Abstract:
OBJECTIVE:Pump-driven extracorporeal gas exchange systems have been advocated in patients suffering from severe acute respiratory distress syndrome who are at risk for life-threatening hypoxemia and/or hypercapnia. This requires extended technical and staff support. DESIGN:We report retrospectively our experience with a new pumpless extracorporeal interventional lung assist (iLA) establishing an arteriovenous shunt as the driving pressure. SETTING:University hospital. PATIENTS:Ninety patients with acute respiratory distress syndrome. INTERVENTIONS:Interventional lung assist was inserted in 90 patients with acute respiratory distress syndrome. MEASUREMENTS AND MAIN RESULTS:Oxygenation improvement, carbon dioxide elimination, hemodynamic variables, and the amount of vasopressor substitution were reported before, 2 hrs after, and 24 hrs after implementation of the system. Interventional lung assist led to an acute and moderate increase in arterial oxygenation (Pao2/Fio2 ratio 2 hrs after initiation of iLA [median and interquartile range], 82 mm Hg [64-103]) compared with pre-iLA (58 mm Hg [47-78], p < .05). Oxygenation continued to improve for 24 hrs after implementation (101 mm Hg [74-142], p < .05). Hypercapnia was promptly and markedly reversed by iLA within 2 hrs (Paco2, 36 mm Hg [30-44]) in comparison with before (60 mm Hg [48-80], p < .05], which allowed a less aggressive ventilation. For hemodynamic stability, all patients received continuous norepinephrine infusion. The incidence of complications was 24.4%, mostly due to ischemia in a lower limb. Thirty-seven of 90 patients survived, creating a lower mortality rate than expected from the Sequential Organ Failure Assessment score. CONCLUSIONS:Interventional lung assist might provide a sufficient rescue measure with easy handling properties and low cost in patients with severe acute respiratory distress syndrome and persistent hypoxia/hypercapnia.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Bein T,Weber F,Philipp A,Prasser C,Pfeifer M,Schmid FX,Butz B,Birnbaum D,Taeger K,Schlitt HJdoi
10.1097/01.CCM.0000215111.85483.BDsubject
Has Abstractpub_date
2006-05-01 00:00:00pages
1372-7issue
5eissn
0090-3493issn
1530-0293journal_volume
34pub_type
杂志文章abstract:OBJECTIVE:To assess clinician perceptions of a machine learning-based early warning system to predict severe sepsis and septic shock (Early Warning System 2.0). DESIGN:Prospective observational study. SETTING:Tertiary teaching hospital in Philadelphia, PA. PATIENTS:Non-ICU admissions November-December 2016. INTERVE...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003803
更新日期:2019-11-01 00:00:00
abstract:OBJECTIVE:To define the impact of prehospital hypotension on the dynamic, systemic acute inflammatory response to blunt trauma. DESIGN:Retrospective study. SETTINGS:Tertiary care institution. PATIENTS:Twenty-two hypotensive blunt trauma patients matched with 28 normotensive blunt trauma patients. INTERVENTION:None....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000000964
更新日期:2015-07-01 00:00:00
abstract:OBJECTIVE:To determine whether activation of the nuclear enzyme poly(adenosine 5'-diphosphate [ADP]-ribose) synthetase (PARS) contributes to mortality rate, myocardial dysfunction, and cardiovascular collapse in a porcine model of sepsis induced by implantation of an infected clot. DESIGN:Prospective, random animal st...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200205000-00004
更新日期:2002-05-01 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:OBJECTIVES:To evaluate the internal consistency, validity, responsiveness, and minimal important difference of the Functional Status Score for the ICU, a physical function measure designed for the ICU. DESIGN:Clinimetric analysis. SETTINGS:Five international datasets from the United States, Australia, and Brazil. PA...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001949
更新日期:2016-12-01 00:00:00
abstract:OBJECTIVE:Unplanned readmission of hospitalized patients to an intensive care unit (ICU) is associated with a worse outcome, but our ability to identify who is likely to deteriorate after ICU dismissal is limited. The objective of this study is to develop and validate a numerical index, named the Stability and Workload...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0B013E318164E3B0
更新日期:2008-03-01 00:00:00
abstract:OBJECTIVE:Oxygenation measured 24 hours after acute respiratory distress syndrome onset more accurately stratifies risk, relative to oxygenation at onset, in both children and adults. However, waiting 24 hours is problematic, especially for interventions that are more efficacious early in the disease course. We aimed t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002958
更新日期:2018-04-01 00:00:00
abstract:OBJECTIVE:Recent studies have demonstrated the therapeutic effectiveness and pharmacologic mechanisms of hyperbaric oxygen therapy (HBOT) in the treatment of a systemic shock state. To elucidate the in vivo role of HBOT during sepsis, we evaluated the effects of HBOT on intestinal mucosal injury and bacterial transloca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000132898.27101.6c
更新日期:2004-08-01 00:00:00
abstract:OBJECTIVE:A comparison of federal Medicare databases to identify critical care medicine (CCM) use, cost discrepancies, and their possible causes. DESIGN:A 6-yr (1995-2000) retrospective analysis of Medicare hospital and CCM use and cost, comparing the Hospital Cost Report Information System (HCRIS) with Medicare Provi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000257255.57899.5D
更新日期:2007-03-01 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:OBJECTIVE:To examine the association between the performance of a tracheostomy and intensive care unit and postintensive care unit mortality, controlling for treatment selection bias and confounding variables. DESIGN:Prospective, observational, cohort study. SETTING:Twelve French medical or surgical intensive care un...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000251134.96055.A6
更新日期:2007-01-01 00:00:00
abstract:OBJECTIVE:Delayed surfactant treatment (>2 hrs after birth) is less effective than early treatment in conventionally ventilated preterm infants with respiratory distress syndrome. The objective of this study was to evaluate if this time-dependent efficacy of surfactant treatment is also present during open lung ventila...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000243794.09377.96
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVES:We recently reported that bacterial lipopolysaccharide stimulates release of tumor necrosis factor (TNF)-alpha from both human vascular tissue and cultured smooth muscle cells. In the current study, we tested the hypothesis that increased intracellular cyclic adenosine 3',5'-monophosphate (cAMP) could inhibi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199711000-00025
更新日期:1997-11-01 00:00:00
abstract:BACKGROUND:Glycemic control is increasingly being recognized as a priority in the treatment of critically ill patients. Titration and monitoring of insulin infusions involve frequent blood glucose measurement to achieve target glucose ranges and prevent adverse events related to hypoglycemia. Therefore, it is imperativ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000189939.10881.60
更新日期:2005-12-01 00:00:00
abstract:OBJECTIVES:To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. DESIGN:Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017. SETTING:ICUs in 12 U.S. acute ca...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004344
更新日期:2020-07-01 00:00:00
abstract:OBJECTIVE:The aim of this study is to test the hypothesis that recruitment maneuvers (RMs) might act differently in models of pulmonary (p) and extrapulmonary (exp) acute lung injury (ALI) with similar transpulmonary pressure changes. DESIGN:Prospective, randomized, controlled experimental study. SETTING:University r...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181760e5d
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVES:Palliative care is now recognized as an essential component of comprehensive care in serious illness that interferes with quality of life. We explored utilization of palliative care in spontaneous intracerebral hemorrhage at a population level using a large national database. DESIGN:Population based cross-s...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001391
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:Adrenal failure is common in critically ill patients, particularly those with sepsis. As liver failure and sepsis are both associated with increased circulating levels of endotoxin and proinflammatory mediators and reduced levels of apoprotein-1/high-density lipoprotein, we postulated that adrenal failure may...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000164541.12106.57
更新日期:2005-06-01 00:00:00
abstract::Because an acute coronary thrombotic event may be viewed as the main trigger of sudden cardiac arrest, urgent coronary angiography followed by percutaneous coronary intervention appeared as a promising tool in the early postresuscitation phase. Unfortunately, large randomized trials, which have unequivocally demonstra...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/ccm.0b013e31818a8ae6
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVES:To determine the accuracy of intramucosal pH (pHi) calculated using arterial bicarbonate instead of mucosal capillary bicarbonate in the Henderson-Hasselbalch equation. DESIGN:Simulation of progressive ischemia in mucosal capillary blood. SETTING:University research laboratory. SUBJECTS:Normal human blood...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00028
更新日期:1999-11-01 00:00:00
abstract:OBJECTIVE:To evaluate the action of high-dose epinephrine by measuring simultaneously its vasopressor and norepinephrine releasing effects in humans during cardiac arrest. DESIGN:A prospective study on consecutive patients admitted with cardiac arrest. SETTING:Emergency Department in a large, urban hospital. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199305000-00012
更新日期:1993-05-01 00:00:00
abstract:BACKGROUND:Venous thromboembolic disease is among the most common causes of morbidity and mortality during pregnancy. The clinical evaluation alone is insufficient for the diagnosis of venous thromboembolic disease, and the normal pregnant state makes this evaluation even more challenging. DIAGNOSIS:Objective testing ...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000183157.15533.4c
更新日期:2005-10-01 00:00:00
abstract:BACKGROUND:Increased intracranial pressure (ICP) worsens the outcome of acute liver failure (ALF). This study investigates the underlying pathophysiological mechanisms and evaluates the therapeutic effect of albumin dialysis in ALF with use of the Molecular Adsorbents Recirculating System without hemofiltration/dialysi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000196203.39832.3c
更新日期:2006-01-01 00:00:00
abstract:OBJECTIVE:To define a biomarker panel to predict organ dysfunction, shock, and in-hospital mortality in emergency department (ED) patients with suspected sepsis. DESIGN:Prospective observational study. SETTING:EDs of ten academic medical centers. PATIENTS:There were 971 patients enrolled. INCLUSION CRITERIA:1) ED p...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318192fd9d
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:To determine the effects of accidental injury of varying severity on interleukin (IL)-1 alpha, IL-6, IL-8, tumor necrosis factor-alpha (TNF-alpha), and endotoxin release. DESIGN:Prospective, multi-unit, longitudinal study. SETTING:Emergency Departments and intensive care units of two university hospitals. ...
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:OBJECTIVES:To determine whether glucose utilization and metabolic substrate (glucose and fat) oxidation could be manipulated in patients with secondary multiple organ dysfunction syndrome. DESIGN:Prospective study. SETTING:Intensive care units (ICU) of two university hospitals. PATIENTS:Eight adults free of hepatic ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199501000-00014
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVES:Visual assessment of the electroencephalogram by experienced clinical neurophysiologists allows reliable outcome prediction of approximately half of all comatose patients after cardiac arrest. Deep neural networks hold promise to achieve similar or even better performance, being more objective and consistent...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000003854
更新日期:2019-10-01 00:00:00
abstract:OBJECTIVE:To determine a) if the admission osmole gap, the difference between osmolality and osmolarity, is the same in the neurologic-neurosurgical intensive care unit (NNICU) population as in healthy controls; b) which of 11 osmole gap formulas, or osmolality, correlates best with mannitol serum concentrations; c) wh...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000120057.04528.60
更新日期:2004-04-01 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
abstract::Prolonged artificial ventilation may result in worsening gas exchange and pulmonary compliance in patients with otherwise normal lungs. Prolonged hyperinflations to 40 cm H2O can completely reverse deterioration of gas exchange and compliance in such patients. Similar efforts have effectively recruited atelectatic lun...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198712000-00001
更新日期:1987-12-01 00:00:00