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  • 1
    Electronic Resource
    Electronic Resource
    Transgastric, pulsed doppler echocardiographic determination of cardiac output (1996)
    Springer
    Intensive care medicine 22 (1996), S. 34-38 
    Details
    ISSN: 1432-1238
    Keywords: Cardiac output ; Transesophageal echocardiography ; Doppler ultrasonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The aim of this study was to evaluate the accuracy of cardiac output measurement with transesophageal echocardiography (TEE) using a transgastric, pulsed Doppler method in acutely ill patients. Design Cardiac output was simultaneously measured by thermodilution (TD) and a transgastric, pulsed Doppler method. Setting The study was carried out in a surgical intensive care unit as part of the management protocol of the patients. Patients Thirty consecutive acutely ill patients with a Swan-Ganz catheter, mechanically ventilated, sedated and with a stable hemodynamic condition were included. Measurements Pulsed Doppler TEE was performed using a transgastric approach in order to obtain a long axis view of the left ventricle. Cardiac output was calculated from the left ventricular outflow tract diameter, the velocity time integral of the blood flow profile and heart rate. Results One patient was excluded because of the presence of aortic regurgitation and another, because of the impossibility of obtaining a transgastric view. Twenty-eight simultaneous measurements were performed in 28 patients. A clinically acceptable correlation and agreement were found between the two methods (Doppler cardiac output=0.889 thermodilution cardiac output +0.74l/min,r=0.975,p〈0.0001). Conclusion Transgastric pulsed Doppler measurement across the left ventricular outflow tract with TEE is a very feasible and clinically acceptable method for cardiac output measurement in acutely ill patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01728328
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  • 2
    Electronic Resource
    Electronic Resource
    Renal effects of low-dose dopamine during vasopressor therapy for posttraumatic intracranial hypertension (1999)
    Springer
    Intensive care medicine 25 (1999), S. 399-405 
    Details
    ISSN: 1432-1238
    Keywords: Key words Brain injury ; Dopamine ; Hemodynamics ; Intracranial pressure ; Kidney function ; Norepinephrine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate the effects of low-dose dopamine (Dop) on renal hemodynamics and function in patients with brain trauma receiving norepinephrine (NE). Design: Prospective clinical study. Setting: Surgical intensive care unit of a university hospital. Patients: 20 stable, non-septic, mechanically ventilated, sedated patients with brain trauma and normal renal function treated with intravenous NE (0.11–0.65 μg/kg per min) to maintain an adequate cerebral perfusion pressure (〉 60 mm Hg). Interventions: Two successive 1-h study periods with NE alone then NE + Dop (2 μg/kg per min). During each period, creatinine (ClCREAT), sodium (ClNa), potassium (ClK), osmolar (ClOSM) and free water (ClH2 O), clearances were measured in all the patients. Effective renal blood flow (ERBF, paraaminohippurate clearance) and glomerular filtration rate (GFR, inulin clearance) were measured in 7 of the 20 patients. Results: Dop during NE infusion induced increases in urine flow and natriuresis which were not correlated with possible changes in arterial pressure. ClCREAT, GFR and their difference remained unchanged, whereas ERBF tended to increase. Fractional sodium excretion [100 × (ClNa/ClCREAT) ] and ClK increased during Dop infusion. Conclusion: The mechanism of Dop-induced natriuresis during NE infusion in brain trauma patients seems mainly related to a direct tubular effect of the drug.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050865
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  • 3
    Electronic Resource
    Electronic Resource
    Left ventricular function after severe trauma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 439-442 
    Details
    ISSN: 1432-1238
    Keywords: Severe trauma ; Myocardial dysfunction ; Fractional area changes ; Transesophageal echocardiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate cardiac function at the early phase of severe trauma. Design Prospective, clinical study. Setting Anesthesiological Intensive Care Unit. Patients 7 consecutive patients admitted after severe trauma (ISS: 38±9, mean±SD), without preexisting cardiac disease. Interventions Each patient received midazolam and sufentanyl for sedation. Right heart catheterization (Swan-Ganz) and transesophageal echocardiography (TEE) were performed. The fractional area change (FAC) of the left ventricle was calculated within 6 h following trauma and at day 1 and day 2 in order to evaluate left ventricular function. Measurements and results All of the patients had a low FAC value 〈50% at day 0 (43.2±2.4%, range 39–46%), which increased significantly at day 2 (52.5±4%, range 47–59%,p=0.001), whereas heart rate and preload (assessed by left ventricular end diastolic area and pulmonary arterial occlusion pressure) were constant and afterload, assessed by systolic blood pressure, increased significantly between day 0 and day 2 (112±21 to 145±24 mmHg,p=0.02). Conclusion The initial phase of severe trauma is associated with an abnormal cardiac function, suggested by a low FAC value. This myocardial dysfunction must be taken into account for early resuscitation after severe injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712161
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  • 4
    Electronic Resource
    Electronic Resource
    Left ventricular function after severe trauma (1996)
    Springer
    Intensive care medicine 22 (1996), S. 439-442 
    Details
    ISSN: 1432-1238
    Keywords: Key words Severe trauma ; Myocardial dysfunction ; Fractional area changes ; Transesophageal echocardiography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Objective:To evaluate cardiac function at the early phase of severe trauma. Design: Prospective, clinical study. Setting: Anesthesiological Intensive Care Unit. Patients: 7 consecutive patients admitted after severe trauma (ISS: 38±9, mean±SD), without preexisting cardiac disease. Interventions: Each patient received midazolam and sufentanyl for sedation. Right heart catheterization (Swan-Ganz) and transesophageal echocardiography (TEE) were performed. The fractional area change (FAC) of the left ventricle was calculated within 6 h following trauma and at day 1 and day 2 in order to evaluate left ventricular function. Measurements and results: All of the patients had a low FAC value 〈50% at day 0 (43.2±2.4%, range 39–46%), which increased significantly at day 2 (52.5±4%, range 47–59%, p=0.001), whereas heart rate and preload (assessed by left ventricular end diastolic area and pulmonary arterial occlusion pressure) were constant and afterload, assessed by systolic blood pressure, increased significantly between day 0 and day 2 (112±21 to 145±24 mmHg, p=0.02). Conclusion: The initial phase of severe trauma is associated with an abnormal cardiac function, suggested by a low FAC value. This myocardial dysfunction must be taken into account for early resuscitation after severe injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712161
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    Paper (German National Licenses)
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  • 5
    Electronic Resource
    Electronic Resource
    Relationship between intracranial pressure, mild hypothermia and temperature-corrected PaCO2 in patients with traumatic brain injury (2000)
    Springer
    Intensive care medicine 26 (2000), S. 722-728 
    Details
    ISSN: 1432-1238
    Keywords: Key words Carbon dioxide ; Hypothermia ; Intracranial pressure ; Jugular venous blood oxygen saturation ; Traumatic brain injury
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To study the effects of mild hypothermia and associated changes in temperature-corrected PaCO2 (cPaCO2) on intracranial pressure (ICP), mean velocity of the middle cerebral artery (Vm), and venous jugular saturation in O2 (SjvO2) in patients with severe traumatic brain injury (TBI).¶Design: Prospective, observational study.¶Setting: Intensive care unit.¶Patients: Severe TBI patients mechanically ventilated, sedated and paralyzed.¶Interventions: Twenty patients were subjected to four consecutive periods: (a) normocapnia-normothermia; (b) hypocapnia-normothermia, where hypocapnia was induced by an increase in minute volume; (c) hypocapnia-hypothermia, where hypocapnia was induced by hypothermia maintaining the ventilatory settings constant; (d) normocapnia-hypothermia, where normocapnia was achieved by a decrease in minute volume.¶Measurements and results: cPaCO2 was 41 ± 8 mmHg in periods 1 and 4, and 31 ± 7 mmHg in periods 2 and 3. Core temperature was 37.1 ± 0.8 °C in periods 1 and 2, and 34.1 ± 1.1 °C in periods 3 and 4. End-tidal CO2 and cPaCO2 values showed no difference between periods 1 and 4 and periods 2 and 3. ICP and Vm were dependent on cPaCO2 but independent of core temperature values. SjvO2 was related to cPaCO2 and was significantly higher during period 3 than during period 2 (P 〈 0.05).¶Conclusion: The decrease in ICP was similar when hypocapnia was induced by hyperventilation or as a result of hypothermia alone. The relationship between cPaCO2 and ICP might predict variations in ICP during changes in core temperature. Further studies are needed to confirm the cerebral metabolic effects of moderate hypothermia in TBI patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051238
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  • 6
    Electronic Resource
    Electronic Resource
    Early SjvO2 monitoring in patients with severe brain trauma (1999)
    Springer
    Intensive care medicine 25 (1999), S. 445-451 
    Details
    ISSN: 1432-1238
    Keywords: Key words SjvO2 ; Cerebral perfusion pressure ; Intracranial pressure
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To investigate early cerebral variables after minimal resuscitation and to compare the adequacy of a cerebral perfusion pressure (CPP) guideline above 70 mmHg, with jugular bulb venous oxygen saturation (SjvO2) monitoring in a patient with traumatic brain injury (TBI). Design: Prospective, observational study. Setting: Anesthesiological intensive care unit. Patients: 27 TBI patients with a postresuscitation Glasgow Coma Scale score less than 8. Intervention: After initial resuscitation, cerebral monitoring was performed and CPP increased to 70 mmHg by an increase in mean arterial pressure (MAP) with volume expansion and vasopressors as needed. Measurements and results: MAP, intracranial pressure (ICP), CPP, and simultaneous arterial and venous blood gases were measured at baseline and after treatment. Before treatment, 37 % of patients had an SjvO2 below 55 %, and SjvO2 was significantly correlated with CPP (r = 0.73, p 〈 0.0001). After treatment, we observed a significant increase (p 〈 0,0001) in CPP (78 ± 10 vs 53 ± 15 mmHg), MAP (103 ± 10 vs 79 ± 9 mmHg) and SvjO2 (72 ± 7 vs 56 ± 12), without a significant change in ICP (25 ± 14 vs 25 ± 11 mmHg). Conclusion: The present study shows that early cerebral monitoring with SjvO2 is critical to assess cerebral ischemic risk and that MAP monitoring alone is not sensitive enough to determine the state of oxygenation of the brain. SjvO2 monitoring permits the early identification of patients with low CPP and high risk of cerebral ischemia. In emergency situations it can be used alone when ICP monitoring is contraindicated or not readily available. However, ICP monitoring gives complementary information necessary to adapt treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050878
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