study. SETTING:Academic liver transplant centers comprising the U.S. Acute Liver Failure Study Group. PATIENTS:Adult critica...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000000144
更新日期:2014-05-01 00:00:00
abstract:OBJECTIVE:To assess whether clinical variables might be useful in selecting patients who will have an acute intracranial abnormality seen in head computed tomographic scans (HCT). DESIGN:Retrospective study. SETTING:Medical intensive care unit (MICU) in a tertiary teaching hospital. MEASUREMENTS:Medical records of p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200005000-00008
更新日期:2000-05-01 00:00:00
abstract:OBJECTIVES:Sepsis remains a serious clinical problem despite intensive research efforts and numerous attempts to improve outcome by modifying the inflammatory response. Substance P, the principal ligand for the neurokinin-1 receptor, is a potent proinflammatory mediator that exacerbates inflammatory responses and cardi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002075
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVES:We previously reported gene expression-based endotypes of pediatric septic shock, endotypes A and B, and that corticosteroid exposure was independently associated with increased mortality among pediatric endotype A patients. The Vasopressin vs Norepinephrine as Initial Therapy in Septic Shock trial tested th...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004709
更新日期:2021-01-01 00:00:00
abstract::Oxygen availability during cardiopulmonary bypass was assessed in 22 patients under hypothermic and relatively normothermic conditions. The patients were divided into two groups, 17 of whom received ACD blood and 5, CPD blood. The mean P50 for all patients fell from a preoperative value of 25.9 +/- 2.4 (SD) to 15.6 +/...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197705000-00007
更新日期:1977-05-01 00:00:00
abstract:BACKGROUND:Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge. OBJECTIVES:To report on a 2-day Society of Critical Car...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318232da75
更新日期:2012-02-01 00:00:00
abstract:OBJECTIVE:To assess the possible benefits of sympatholytics on uncontrolled hemorrhage in unanesthetized rats. DESIGN:A randomized laboratory study using rats to test the effects of sympatholytics on uncontrolled hemorrhage. SETTING:Research laboratory. SUBJECTS:Forty female Sprague-Dawley rats, randomly assigned in...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00025
更新日期:1999-09-01 00:00:00
abstract::The hemodynamic effects of digitalis were examined in ten patients with acute cardiac failure. Administration of 10 micrograms/kg of digoxin iv resulted in significant increases in cardiac index, stroke volume index, and left ventricular stroke work index within one hour in five patients with acute myocardial infarcti...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198711000-00002
更新日期:1987-11-01 00:00:00
abstract::Healthcare systems spend considerable resources collecting and processing blood cultures for the detection of blood stream pathogens. The process is initiated with the collection of blood cultures that depend upon proper skin disinfection, collection of an adequate number of specimens and volume of blood, and prompt p...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e318270e771
更新日期:2012-12-01 00:00:00
abstract::Pulmonary mechanics were studied in ten anemic preterm infants using an esophageal balloon and mask, before and after transfusion with 10 ml/kg of packed RBC. Their mean birth weight was 1212 +/- 323 g and gestational age was 29.27 +/- 2.4 wk. Transfusions were carried out at a mean postnatal age of 41.9 +/- 21.8 days...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199012000-00010
更新日期:1990-12-01 00:00:00
abstract:OBJECTIVES:To evaluate the cardiovascular response and acute stress reaction after arousal induced by a benzodiazepine antagonist, flumazenil, in patients sedated with midazolam. DESIGN:Prospective study. SETTING:Emergency center in a university hospital. PATIENTS:A total of 12 patients were ventilated mechanically ...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章
doi:10.1097/00003246-200002000-00005
更新日期:2000-02-01 00:00:00
abstract::Quality improvement (QI) activities have been done as long as medicine has been practiced and are integral to safety and efficacy of patient care. The 20th century witnessed sophisticated advances of QI methods, with concurrent advances in research ethics. The suggestion that some interventional QI activities resemble...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000054902.85329.50
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVE:Mitochondrial damage and dysfunction are thought to play an important role in the pathogenesis of sepsis-induced organ failures. Unfortunately, specific markers of mitochondrial damage in vital organs do not currently exist. Recently, carbomyl phosphate synthase (CPS)-1, a protein primarily localized to liver...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000230240.02216.21
更新日期:2006-09-01 00:00:00
abstract:OBJECTIVES:To provide an overview of key elements of the Affordable Care Act. To evaluate ways in which the Affordable Care Act will likely impact the practice of critical care medicine. To describe strategies that may help health systems and providers effectively adapt to changes brought about by the Affordable Care A...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001431
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:Antioxidant therapy has shown some promise in critical care medicine in which glutathione depletion and heart failure are often seen in critically ill patients. This study was designed to examine the impact of glutathione depletion and the free radical scavenger, metallothionein (MT), on cardiac function. DE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31817bf925
更新日期:2008-07-01 00:00:00
abstract:OBJECTIVES:To determine the effects of sustained, 3-day endotoxin infusion on early steps of the insulin-signaling pathway in rat liver and skeletal muscle in vivo; to examine insulin signaling in well-established acute endotoxin models of insulin resistance. DESIGN:Prospective, controlled animal study. SETTING:Unive...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00032
更新日期:2001-04-01 00:00:00
abstract:OBJECTIVES:To review the reports of prolonged neuromuscular blockade secondary to vecuronium and atracurium administration. To propose mechanisms for prolonged blockade, as well as methods to avoid prolonged blockade. DATA SOURCES:A literature search was conducted of articles published from 1980 to 1993. Articles pert...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199405000-00028
更新日期:1994-05-01 00:00:00
abstract:OBJECTIVES:Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, there has been little systematic study of the impact of patient preferences on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199611000-00009
更新日期:1996-11-01 00:00:00