Abstract:
OBJECTIVE:Therapeutic hypothermia in the ICU requires mechanical ventilation and sedation. Hypothermia reduces the metabolism of commonly used IV sedatives. The use of long-acting sedative agents may confound neurologic assessment. Volatile anesthetics have been reported to provide protection against ischemia-reperfusion injury and have been safely used in the ICU to provide sedation in trials with shorter wake-up times. There are no clinical studies in this setting. We describe a case series and discuss potential benefits. DESIGN:Retrospective study. SETTINGS:Ten-bed ICU, university hospital. PATIENTS:Twelve patients resuscitated from cardiac arrest with Glasgow Coma Scale score less than or equal to 4. INTERVENTION:Isoflurane sedation with the AnaConDa during 24 hours therapeutic hypothermia, until rewarming. MEASUREMENTS AND MAIN RESULTS:Data were extracted from the computerized ICU chart/monitors, hospital and prehospital charts, and the national death index. Patients were 49-76 years old. Median return of spontaneous circulation was 14 minutes. Glasgow Coma Scale scores were assessed within 24 hours from reaching normal body temperature and compared with outcomes at 6 months: six patients had poor Glasgow Coma Scale scores (< 8) that remained low and all died before 6-month follow-up, whereas another six patients had high scores (> 8) and survived to 6 months with good Cerebral Performance Category. In the ICU, four of the survivors were directly extubated after rewarming while two were once more sedated due to pneumonia requiring invasive ventilator therapy. All patients required norepinephrine to maintain adequate mean arterial pressure. Isoflurane sedation was changed to midazolam in two nonsurviving patients because of hemodynamic instability, which persisted despite the change. CONCLUSIONS:Sedation with volatile anesthetics during therapeutic hypothermia may be a feasible short-acting option with potential postconditioning effects protecting vital organs from ischemia-reperfusion injury. Its measurability and insignificant drug accumulation could facilitate early neurologic assessment. Prospective clinical trials are warranted.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Hellström J,Öwall A,Martling CR,Sackey PVdoi
10.1097/CCM.0b013e3182a643d7subject
Has Abstractpub_date
2014-02-01 00:00:00pages
e161-6issue
2eissn
0090-3493issn
1530-0293journal_volume
42pub_type
杂志文章abstract::The effects of the Trendelenburg (TREND) position and passive straight leg raising (PLR) on cardiopulmonary performance in 18 anesthetized patients undergoing myocardial revascularization were studied with a two-dimensional transesophageal echocardiography probe and a thermodilution right ventricular ejection fraction...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198904000-00003
更新日期:1989-04-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004896
更新日期:2021-01-28 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000271159.84639.2B
更新日期:2007-08-01 00:00:00
abstract::Position of the CVP port on a flow-directed balloon-tip pulmonary arterial catheter affects the accuracy of both thermodilution cardiac output determinations and CVP measurements. Systemic allometry (the study of the growth of a part in relation to the total organism) has been used to determine an easily measured inde...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198611000-00013
更新日期:1986-11-01 00:00:00
abstract:OBJECTIVE:To determine the specific effect of peak volume history pressure on the inflation limb of the pressure-volume curve and peak pressure-volume curve pressure on the deflation limb of the pressure-volume curve. DESIGN:Prospective assessment of pressure-volume curves in saline, lung lavage injured sheep. SETTIN...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000128573.28173.2e
更新日期:2004-06-01 00:00:00
abstract:OBJECTIVE:Traumatic brain injury contributes to morbidity and mortality in children and boys are disproportionately represented. Hypotension is common and worsens outcome after traumatic brain injury. Extracellular signal-related kinase mitogen-activated protein kinase is upregulated and reduces cerebral blood flow aft...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181e8ac1a
更新日期:2010-09-01 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:Existing handheld glucose meters are glucose oxidase (GO)-based. Oxygen side reactions can introduce oxygen dependency, increase potential error, and limit clinical use. Our primary objectives were to: a) introduce a new glucose dehydrogenase (GD)-based electrochemical biosensor for point-of-care testing; b)...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199803000-00036
更新日期:1998-03-01 00:00:00
abstract::Standard cardiopulmonary-cerebral resuscitation fails to achieve restoration of spontaneous circulation in approximately 50% of normovolemic sudden cardiac arrests outside hospitals and in essentially all victims of penetrating truncal trauma who exsanguinate rapidly to cardiac arrest. Among cardiopulmonary-cerebral r...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200011001-00012
更新日期:2000-11-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200010000-00028
更新日期:2000-10-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199306000-00010
更新日期:1993-06-01 00:00:00
abstract::The metabolic support of critically ill patients is a relatively new topic of active research and discussion, and surprisingly little is known about the effects of critical illness on metabolic physiology and activity. The metabolic changes seen in critical illness are highly complex, and how and when to treat them ar...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000278601.93369.72
更新日期:2007-09-01 00:00:00
abstract::A high rate of death from septic shock persists despite general improvements in care. The relative failure of mechanistically based therapies in various clinical trials should also trigger a reconsideration of such mechanistic approaches. Despite reversion of shock by hydrocortisone, the similar death rate compared wi...
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pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181f23dc4
更新日期:2010-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the possible effects of a combination of systemic nitric oxide synthesis inhibition (to increase mean arterial blood pressure) and nitric oxide inhalation (to decrease pulmonary vascular pressure) in porcine endotoxin shock. DESIGN:Prospective trial. SETTING:Laboratory at a large university medi...
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pub_type: 杂志文章
doi:10.1097/00003246-199505000-00020
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE:To evaluate diagnostic and prognostic values of C-reactive protein (CRP) dosage in critically ill patients. DESIGN:Prospective, observational study. SETTING:Medical intensive care unit (ICU) in a university hospital. PATIENTS:A consecutive series of 74 patients admitted to the ICU. INTERVENTION:CRP measur...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200203000-00006
更新日期:2002-03-01 00:00:00
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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:OBJECTIVE:To investigate the impact of prophylactic continuous lateral rotation therapy on the prevalence of ventilator-associated pneumonia, duration of mechanical ventilation, length of stay, and mortality in critically ill medical patients. DESIGN:Prospective, randomized, clinical study. SETTING:Three medical inte...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3181bc8218
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:Spread of multidrug-resistant organisms within the intensive care unit (ICU) results in substantial morbidity and mortality. Novel strategies are needed to reduce transmission. This study sought to determine if the use of daily chlorhexidine bathing would decrease the incidence of colonization and bloodstream...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e31819ffe6d
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:Intensive care unit (ICU) length of stay (LOS) and hospital LOS are common indices used to compare performance of hospitals and are yardsticks used in efforts to contain costs, yet there is no standardized method of quantitating this outcome variable. Attempts have been made to correct LOS according to diseas...
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pub_type: 杂志文章
doi:10.1097/00003246-200006000-00071
更新日期:2000-06-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197801000-00009
更新日期:1978-01-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,评审
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更新日期:2002-05-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e3181fb7b5f
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVES:Formal guidelines recommend that therapeutic hypothermia be considered after in-hospital cardiac arrest. The rate of therapeutic hypothermia use after in-hospital cardiac arrest and details about its implementation are unknown. We aimed to determine the use of therapeutic hypothermia for adult in-hospital ca...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318287f2c4
更新日期:2013-06-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199611000-00019
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVE:The renal effects of dopamine in critically ill patients remain controversial. Low-dose dobutamine has been reported to improve renal function. We compared the effects of various doses of dopamine and dobutamine on renal function in critically ill patients. DESIGN:Prospective, single-blind, randomized study....
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200004000-00002
更新日期:2000-04-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000278046.24345.C7
更新日期:2007-09-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199607000-00027
更新日期:1996-07-01 00:00:00
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journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e318194ad22
更新日期:2009-03-01 00:00:00
abstract::Recent advances in prenatal and neonatal care have increased the number of live births and extended the life expectancy of critically ill premature infants. These infants represent a formidable therapeutic challenge in that multisystem involvement and previously uncommon conditions, such as intravascular coagulation, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197701000-00007
更新日期:1977-01-01 00:00:00
abstract::A total of 2711 pulmonary artery wedge pressure (WP) measurement attempts were made prospectively from WP recordings in 44 (30 men) critically ill patients, using 77 flow-directed catheters. Of these, 322 (12%) failed to yield a WP measurement, and 521 (18%) were associated with technical problems. One half of these t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198403000-00003
更新日期:1984-03-01 00:00:00