Abstract:
OBJECTIVES:The results from the recent Targeted Temperature Management trial raised the question whether cooling or merely the avoidance of fever mediates better neurologic outcome in resuscitated patients. As temperature per se is a major determinant of cardiac function, we characterized the effects of hyperthermia (40.5°C), normothermia (38.0°C), and mild hypothermia (33.0°C) on left ventricular contractile function in healthy pigs and compared them with dobutamine infusion. DESIGN:Animal study. SETTING:Large animal facility, Medical University of Graz, Graz, Austria. SUBJECTS:Nine anesthetized and mechanically ventilated closed-chest Landrace pigs (67 ± 2 kg). INTERVENTIONS:Core body temperature was controlled using an intravascular device. At each temperature step, IV dobutamine was titrated to double maximum left ventricular dP/dt (1.8 ± 0.1 µg/kg/min at normothermia). Left ventricular pressure-volume relationships were assessed during short aortic occlusions. Left ventricular contractility was assessed by the calculated left ventricular end-systolic volume at an end-systolic left ventricular pressure of 100 mm Hg. MEASUREMENTS AND MAIN RESULTS:Heart rate (98 ± 4 vs 89 ± 4 vs 65 ± 2 beats/min; all p < 0.05) and cardiac output (6.7 ± 0.3 vs 6.1 ± 0.3 vs 4.4 ± 0.2 L/min) decreased with cooling from hyperthermia to normothermia and mild hypothermia, whereas left ventricular contractility increased (left ventricular end-systolic volume at a pressure of 100 mm Hg: 74 ± 5 mL at hyperthermia, 52 ± 4 mL at normothermia, and 41 ± 3 mL at mild hypothermia; all p < 0.05). The effect of cooling on left ventricular end-systolic volume at a pressure of 100 mm Hg (hyperthermia to normothermia: -28% ± 3% and normothermia to mild hypothermia: -20% ± 5%) was of comparable effect size as dobutamine at a given temperature (hyperthermia: -28% ± 4%, normothermia: -27% ± 6%, and mild hypothermia: -27% ± 9%). CONCLUSIONS:Cooling from hyperthermia to normothermia and from normothermia to mild hypothermia increased left ventricular contractility to a similar degree as a significant dose of dobutamine in the normal porcine heart. These data indicate that cooling can reduce the need for positive inotropes and that lower rather than higher temperatures are appropriate for the resuscitated failing heart.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Alogna A,Manninger M,Schwarzl M,Zirngast B,Steendijk P,Verderber J,Zweiker D,Maechler H,Pieske BM,Post Hdoi
10.1097/CCM.0000000000001358subject
Has Abstractpub_date
2016-03-01 00:00:00pages
e158-67issue
3eissn
0090-3493issn
1530-0293journal_volume
44pub_type
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更新日期:2004-04-01 00:00:00
abstract::Measuring gas exchange in critically ill patients can provide valuable information on their nutritional status and energy expenditure. Several semiautomated machines are available for measuring oxygen consumption (VO2) and carbon dioxide production (VCO2). This study evaluated, under controlled laboratory conditions, ...
journal_title:Critical care medicine
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doi:10.1097/00003246-198609000-00010
更新日期:1986-09-01 00:00:00
abstract::Humidification of inspired gases is indispensible to prevent serious injury to the tracheal mucosa of patients on mechanical ventilation. High-frequency jet ventilation (HFJV), recently introduced for the management of some forms of respiratory failure, presents unusual technical problems of humidification. The presen...
journal_title:Critical care medicine
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doi:10.1097/00003246-198502000-00013
更新日期:1985-02-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318236ef8b
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVES:The mortality outcome of mechanical ventilation, a key intervention in the critically ill, has been variously reported to be determined by intensive care patient volume. We determined the volume-(mortality)-outcome relationship of mechanically ventilated patients whose records were contributed to the Austral...
journal_title:Critical care medicine
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doi:10.1097/CCM.0b013e318236f2af
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:To determine whether continuous gas flow in the breathing circuit or an airleak around the tracheal tube cuff will introduce errors into the measurement of oxygen consumption (VO2) with indirect calorimetry. DESIGN:Nonrandomized, controlled trial. SETTING:Experimental laboratory. SUBJECTS:Ten healthy, anes...
journal_title:Critical care medicine
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doi:10.1097/00003246-199209000-00023
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doi:10.1097/01.CCM.0000057843.47705.E8
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abstract::The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100-4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown. Intracardiac pressures and oxygen saturations were measured in each chamber entered. Th...
journal_title:Critical care medicine
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doi:10.1097/00003246-197908000-00002
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doi:10.1097/00003246-198311000-00011
更新日期:1983-11-01 00:00:00
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doi:10.1097/00003246-198104000-00006
更新日期:1981-04-01 00:00:00
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doi:10.1097/00003246-197906000-00004
更新日期:1979-06-01 00:00:00
abstract::Reproducibility of thermal-dye extravascular lung water (EVLW) estimation by a lung water computer was studied by performing ten consecutive measurements in 45 critically ill patients. EVLW ranged over a wide spectrum from 187 to 1163 ml (2.4 to 18.6 ml/kg). The mean coefficient of variation of ten consecutive measure...
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更新日期:1987-06-01 00:00:00
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更新日期:2020-12-01 00:00:00
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doi:10.1097/CCM.0000000000001403
更新日期:2016-03-01 00:00:00
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更新日期:2012-11-01 00:00:00
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更新日期:2008-04-01 00:00:00
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更新日期:1976-03-01 00:00:00
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更新日期:2004-02-01 00:00:00
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更新日期:1997-10-01 00:00:00
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更新日期:2006-04-01 00:00:00
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更新日期:2018-09-01 00:00:00
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更新日期:2015-03-01 00:00:00
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更新日期:2000-08-01 00:00:00
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更新日期:1982-07-01 00:00:00