Myocardial ischemia and weaning failure in patients with coronary artery disease: an update.

Abstract:

OBJECTIVE:To determine the frequency and effects of weaning-related myocardial ischemia on weaning outcomes in patients with coronary artery disease. DESIGN:Prospective cohort study. SETTING:Medical and cardiac intensive care units of a 300-bed teaching community hospital. MEASUREMENTS AND MAIN RESULTS:Three-lead ST segments, heart rate-systolic blood pressure products, and respiratory rate/tidal volume ratios were obtained for patients with coronary artery disease just before and during their initial trials of weaning from mechanical ventilation. ST segments were interpreted by a blinded cardiologist. Eighty-three patients with a mean age of 72.4 +/- 1.1 years (mean +/- SEM), a mean Acute Physiology and Chronic Health Evaluation II score of 16.4 +/- 0.8, and a mean duration of mechanical ventilation of 4.6 +/- 0.9 days were studied. Eight patients showed electrocardiographic evidence of ischemia during weaning, and seven of these patients failed to be liberated on their first day of weaning. The presence of ischemia significantly increased the risk of weaning failure (risk ratio, 2.1; 95% confidence interval, 1.4-3.1). The rate-pressure product for the group as a whole increased significantly during weaning, from 11.9 +/- 0.4 to 13.5 +/- 0.5 mm Hg x beats/min x 10(3) (p < .01). The increase in rate-pressure product tended to be greater in patients who became ischemic (12.8 +/- 0.9 to 17.3 +/- 2.0 mm Hg x beats/min x 10(3)) than in patients who were not ischemic during weaning (11.8 +/- 0.4 to 13.0 +/- 0.5 mm Hg x beats/min x 10(3); p = .05). The rate/volume ratio did not change significantly during weaning, but the rate/volume ratios after both 1 min (65.6 +/- 4.6 vs. 98.0 +/- 9.4 breaths/min/L; p < .05) and 30 mins (68.6 +/- 4.3 vs. 91.1 +/- 8.9 breaths/min/L; p < .05) of unassisted breathing were lower in successful than in unsuccessful patients. CONCLUSION:Electrocardiographic evidence of myocardial ischemia occurs frequently and is associated with significantly increased risk of first-day weaning failure in patients with coronary artery disease.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Srivastava S,Chatila W,Amoateng-Adjepong Y,Kanagasegar S,Jacob B,Zarich S,Manthous CA

doi

10.1097/00003246-199910000-00005

subject

Has Abstract

pub_date

1999-10-01 00:00:00

pages

2109-12

issue

10

eissn

0090-3493

issn

1530-0293

journal_volume

27

pub_type

临床试验,杂志文章
  • RBC transfusion practices among critically ill patients: has evidence changed practice?

    abstract:OBJECTIVE:Increasing evidence, including publication of the Transfusion Requirements in Critical Care trial in 1999, supports a lower hemoglobin threshold for RBC transfusion in ICU patients. However, little is known regarding the influence of this evidence on clinical practice over time in a large population-based coh...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31828e9a49

    authors: Murphy DJ,Needham DM,Netzer G,Zeger SL,Colantuoni E,Ness P,Pronovost PJ,Berenholtz SM

    更新日期:2013-10-01 00:00:00

  • Sucralfate does not reduce the risk of acid aspiration pneumonitis.

    abstract:OBJECTIVE:To study the pulmonary effects of aspirating a mixture of sucralfate in water and sucralfate in hydrochloric acid in an animal model of aspiration pneumonia. DESIGN:Prospective, randomized, controlled study with repeated measures. SETTING:University research laboratory. SUBJECTS:Thirty-two in situ, isolate...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199309000-00020

    authors: Toung TJ,Rosenfeld BA,Yoshiki A,Grayson RF,Traystman RJ

    更新日期:1993-09-01 00:00:00

  • Prolonged extracorporeal life support (ECLS) for varicella pneumonia.

    abstract:OBJECTIVE:To review the institutional experience of a national tertiary referral center for extracorporeal life support (ECLS) in severe varicella pneumonia. DATA SOURCES:Hospital records and ECLS flow sheets. STUDY SELECTION:All pediatric (nonneonatal) and adult patients who were treated for varicella pneumonia with...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199706000-00014

    authors: Lee WA,Kolla S,Schreiner RJ Jr,Hirschl RB,Bartlett RH

    更新日期:1997-06-01 00:00:00

  • Intestinal nitric oxide output during reduced mucosal blood flow in healthy volunteers.

    abstract:OBJECTIVE:Nitric oxide regulates epithelial permeability and other properties of the intestinal mucosal barrier. It previously has been shown in animals that intestinal mucosal nitric oxide production is impaired during gut hypoperfusion. The study was performed to confirm the presence of intestinal mucosal nitric oxid...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.CCM.0000080489.67211.1F

    authors: Snygg J,Aneman A,Pettersson A,Fändriks L

    更新日期:2003-08-01 00:00:00

  • Sepsis-associated changes of the arachidonic acid metabolism and their diagnostic potential in septic patients.

    abstract:OBJECTIVES:Sepsis-associated changes of the arachidonic acid metabolism and the utility of arachidonic acid metabolites for the diagnosis of sepsis have been poorly investigated so far. Therefore, the primary objective of our study was to screen for differentially regulated arachidonic acid metabolites in septic patien...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3182416f05

    authors: Bruegel M,Ludwig U,Kleinhempel A,Petros S,Kortz L,Ceglarek U,Holdt LM,Thiery J,Fiedler GM

    更新日期:2012-05-01 00:00:00

  • Maximum infusion rates and CVP accuracy during high-flow delivery through multilumen catheters.

    abstract::Flow rates and pressure recording accuracy were compared for Argyle 14-, 16-, and 18-ga double-lumen and Edwards 7-Fr triple-lumen CVP catheters. Physiologic saline solution was pressure-infused into dogs through one lumen and CVP was measured via the other lumen. CVP accuracy was unaltered by simultaneous rapid infus...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198507000-00017

    authors: Ikeda S,Schweiss JF

    更新日期:1985-07-01 00:00:00

  • Influence of aminosteroid and glucocorticoid treatment on inflammation and immune function during cardiopulmonary bypass.

    abstract:OBJECTIVE:During cardiopulmonary bypass, inflammation and immunosuppression is present. We measured circulating mediators and monocyte-based functions and tested the hypothesis that these variables are influenced by methylprednisolone (MP) or tirilazad mesylate (TM) treatment. DESIGN:Randomized, controlled, double-bli...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00003246-200111000-00015

    authors: Volk T,Schmutzler M,Engelhardt L,Döcke WD,Volk HD,Konertz W,Kox WJ

    更新日期:2001-11-01 00:00:00

  • Endotoxemia causes ileal mucosal acidosis in the absence of mucosal hypoxia in a normodynamic porcine model of septic shock.

    abstract:OBJECTIVE:To evaluate the hypothesis that splanchnic ischemia and mucosal hypoxia are responsible for lipopolysaccharide-induced intramucosal acidosis in pigs. DESIGN:Prospective, randomized, unblinded study. SETTING:Surgical research laboratory at a large, university-affiliated medical center. SUBJECTS:Anesthetized...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199507000-00011

    authors: VanderMeer TJ,Wang H,Fink MP

    更新日期:1995-07-01 00:00:00

  • Dimethyl-prostaglandin E2 prevents stress ulceration with minimal complications.

    abstract::Gastric mucosal damage produced by topical application of necrotizing agents is diminished by topical or systemic pretreatment with a variety of E and F prostaglandins. The rat restraint model of gastric mucosal injury is more analogous to clinical stress ulceration than are models using intragastric application of to...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198901000-00011

    authors: Ephgrave KS,Horton J,Burns D

    更新日期:1989-01-01 00:00:00

  • The rising incidence of intentional ingestion of ethanol-containing hand sanitizers.

    abstract:OBJECTIVE:To describe a case of intentional ingestion of hand sanitizer in our hospital and to review published cases and those reported to the American Association of Poison Control Centers' National Poison Data System. DESIGN:A case report, a literature review of published cases, and a query of the National Poison D...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0b013e31822f09c0

    authors: Gormley NJ,Bronstein AC,Rasimas JJ,Pao M,Wratney AT,Sun J,Austin HA,Suffredini AF

    更新日期:2012-01-01 00:00:00

  • A prospective, multicenter derivation of a biomarker panel to assess risk of organ dysfunction, shock, and death in emergency department patients with suspected sepsis.

    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

    authors: Shapiro NI,Trzeciak S,Hollander JE,Birkhahn R,Otero R,Osborn TM,Moretti E,Nguyen HB,Gunnerson KJ,Milzman D,Gaieski DF,Goyal M,Cairns CB,Ngo L,Rivers EP

    更新日期:2009-01-01 00:00:00

  • Mechanical ventilators optimized for pediatric use decrease work of breathing and oxygen consumption during pressure-support ventilation.

    abstract:OBJECTIVES:a) To investigate whether the patient work of breathing needed to trigger inspiration is affected by the type of ventilator delivering pressure-support ventilation for mechanically ventilated pediatric patients. b) To determine whether changes in oxygen consumption (VO2) trend with changes in work of breathi...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:

    authors: el-Khatib MF,Chatburn RL,Potts DL,Blumer JL,Smith PG

    更新日期:1994-12-01 00:00:00

  • Effects of inhaled nitric oxide in a rat model of Pseudomonas aeruginosa pneumonia.

    abstract:OBJECTIVE:Antimicrobial effects of nitric oxide (NO) have been demonstrated in vitro against a variety of infectious pathogens, yet in vivo evidence of a potential therapeutic role for exogenous NO as an antimicrobial agent is limited. Thus, we assessed the effects of inhaled NO on pulmonary infection, leukocyte infilt...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200007000-00035

    authors: Webert KE,Vanderzwan J,Duggan M,Scott JA,McCormack DG,Lewis JF,Mehta S

    更新日期:2000-07-01 00:00:00

  • Mortality-adjusted duration of mechanical ventilation in critically ill children with symptomatic central venous line-related deep venous thrombosis.

    abstract:OBJECTIVE:To determine the association between symptomatic central venous line-related deep venous thrombosis and a mortality-adjusted measure of duration of mechanical ventilation in critically ill children with central venous lines. DESIGN:Retrospective matched cohort study. SETTING:Eleven pediatric intensive care ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e31820eb8a1

    authors: Faustino EV,Lawson KA,Northrup V,Higgerson RA

    更新日期:2011-05-01 00:00:00

  • Detecting life-threatening lactic acidosis related to nucleoside-analog treatment of human immunodeficiency virus-infected patients, and treatment with L-carnitine.

    abstract:OBJECTIVE:Our first objective was to determine a blood lactate threshold predictive of survival in human immunodeficiency virus patients experiencing lactic acidosis related to nucleoside analogs, and second, to test l-carnitine for the treatment of patients exceeding that threshold. DESIGN:a) Retrospective study usin...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,多中心研究

    doi:10.1097/01.CCM.0000053649.69377.08

    authors: Claessens YE,Cariou A,Monchi M,Soufir L,Azoulay E,Rouges P,Goldgran-Toledano D,Branche F,Dhainaut JF

    更新日期:2003-04-01 00:00:00

  • Reduction of colonization and infection rate during pediatric intensive care by selective decontamination of the digestive tract.

    abstract:OBJECTIVE:To compare the effects of two different antibiotic regimes on the colonization and infection rates of critically ill pediatric patients. DESIGN:A prospective randomized trial. SETTING:A pediatric ICU in a university hospital. PATIENTS:Fifty critically ill pediatric patients who required intensive care for ...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1097/00003246-199110000-00005

    authors: Zobel G,Kuttnig M,Grubbauer HM,Semmelrock HJ,Thiel W

    更新日期:1991-10-01 00:00:00

  • Cost accounting of adult intensive care: methods and human and capital inputs.

    abstract:OBJECTIVE:To cost adult intensive care by determining inputs to production, resource consumption per patient, and total cost per intensive care unit (ICU) stay. DESIGN:Prospective cost-accounting analysis of each patient stay in the ICU, over a 1-yr period. SETTING:An 11-bed, medical/surgical adult ICU, in a 932-bad ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199607000-00017

    authors: Noseworthy TW,Konopad E,Shustack A,Johnston R,Grace M

    更新日期:1996-07-01 00:00:00

  • Critical Care Organizations in Academic Medical Centers in North America: A Descriptive Report.

    abstract:OBJECTIVES:With the exception of a few single-center descriptive reports, data on critical care organizations are relatively sparse. The objectives of our study were to determine the structure, governance, and experience to date of established critical care organizations in North American academic medical centers. DES...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000001200

    authors: Pastores SM,Halpern NA,Oropello JM,Kostelecky N,Kvetan V

    更新日期:2015-10-01 00:00:00

  • Oxygen availability during hypothermic cardiopulmonary bypass.

    abstract::Oxygen availability during cardiopulmonary bypass was assessed in 22 patients under hypothermic and relatively normothermic conditions. The patients were divided into two groups, 17 of whom received ACD blood and 5, CPD blood. The mean P50 for all patients fell from a preoperative value of 25.9 +/- 2.4 (SD) to 15.6 +/...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-197705000-00007

    authors: Fisher A,Foëx P,Emerson PM,Darley JH,Rauscher LA

    更新日期:1977-05-01 00:00:00

  • Multicenter, randomized, controlled trials evaluating mortality in intensive care: doomed to fail?

    abstract:OBJECTIVES:To determine how many multicenter, randomized controlled trials have been published that assess mortality as a primary outcome in the adult intensive care unit population, and to evaluate their methodologic quality. DATA SOURCE:A sensitive search strategy for randomized controlled trials was conducted in th...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0b013e318168ea3e

    authors: Ospina-Tascón GA,Büchele GL,Vincent JL

    更新日期:2008-04-01 00:00:00

  • Skeletal morbidity among survivors of critical illness.

    abstract:OBJECTIVES:To describe the incident fracture rate in survivors of critical illness and to compare fracture risk with population-matched control subjects. DESIGN:Retrospective longitudinal case-cohort study. SETTING:A tertiary adult intensive care unit in Australia. PATIENTS:All patients ventilated admitted to intens...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e318211ff3d

    authors: Orford NR,Saunders K,Merriman E,Henry M,Pasco J,Stow P,Kotowicz M

    更新日期:2011-06-01 00:00:00

  • B-type natriuretic peptide and risk of acute kidney injury in patients hospitalized with acute coronary syndromes*.

    abstract:OBJECTIVES:To investigate whether admission B-type natriuretic peptide levels predict the development of acute kidney injury in acute coronary syndromes. DESIGN:Prospective study. SETTING:Single-center study, 13-bed intensive cardiac care unit at a University Cardiological Center. PATIENTS:Six-hundred thirty-nine ac...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000000025

    authors: Moltrasio M,Cabiati A,Milazzo V,Rubino M,De Metrio M,Discacciati A,Rumi P,Marana I,Marenzi G

    更新日期:2014-03-01 00:00:00

  • Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.

    abstract:OBJECTIVE:To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN:Blinded, concurrent data collection, retrospective chart review. SETTING:Surgical ICU. PATIENTS:All patients (n = 308) for whom a surgical ICU...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199203000-00016

    authors: Marshall MF,Schwenzer KJ,Orsina M,Fletcher JC,Durbin CG Jr

    更新日期:1992-03-01 00:00:00

  • Oxygen transport measurements to evaluate tissue perfusion and titrate therapy: dobutamine and dopamine effects.

    abstract:BACKGROUND:Increased cardiac index, oxygen delivery (DO2), and oxygen consumption (VO2) patterns were shown to characterize the physiologic status of surviving high-risk surgical patients, and indicate increased metabolic needs; relatively normal DO2 and VO2 values were found to characterize the sequential pattern of n...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199105000-00014

    authors: Shoemaker WC,Appel PL,Kram HB

    更新日期:1991-05-01 00:00:00

  • Morphological effects of transfusions with hemoglobin solutions.

    abstract::The current investigation describes the morphological and pathophysiological effects of stroma-free hemoglobin solution (SFH) on the liver and kidney. One h after a 75% blood volume exchange in animals receiving 7% SFH, hepatic morphology was normal. Animals whose blood was similarly exchanged with 7% albumin demonstr...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198204000-00011

    authors: Friedman HI,DeVenuto F

    更新日期:1982-04-01 00:00:00

  • Increased percentage of CD4+CD25+ regulatory T cells during septic shock is due to the decrease of CD4+CD25- lymphocytes.

    abstract:OBJECTIVE:The elevation of the percentage of regulatory CD4+CD25+ T lymphocytes (Treg) has been recently described during septic shock. The objective of the present study was to investigate whether this increased percentage was due to Treg proliferation. DESIGN:Observational study. SETTING:Adult intensive care units ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000145999.42971.4b

    authors: Venet F,Pachot A,Debard AL,Bohé J,Bienvenu J,Lepape A,Monneret G

    更新日期:2004-11-01 00:00:00

  • Cyclooxygenase-2 inhibition provides lasting protection against neonatal hypoxic-ischemic brain injury.

    abstract:OBJECTIVE:To investigate whether inhibition of cyclooxygenase-2, a critical component of the inflammatory pathway, is neuroprotective in a neonatal rat model of cerebral hypoxia-ischemia. The development of brain inflammation largely contributes to neonatal brain injury that may lead to a lifetime of neurologic deficit...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181cb1158

    authors: Fathali N,Ostrowski RP,Lekic T,Jadhav V,Tong W,Tang J,Zhang JH

    更新日期:2010-02-01 00:00:00

  • Protective effect of a novel, potent inhibitor of poly(adenosine 5'-diphosphate-ribose) synthetase in a porcine model of severe bacterial sepsis.

    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

    authors: Goldfarb RD,Marton A,Szabó E,Virág L,Salzman AL,Glock D,Akhter I,McCarthy R,Parrillo JE,Szabó C

    更新日期:2002-05-01 00:00:00

  • The Effectiveness of α2 Agonists As Sedatives in Pediatric Critical Care: A Propensity Score-Matched Cohort Study.

    abstract:OBJECTIVES:There is limited evidence supporting the widespread use of α2 agonists (clonidine and dexmedetomidine) in pediatric critical care sedation. This study sought to test the association between the use of α2 agonists and enhanced sedation. DESIGN:A retrospective observational cohort study was conducted. Noninfe...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000003789

    authors: Hayden JC,Doherty DR,Dawkins I,Leacy FP,Healy M,Breatnach CV,Cousins G,Gallagher PJ

    更新日期:2019-07-01 00:00:00

  • Exosomes in Critical Illness.

    abstract:OBJECTIVE:Exosomes are small, cell-released vesicles (40-100 nm in size) with the potential to transfer proteins, lipids, small RNAs, messenger RNAs, or DNA between cells via interstitial fluids. Due to their role in tissue homeostasis, exosomes have emerged as a new type of therapeutic and diagnostic (theranostic) too...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/CCM.0000000000002328

    authors: Terrasini N,Lionetti V

    更新日期:2017-06-01 00:00:00