Abstract:
INTRODUCTION:Pulse-pressure variation (PPV) due to increased right ventricular afterload and dysfunction may misleadingly suggest volume responsiveness. We aimed to assess prediction of volume responsiveness with PPV in patients with increased pulmonary artery pressure. METHODS:Fifteen cardiac surgery patients with a history of increased pulmonary artery pressure (mean pressure, 27 +/- 5 mm Hg (mean +/- SD) before fluid challenges) and seven septic shock patients (mean pulmonary artery pressure, 33 +/- 10 mm Hg) were challenged with 200 ml hydroxyethyl starch boli ordered on clinical indication. PPV, right ventricular ejection fraction (EF) and end-diastolic volume (EDV), stroke volume (SV), and intravascular pressures were measured before and after volume challenges. RESULTS:Of 69 fluid challenges, 19 (28%) increased SV > 10%. PPV did not predict volume responsiveness (area under the receiver operating characteristic curve, 0.555; P = 0.485). PPV was >or=13% before 46 (67%) fluid challenges, and SV increased in 13 (28%). Right ventricular EF decreased in none of the fluid challenges, resulting in increased SV, and in 44% of those in which SV did not increase (P = 0.0003). EDV increased in 28% of fluid challenges, resulting in increased SV, and in 44% of those in which SV did not increase (P = 0.272). CONCLUSIONS:Both early after cardiac surgery and in septic shock, patients with increased pulmonary artery pressure respond poorly to fluid administration. Under these conditions, PPV cannot be used to predict fluid responsiveness. The frequent reduction in right ventricular EF when SV did not increase suggests that right ventricular dysfunction contributed to the poor response to fluids.
journal_name
Crit Carejournal_title
Critical care (London, England)authors
Wyler von Ballmoos M,Takala J,Roeck M,Porta F,Tueller D,Ganter CC,Schröder R,Bracht H,Baenziger B,Jakob SMdoi
10.1186/cc9060subject
Has Abstractpub_date
2010-01-01 00:00:00pages
R111issue
3eissn
1364-8535issn
1466-609Xpii
cc9060journal_volume
14pub_type
杂志文章相关文献
CRITICAL CARE文献大全abstract:INTRODUCTION:Glial fibrillary acidic protein (GFAP) may serve as a serum marker of traumatic brain injury (TBI) that can be used to monitor biochemical changes in patients and gauge the response to treatment. However, the temporal profile of serum GFAP in the acute period of brain injury and the associated utility for ...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-015-1081-8
更新日期:2015-10-12 00:00:00
abstract:INTRODUCTION:The aim of this study was to determine whether the degree of fluid responsiveness in critically ill septic patients is related to baseline mixed venous oxygen saturation (SvO2) levels. We also sought to define whether fluid responsiveness would be less likely in the presence of a high SvO2 (>70%). METHODS...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc10326
更新日期:2011-07-26 00:00:00
abstract:INTRODUCTION:Critically ill patients and families rely upon physicians to provide estimates of prognosis and recommendations for care. Little is known about patient and clinician factors which influence these predictions. The association between these predictions and recommendations for continued aggressive care is als...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7926
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Effective antimicrobial treatment is key to reduce mortality associated with bacterial sepsis in patients on intensive care units (ICUs). Dose adjustments are often necessary to account for pathophysiological changes or renal replacement therapy. Extracorporeal membrane oxygenation (ECMO) is increasingly bei...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-020-03397-1
更新日期:2020-11-25 00:00:00
abstract::Developments in recent years have placed powerful new tools of diagnosis, therapy, and communication at the disposal of medicine in general, and of critical care in particular. The art of healing requires not only technical proficiency, but also personal connection, multidisciplinary teamwork, and commitment to the ve...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc14721
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Acute kidney injury (AKI) is common among intensive care unit (ICU) patients. AKI is highly heterogeneous, with variable links to poor outcomes. Current approaches to classify AKI severity and identify patients at highest risk for poor outcomes focus on the maximum change in serum creatinine (SCr) values. Ho...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/s13054-016-1546-4
更新日期:2016-11-17 00:00:00
abstract::Urinary indices are classically believed to allow differentiation of transient (or pre-renal) acute kidney injury (AKI) from persistent (or acute tubular necrosis) AKI. However, the data validating urinalysis in critically ill patients are weak. In the previous issue of Critical Care, Pons and colleagues demonstrate i...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc12676
更新日期:2013-05-07 00:00:00
abstract::Acute respiratory distress syndrome (ARDS) has a substantial mortality rate and annually affects more than 140,000 people in the USA alone. Standard management includes lung protective ventilation but this impairs carbon dioxide clearance and may lead to right heart dysfunction or increased intracranial pressure. Extr...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc11356
更新日期:2012-09-21 00:00:00
abstract::Tracheal reintubation is a common event in critical care. Elmer and colleagues provide the first comparison of complication rates of initial and subsequent reintubation(s) during the same hospitalization. Their work shows an increased risk of complications associated with reintubation, in particular hypoxemia and hypo...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/s13054-015-0841-9
更新日期:2015-03-27 00:00:00
abstract::Many aspects of left ventricular function are explained by considering ventricular pressure-volume characteristics. Contractility is best measured by the slope, Emax, of the end-systolic pressure-volume relationship. Ventricular systole is usefully characterized by a time-varying elastance (ΔP/ΔV). An extended area, t...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/s13054-016-1439-6
更新日期:2016-09-10 00:00:00
abstract:INTRODUCTION:Many patients experience 'relocation stress' when they are transferred from an intensive care unit (ICU) to step-down (high dependency) or general ward care, and much has been written about the psychological causes. This qualitative analysis of in-depth, narrative interviews with former ICU patients explor...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc6795
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:The objective was to study the effects of a novel lung volume optimization procedure (LVOP) using high-frequency oscillatory ventilation (HFOV) upon gas exchange, the transpulmonary pressure (TPP), and hemodynamics in a porcine model of surfactant depletion. METHODS:With institutional review board approva...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc5052
更新日期:2006-01-01 00:00:00
abstract::This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2015 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2015. Further information about the Annual Update in Intensive Care a...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/s13054-015-0807-y
更新日期:2015-03-16 00:00:00
abstract:INTRODUCTION:The effect of sepsis on epidermal wound healing has not been previously studied. It was hypothesised that epidermal wound healing is disturbed in severe sepsis. METHODS:Blister wounds were induced in 35 patients with severe sepsis and in 15 healthy controls. The healing of the wounds was followed up by me...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7932
更新日期:2009-01-01 00:00:00
abstract:INTRODUCTION:The aim of the present multicenter study was to assess long term (36 months) health related quality of life in patients after critical illness, compare ICU survivors health related quality of life to that of the general population and examine the impact of pre-existing disease and factors related to ICU ca...
journal_title:Critical care (London, England)
pub_type: 杂志文章,多中心研究
doi:10.1186/cc8967
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVES:To evaluate the incidence and mortality of acute respiratory distress syndrome (ARDS) in medical/respiratory intensive care units (MICUs/RICUs) to assess ventilation management and the use of adjunct therapy in routine clinical practice for patients fulfilling the Berlin definition of ARDS in mainland China....
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-020-03112-0
更新日期:2020-08-20 00:00:00
abstract::The use of extracorporeal cardiopulmonary resuscitation (ECPR) to restore circulation during cardiac arrest is a time-critical, resource-intensive intervention of unproven efficacy. The current COVID-19 pandemic has brought additional complexity and significant barriers to the ongoing provision and implementation of E...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-020-03172-2
更新日期:2020-07-27 00:00:00
abstract:INTRODUCTION:Experimental research has demonstrated that the level of neuroprotection conferred by the various barbiturates is not equal. Until now no controlled studies have been conducted to compare their effectiveness, even though the Brain Trauma Foundation Guidelines recommend that such studies be undertaken. The ...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc6999
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Inhaled nitric oxide (iNO) is a rescue therapy for severe hypoxemia in patients with acute respiratory distress syndrome (ARDS). Pooled data from clinical trials have signaled a renal safety warning for iNO therapy, but the significance of these findings in daily clinical practice is unclear. We used primary...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/s13054-016-1566-0
更新日期:2016-11-30 00:00:00
abstract:INTRODUCTION:Correct bedside measurement of intra-abdominal pressure (IAP) is important. The bladder method is considered as the gold standard for indirect IAP measurement, but the instillation volumes reported in the literature vary substantially. The aim of this study was to evaluate the effect of instillation volume...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc4962
更新日期:2006-01-01 00:00:00
abstract:INTRODUCTION:Procalcitonin (PCT) and C-reactive protein (CRP) are established markers of infection in the general population. In contrast, several studies reported falsely increased PCT levels in patients receiving T-cell antibodies. We evaluated the validity of these markers in patients scheduled for hemopoietic stem ...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc7749
更新日期:2009-01-01 00:00:00
abstract::Despite progress in the diagnosis, prevention and therapy for hospital-acquired infections, ventilator-associated pneumonia (VAP) continues to complicate the course of a significant proportion of patients receiving mechanical ventilation. Mortality rates among patients with VAP have been reported to be as high as 72%,...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc3014
更新日期:2005-06-01 00:00:00
abstract:INTRODUCTION:Little is known about mortality rates following general surgical procedures in the United Kingdom. Deaths are most common in the 'high-risk' surgical population consisting mainly of older patients, with coexisting medical disease, who undergo major surgery. Only limited data are presently available to desc...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc4928
更新日期:2006-01-01 00:00:00
abstract::Severe sepsis is more and more frequent, especially because of an increased rate of immunocompromised patients. Despite the improvement in the overall prognosis of HIV/AIDS patients and the improvement of global ICU care, the prognosis of HIV/ADS patients hospitalized in ICU with severe sepsis remained poor. This situ...
journal_title:Critical care (London, England)
pub_type: 评论,杂志文章
doi:10.1186/cc3923
更新日期:2005-01-01 00:00:00
abstract::Many advances in medicine have been achieved through challenging established dogma with revolutionary thought and novel practices. Each and every specialty is reinvigorated by regular re-evaluation of processes and practices in the light of new evidence and fresh conceptualization. Challenge can galvanize fresh thinki...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/cc10245
更新日期:2011-07-26 00:00:00
abstract::COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 co...
journal_title:Critical care (London, England)
pub_type: 杂志文章,评审
doi:10.1186/s13054-020-03369-5
更新日期:2020-12-24 00:00:00
abstract:BACKGROUND:Severe traumatic brain injury (TBI) has been increasing with greater incidence of injuries from traffic or sporting accidents. Although there are a number of animal models of TBI using progesterone for head injury, the effects of progesterone on neurologic outcome of acute TBI patients remain unclear. The ai...
journal_title:Critical care (London, England)
pub_type: 杂志文章,随机对照试验
doi:10.1186/cc6887
更新日期:2008-01-01 00:00:00
abstract:INTRODUCTION:To investigate whether respiratory variation of inferior vena cava diameter (cIVC) predict fluid responsiveness in spontaneously breathing patients with acute circulatory failure (ACF). METHODS:Forty patients with ACF and spontaneous breathing were included. Response to fluid challenge was defined as a 15...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc11672
更新日期:2012-10-08 00:00:00
abstract:INTRODUCTION:Angiopoietin-2 (ang-2), an angiogenic peptide released by endothelial cell Weibel-Palade bodies (WPBs), increases endothelial activation and vascular permeability. Ang-2 is raised in severe sepsis but the mechanisms underlying this are not known. Nitric oxide (NO) inhibits WPB exocytosis, and bioavailabili...
journal_title:Critical care (London, England)
pub_type: 杂志文章
doi:10.1186/cc9020
更新日期:2010-01-01 00:00:00
abstract:INTRODUCTION:Ventilator-associated pneumonia (VAP) remains a common hazardous complication in mechanically ventilated patients and is associated with increased morbidity and mortality. We undertook a systematic review and meta-analysis of randomized controlled trials to assess the effect of toothbrushing as a component...
journal_title:Critical care (London, England)
pub_type: 杂志文章,meta分析,评审
doi:10.1186/cc11675
更新日期:2012-10-12 00:00:00