Abstract:
INTRODUCTION:Barotrauma and cardiovascular insufficiency are frequently encountered problems in patients with acute bronchospastic disease who require mechanical ventilation. Permissive hypercapnia is a recognized strategy for minimizing these adverse effects; however, it has potential risks. Tracheal gas insufflation (TGI) has been shown to increase carbon dioxide elimination efficiency and thus could permit mechanical ventilation at lower peak airway pressures without inducing hypercapnia. However, caution exists as to the impact of TGI on lung volumes, given that expiratory flow limitation is a hallmark of bronchospastic disease. PURPOSE:To examine these issues, we studied ventilatory and hemodynamic effects of continuous TGI as an adjunct to mechanical ventilation before and after methacholine-induced bronchospasm. MATERIALS AND METHODS:Ten anesthetized, paralyzed dogs were ventilated on volume-controlled mechanical ventilation during administration of continuous TGI (0, 2, 6, and 10 L/min) while total inspired minute ventilation (ventilator-derived minute ventilation plus TGI) was kept constant. In an additional step, with TGI flow of 10 L/min, total inspired minute ventilation was decreased by 30%. RESULTS:PaCO2 decreased (44 +/- 7 mm Hg at zero flow to 34 +/- 7 mm Hg at 6 L/min and 31 +/- 6 mm Hg at 10 L/min, respectively, P < .05), as did the dead space to tidal volume ratio at TGI of 6 and 10 L/min compared with zero flow. There were no significant changes in end-expiratory transpulmonary pressure, mean arterial pressure, or cardiac output. During the highest TGI flow (10 L/min), with a 30% reduction of total inspired minute ventilation, both PaCO2 and peak airway pressure remained less than during zero flow conditions. CONCLUSION:We conclude that TGI increases carbon dioxide elimination efficiency during constant and decreased minute ventilation conditions without any evidence of hyperinflation or hemodynamic instability during methacholine-induced bronchospasm.
journal_name
J Crit Carejournal_title
Journal of critical careauthors
Miro AM,Hoffman LA,Tasota FJ,Sigler DW,Gowski DT,Lutz J,Zullo T,Pinsky MRdoi
10.1016/s0883-9441(97)90021-6subject
Has Abstractpub_date
1997-03-01 00:00:00pages
13-21issue
1eissn
0883-9441issn
1557-8615pii
S0883-9441(97)90021-6journal_volume
12pub_type
杂志文章abstract:PURPOSE:Studies have shown that lung-ultrasound may be superior to chest x-ray (CXR) in diagnosing ventilator-associated pneumonia (VAP). This study investigated whether the use of lung-ultrasound monitoring could detect VAP earlier and improve patient outcome. METHODS:This was a single-center diagnostic randomized co...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2020.03.012
更新日期:2020-08-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2006.12.008
更新日期:2007-09-01 00:00:00
abstract:PURPOSE:Alcohol-use disorders (AUDs) have been associated with increased sepsis-related mortality. As patients with AUDs are often thiamine deficient, we investigated practice patterns relating to thiamine administration in patients with AUDs presenting with septic shock and explored the association between receipt of ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.08.022
更新日期:2018-02-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2019.09.012
更新日期:2019-12-01 00:00:00
abstract:HYPOTHESIS:As vasopressin is a small peptide, its sieving coefficient (SC) and clearance (CL) during continuous renal replacement therapy may be intermediate to those for urea and β2 microglobulin (commonly used markers for small- and middle-molecular weight solutes, respectively). METHODS:A prospective, minimal-risk ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2010.03.005
更新日期:2010-12-01 00:00:00
abstract:PURPOSE:To describe the prevalence of hypocapnia and hypercapnia during the earliest period of mechanical ventilation, and determine the association between PaCO2 and mortality. MATERIALS AND METHODS:A cohort study using an emergency department registry of mechanically ventilated patients. PaCO2 was categorized: hypoc...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.04.033
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Studies investigating the metabolic effects of citrate-based substitution fluids are lacking. This study aims to compare the effect of citrate- vs bicarbonate-based substitution fluid used during continuous venovenous hemofiltration (CVVH) for acute kidney injury on acid-base balance and electrolytes in crit...
journal_title:Journal of critical care
pub_type: 临床试验,杂志文章
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更新日期:2010-03-01 00:00:00
abstract:PURPOSE:Hyperglycemia and hypoglycemia are frequently encountered in critically ill patients and associated with adverse outcomes. We configured a smart glycemia alert (S-GLY alert) with our Intensive Care Information System to decrease the number of hyperglycemic values and increase the proportion of time within the g...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2014.07.030
更新日期:2015-02-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1053/jcrc.2002.33032
更新日期:2002-03-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2019.07.009
更新日期:2019-12-01 00:00:00
abstract::The aim was to explore how relatives and physicians understood cases where organ donation had been requested and what factors were salient for the decision on donation. Physicians of 25 deceased patients and 20 relatives were interviewed. The material was analyzed using qualitative methods. Eleven patients had declare...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2007.03.002
更新日期:2007-12-01 00:00:00
abstract:PURPOSE:Hyperosmolar therapies aim at controlling increased intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The aim of this study was to evaluate the effect of 7.5% hypertonic saline (HTS) on ICP and cerebral perfusion pressure (CPP) in children with severe TBI. MATERIALS AND METHODS:Medical...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.10.014
更新日期:2017-04-01 00:00:00
abstract:PURPOSE:This study was designed to determine the recompression strategy and the potential risk factors associated with the development of severe diving-related spinal cord decompression sickness (DCS). MATERIAL AND METHODS:Sixty-three injured recreational divers (52 men and 11 women; 46 +/- 12 years) presenting with s...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2009.05.011
更新日期:2010-06-01 00:00:00
abstract::Noninvasive positive pressure ventilation has been demonstrated to be of benefit in preventing endotracheal intubation and reducing mortality in specific patients in the setting of acute exacerbations of chronic obstructive pulmonary disease. The successful application of noninvasive positive pressure ventilation depe...
journal_title:Journal of critical care
pub_type: 指南,杂志文章,实务指引
doi:10.1016/j.jcrc.2004.04.006
更新日期:2004-06-01 00:00:00
abstract::Cell-free circulating DNA (cf-DNA) can be detected by various of laboratory techniques. We described a branched DNA-based Alu assay for measuring cf-DNA in septic patients. Compared to healthy controls and systemic inflammatory response syndrome (SIRS) patients, serum cf-DNA levels were significantly higher in septic ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2015.10.013
更新日期:2016-02-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jcrc.2015.11.015
更新日期:2016-04-01 00:00:00
abstract:PURPOSE:Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2018.10.009
更新日期:2019-02-01 00:00:00
abstract:PURPOSE:To investigate the impact of delay in rapid response call (RRC) activation on Hospital mortality. MATERIALS AND METHODS:This study was conducted in a university affiliated hospital providing medical, surgical, mental health, maternity, and pediatric services. RRCs were considered delayed if RRC activation was ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.05.006
更新日期:2017-10-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2012.06.002
更新日期:2013-02-01 00:00:00
abstract::Patients with COVID-19 ARDS have distinct physiological and immunological phenotypes compared to patients with non-COVID ARDS. Patients with COVID-19 ARDS (n = 32) had a significant improvement in PaO2: FiO2 ratio (p = 0.046) following low-dose steroid treatment, unlike patients with non-COVID ARDS (n = 16) (p = 0.529...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2020.11.012
更新日期:2020-11-21 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2017.10.038
更新日期:2018-04-01 00:00:00
abstract:PURPOSE:It is unclear whether ventilator-associated pneumonia (VAP) is actually a bilateral and multifocal process. In addition, the diagnostic role of chest x-ray is under debate. Assuming a low microbiologic concordance between the left and right lungs, the reliability of a single pulmonary sampling becomes questiona...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2016.02.016
更新日期:2016-06-01 00:00:00
abstract::The concept of permissive hypotension is a controversial topic in trauma care. While driving blood pressure to "normal" levels with large volume crystalloid infusions is not appropriate, definitive data on the target blood pressure for hypotensive resuscitation are lacking. Indeed, the concept of systolic blood pressu...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2013.11.017
更新日期:2014-04-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章,评审
doi:10.1016/j.jcrc.2018.10.018
更新日期:2019-02-01 00:00:00
abstract:PURPOSE:The aim of the study was to investigate predictors of post-intensive care unit (ICU) in-hospital mortality with special emphasis on the impact of sepsis and organ system failure. METHODS:This study is a subanalysis of the database from the observational Sepsis Occurrence in Acutely Ill Patients study conducted...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2007.09.006
更新日期:2008-12-01 00:00:00
abstract:PURPOSE:Handover of patient care is a potential safety risk for the patient due to loss of information which may result in adverse outcome. We hypothesized that a checklist for handover from the operating room (OR) to the intensive care unit (ICU) will lead to an increase of quality regarding information transfer compa...
journal_title:Journal of critical care
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jcrc.2015.12.016
更新日期:2016-04-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2015.09.035
更新日期:2016-02-01 00:00:00
abstract:PURPOSE:Epidemiological information is lacking after identification of new-onset atrial fibrillation (AF) in critically ill patients. This study aimed to describe the clinical course after the identification of new-onset AF. MATERIALS AND METHODS:This prospective cohort study enrolled adult patients with new-onset AF ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2020.06.014
更新日期:2020-10-01 00:00:00
abstract:PURPOSE:There is a paucity of literature to support undertaking emergency laparotomy when indicated in patients supported on ECMO. Our study aims to identify the prevalence, outcomes and complications of this high risk surgery at a large ECMO centre. MATERIALS AND METHODS:A single centre, retrospective, observational ...
journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2019.06.021
更新日期:2019-10-01 00:00:00
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journal_title:Journal of critical care
pub_type: 杂志文章
doi:10.1016/j.jcrc.2008.11.010
更新日期:2009-12-01 00:00:00