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  • 1
    ISSN: 1432-1238
    Keywords: Key words Cardiac surgery ; Aortic surgery ; Cardiac output ; Oxygen consumption ; Oxygen extraction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Weaning from mechanical ventilation is usually associated with an increase in oxygen consumption (VO2), which may stress the cardiovascular system. We studied relative changes in the cardiac index and oxygen extraction ratio (EO2) during successful weaning in patients after cardiac surgery (n = 52), cardiac transplantation (n = 17), or abdominal aortic surgery (n = 11). Cardiac index was determined by the thermodilution technique and arterial and mixed venous blood gases were obtained before and 30 min after the start of weaning through a T-piece. The cardiovascular changes were evaluated in 42 patients in whom VO2 (calculated by Fick's equation) increased by more than 10 %. Cardiac index increased more after abdominal aortic surgery (from 3.27 ± 0.77 to 4.44 ± 0.58 l min–1 m–2, p 〈 0.01) than after cardiac surgery (from 2.53 ± 0.59 to 2.87 ± 0.46 l min–1 m–2, p 〈 0.01) or cardiac transplantation (from 2.99 ± 0.64 to 3.33 ± 0.74 l min–1 m–2, p 〈 0.05). EO2 remained stable in patients after aortic surgery (from 25.9 ± 7.1 to 25.2 ± 5.6 %, NS) but increased slightly after cardiac surgery (from 33.3 ± 6.1 to 37.3 ± 6.4 %, NS) and significantly after cardiac transplantation (from 25.8 ± 4.1 to 28.2 ± 4.0 %, p 〈 0.05). Hence the cardiovascular response to weaning from mechanical ventilation may vary according to the type of surgery.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1238
    Keywords: Cardiac output determination ; Bioimpedance ; Thermodilution ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To study the possible influence of mechanical ventilation on the accurracy of thoracic electrical bioimpedance (TEI) in the measurement of cardiac output, we determined cardiac output concurrently by TEI using Kubicek's equation and by thermodilution in 8 acutely ill patients who were mechanically ventilated (assist/control mode) but who had no underlying respiratory failure. Cardiac outputs were lower with TEI than with thermodilution (3.97±0.80 vs 4.83±1.16 l/min p=0.004) and there was poor correlation between the values (r=0.41). Although there is a need to develop non-invasive techniques to measure cardiac output, the present study indicates that TEI is not reliable in mechanically ventilated patients.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1238
    Keywords: Key words Nutrition ; Enteral nutrition ; Malnutrition ; Intensive care ; Critical illness
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Severe protein-calorie malnutrition is a major problem in many intensive care (ICU) patients, due to the increased catabolic state often associated with acute severe illness and the frequent presence of prior chronic wasting conditions. Nutritional support is thus an important part of the management of these patients. Over the years, enteral nutrition (EN) has gained considerable popularity, due to its favorable effects on the digestive tract and its lower cost and rate of complications compared to parenteral nutrition. However, clinicians caring for ICU patients are often faced with contradictory data and difficult decisions when having to determine the optimal timing and modalities of EN administration, estimation of patient requirements, and choice of formulas. The pur- pose of this paper is to provide practical guidelines on these various aspects of enteral nutritional support, based on presently available evidence.
    Type of Medium: Electronic Resource
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