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  • 1
    Electronic Resource
    Electronic Resource
    Effects of rapid permissive hypercapnia on hemodynamics, gas exchange, and oxygen transport and consumption during mechanical ventilation for the acute respiratory distress syndrome (1996)
    Springer
    Intensive care medicine 22 (1996), S. 182-191 
    Details
    ISSN: 1432-1238
    Keywords: Permissive hypercapnia ; Mechanical ventilation ; Alveolar hypoventilation ; Oxygen transport ; Oxygen consumption ; DO2/VO2 relationship ; Hemoglobin dissociation curve ; ARDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To measure the effects of rapid permissive hypercapnia on hemodynamics and gas exchange in patients with acute respiratory distress syndrome (ARDS). Design Prospective study.Setting: 18-bed, medical intensive care unit, university hospital. Patients 11 mechanically ventilated ARDS patients. Intervention Patients were sedated and ventilated in the controlled mode. Hypercapnia was induced over a 30–60 min period by decreasing tidal volume until pH decreased to 7.2 and/or P50 increased by 7.5 mmHg. Settings were then maintained for 2 h. Results Minute ventilation was reduced from 13.5±6.1 to 8.2±4.1l/min (mean±SD), PaCO2 increased (40.3±6.6 to 59.3±7.2 mmHg), pH decreased (7.40±0.05 to 7.26±0.05), and P50 increased (26.3±2.02 to 31.1±2.2 mmHg) (p〈0.05). Systemic vascular resistance decreased (865±454 to 648±265 dyne·s·cm−5, and cardiac index (CI) increased (4±2.4 to 4.7±2.4 l/min/m2) (p〈0.05). Mean systemic arterial pressure was unchanged. Pulmonary vascular resistance was unmodified, and mean pulmonary artery pressure (MPAP) increased (29±5 to 32±6 mmHg,p〈0.05). PaO2 remained unchanged, while saturation decreased (93±3 to 90±3%,p〈0.05), requiring an increase in FIO2 from 0.56 to 0.64 in order to maintain an SaO2〉90%. PvO2 increased (36.5±5.7 to 43.2±6.1 mmHg,p〈0.05), while saturation was unmodified. The arteriovenous O2 content difference was unaltered. Oxygen transport (DO2) increased (545±240 to 621±274 ml/min/m2,p〈0.05), while the O2 consumption and extraction ratio did not change significantly. Venous admixture (Qva/Qt) increased (26.3±12.3 to 32.8±13.2,p〈0.05). Conclusions These data indicate that acute hypercapnia increases DO2 and O2 off-loading capacity in ARDS patients with normal plasma lactate, without increasing O2 extraction. Whether this would be beneficial in patients with elevated lactate levels, indicating tissue hypoxia, remains to be determined. Furthermore, even though hypercapnia was well tolerated, the increase in Qva/Qt, CI, and MPAP should prompt caution in patients with severe hypoxemia, as well as in those with depressed cardiac function and/or severe pulmonary hypertension.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712235
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    Paper (German National Licenses)
    Fulltext
  • 2
    Electronic Resource
    Electronic Resource
    Effects of rapid permissive hypercapnia on hemodynamics, gas exchange, and oxygen transport and consumption during mechanical ventilation for the acute respiratory distress syndrome (1996)
    Springer
    Intensive care medicine 22 (1996), S. 182-191 
    Details
    ISSN: 1432-1238
    Keywords: Key words Permissive hypercapnia ; Mechanical ventilation ; Alveolar hypoventilation ; Oxygen transport ; Oxygen consumption ; DO2/VO2 relationship ; Hemoglobin dissociation curve ; ARDS
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To measure the effects of rapid permissive hypercapnia on hemodynamics and gas exchange in patients with acute respiratory distress syndrome (ARDS). Design: Prospective study. Setting: 18-bed, medical intensive care unit, university hospital. Patients: 11 mechanically ventilated ARDS patients. Intervention: Patients were sedated and ventilated in the controlled mode. Hypercapnia was induced over a 30–60 min period by decreasing tidal volume until pH decreased to 7.2 and/or P50 increased by 7.5 mmHg. Settings were then maintained for 2 h. Results: Minute ventilation was reduced from 13.5±6.1 to 8.2±4.1 l/min (mean±SD), PaCO2 increased (40.3±6.6 to 59.3± 7.2 mmHg), pH decreased (7.40±0.05 to 7.26±0.05), and P50 increased (26.3±2.02 to 31.1± 2.2 mmHg) (p〈0.05). Systemic vascular resistance decreased (865±454 to 648±265 dyne·s·cm–5, and cardiac index (CI) increased (4±2.4 to 4.7±2.4 l/min/m2) (p〈0.05). Mean systemic arterial pressure was unchanged. Pulmonary vascular resistance was unmodified, and mean pulmonary artery pressure (MPAP) increased (29±5 to 32± 6 mmHg, p〈0.05). PaO2 remained unchanged, while saturation decreased (93±3 to 90±3%, p〈0.05), requiring an increase in FIO2 from 0.56 to 0.64 in order to maintain an SaO2〉90%. PvO2 increased (36.5±5.7 to 43.2± 6.1 mmHg, p〈0.05), while saturation was unmodified. The arteriovenous O2 content difference was unaltered. Oxygen transport (DO2) increased (545±240 to 621± 274 ml/min/m2, p〈0.05), while the O2 consumption and extraction ratio did not change significantly. Venous admixture (Qva/Qt) increased (26.3±12.3 to 32.8±13.2, p〈0.05). Conclusions: These data indicate that acute hypercapnia increases DO2 and O2 off-loading capacity in ARDS patients with normal plasma lactate, without increasing O2 extraction. Whether this would be beneficial in patients with elevated lactate levels, indicating tissue hypoxia, remains to be determined. Furthermore, even though hypercapnia was well tolerated, the increase in Qva/Qt, CI, and MPAP should prompt caution in patients with severe hypoxemia, as well as in those with depressed cardiac function and/or severe pulmonary hypertension.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01712235
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Relationship between pulmonary oxygen consumption, lung inflammation, and calculated venous admixture in patients with acute lung injury (1996)
    Springer
    Intensive care medicine 22 (1996), S. 277-285 
    Details
    ISSN: 1432-1238
    Keywords: Acute lung injury ; Pulmonary oxygen consumption ; DO2/VO2 relationship ; Venous admixture ; IL-6 ; Elastase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To determine in patients with acute lung injury whether increased pulmonary oxygen consumption (VO2pulm), computed as the difference between oxygen consumption measured by indirect calorimetry (VO2meas) and calculated by the reverse Fick method (VO2Fick), would: (1) correlate with the degree of lung inflammation assessed by bronchoalveolar lavage (BAL); (2) lead to an overestimation of calculated venous admixture (Qva/Qt). Design Prospective study. Setting University hospital, medical intensive care unit. Intervention None. Measurements and results In nine mechanically ventilated patients with acute lung injury (Apache II 12±5, lung injury score 2±0.6, mean±SD), whole-body VO2 (VO2wb) was determined simultaneously by indirect calorimetry and the reverse Fick technique, after which BAL was immediately performed. VO2meas was significantly higher than VO2Fick (128±24 and 102±18 ml/min per m2, respectively,p〈0.001). Median VO2pulm was 25.3 ml/min per m2 (range 1.98–51.5), thus representing 19±11% of VO2wb. Total BAL cellularity was increased in all patients (median 47, range 24–200×104/ml), as was the total polymorphonuclear (PMN) count (median 78 range 5–93×104/ml). Macrophage counts were in the normal range. There were raised BAL levels of interleukin-6 (IL-6) (median 945, range 23–1800 ng/ml) and elastase (median 391, range 5–949 ng/ml). Median protein levels were 270 μg/ml (range 50–505). There was no correlation between VO2pulm and BAL cellularity, PMNs, elastase, IL-6, or protein. Qva/Qt was 31.7±8%. Qva/Qt, corrected for the presence of VO2pulm, (Qva/Qtcorr), was 30.3±8% (p〈0.01 vs Qva/Qt), a 4.2% overestimation due to VO2pulm. There was no correlation between Qva/Qt or Qva/Qtcorr and VO2pulm. Conclusions In mechanically ventilated patients with acute lung injury, VO2pulm was increased and led to a 19% underestimation of VO2wb determined by the reverse Fick method, as well as to a 4.2% overestimation of calculated Qva/Qt. Lung inflammatory activity was increased, as assessed by BAL cellularity, IL-6 and elastase levels. However, there was no correlation between VO2pulm and the intensity of pulmonary inflammation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700447
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    Relationship between pulmonary oxygen consumption, lung inflammation, and calculated venous admixture in patients with acute lung injury (1996)
    Springer
    Intensive care medicine 22 (1996), S. 277-285 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute lung injury ; Pulmonary oxygen consumption ; DO2/VO2 relationship ; Venous admixture ; IL-6 ; Elastase
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Objective: To determine in patients with acute lung injury whether increased pulmonary oxygen consumption (VO2pulm), computed as the difference between oxygen consumption measured by indirect calorimetry (VO2meas) and calculated by the reverse Fick method (VO2Fick), would: (1) correlate with the degree of lung inflammation assessed by bronchoalveolar lavage (BAL); (2) lead to an overestimation of calculated venous admixture (Qva/Qt). Design: Prospective study. Setting: University hospital, medical intensive care unit. Intervention: None. Measurements and results: In nine mechanically ventilated patients with acute lung injury (Apache II 12±5, lung injury score 2±0.6, mean±SD), whole-body VO2 (VO2wb) was determined simultaneously by indirect calorimetry and the reverse Fick technique, after which BAL was immediately performed. VO2meas was significantly higher than VO2Fick (128±24 and 102±18 ml/min per m2, respectively, p〈0.001). Median VO2pulm was 25.3 ml/min per m2 (range 1.98–51.5), thus representing 19±11% of VO2wb. Total BAL cellularity was increased in all patients (median 47, range 24–200 ×104/ml), as was the total polymorphonuclear (PMN) count (median 78 range 5–93×104/ml). Macrophage counts were in the normal range. There were raised BAL levels of interleukin-6 (IL-6) (median 945, range 23–1800 ng/ml) and elastase (median 391, range 5–949 ng/ml). Median protein levels were 270 μg/ml (range 50–505). There was no correlation between VO2pulm and BAL cellularity, PMNs, elastase, IL-6, or protein. Qva/Qt was 31.7±8%. Qva/Qt, corrected for the presence of VO2pulm, (Qva/Qtcorr), was 30.3±8% (p〈0.01 vs Qva/Qt), a 4.2% overestimation due to VO2pulm. There was no correlation between Qva/Qt or Qva/Qtcorr and VO2pulm. Conclusions: In mechanically ventilated patients with acute lung injury, VO2pulm was increased and led to a 19% underestimation of VO2wb determined by the reverse Fick method, as well as to a 4.2% overestimation of calculated Qva/Qt. Lung inflammatory activity was increased, as assessed by BAL cellularity, IL-6 and elastase levels. However, there was no correlation between VO2pulm and the intensity of pulmonary inflammation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700447
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Effects of inhaled salmeterol and salbutamol (albuterol) on morning dips compared in intensive care patients recovering from an acute severe asthma attack (1997)
    Springer
    Intensive care medicine 23 (1997), S. 1225-1230 
    Details
    ISSN: 1432-1238
    Keywords: Key words Asthma ; Acute severe asthma ; Morning dip ; Salbutamol ; Albuterol ; Salmeterol
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To assess the effect of a long-acting inhaled β 2-agonist, salmeterol (SM), compared to a short-acting inhaled β 2-agonist, salbutamol (or albuterol, SB), on the occurrence of morning dip (MD) in patients recovering from an acute severe asthma attack (ASA). Design: Prospective study Setting: 18-bed, medical intensive care unit (ICU) in a university hospital. Patients: 19 patients suffering from an ASA. Interventions: Serial measurements of the peak expiratory flow rate (PEFR), arterial blood gases, vital capacity and forced expiratory volume in one second (FEV1) were performed from admission. All patients were first treated with i. v. methyl prednisolone and i. v. SB. Once the PEFR was stable and 〉 35 % of predicted value, i. v. SB was stopped while i. v. steroids were maintained, and patients were randomised to either inhaled SB (9 patients, 400 μg every 4 h) or inhaled SM (10 patients, 100 μg every 12 h). Results: The mean admission PEFR was 26.1 ± 11.7 % of the predicted value and was not different between the two groups. MD was more frequent with SB (6/9 patients) than with SM (4/10). The severity of MD, expressed in l/min fall in PEFR, was higher in SB than in SM (106 ± 25 vs 55 ± 37; p 〈 0.05). Discussion: MD is frequent in ASA. In ASA, SM appears to reduce the frequency and the severity of MD more than SB. The clinical implications of this observation, particularly a lowering of mortality and a shortening of the ICU stay, remain to be investigated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050490
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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