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  • 1990-1994  (4)
Materialart
Erscheinungszeitraum
Jahr
  • 1
    Digitale Medien
    Digitale Medien
    Oxford, UK : Blackwell Publishing Ltd
    Anaesthesia 49 (1994), S. 0 
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: We investigated the impact of right ventricular performance on oxygen kinetics in 15 consecutive patients with acute respiratory distress syndrome. Six hundred and twenty-two complete assessments of haemodynamics, right ventricular function and oxygenation were used for evaluation. Patients were grouped as survivors (n = 8) and nonsurvivors (n = 7) and studied during four phases of lung failure. Oxygen delivery and consumption were significantly higher in survivors compared to nonsurvivors despite comparable arterial oxygen saturation. Right ventricular end-diastolic volumes were similar for both groups, while end-systolic volumes were significantly higher in nonsurvivors due to depressed ejection fraction (40.5 (SD 1.2) versus 34.4 (SD 2.8)%) during all phases of lung failure. No clinically relevant differences in right ventricular function or oxygenation were observed between periods of moderate or severe pulmonary hypertension. Nonsurvivors have depressed cardiac function caused by reduced contractility and not by inadequate right ventricular end-diastolic volume (preload) or increased pulmonary artery pressure (afterload). Maintenance of oxygen delivery in ARDS is predominantly a function of cardiac performance and not of pulmonary gas exchange.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 2
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: The purpose of our study was to test the hypothesis that the quotient between plasma glucose and whole body oxygen consumption (V̇o2) as a ‘metabolic index’ is a sensitive indicator of early graft function. Arterial levels of glucose and oxygen consumption were determined in 100 consecutive patients during orthotopic liver transplantation performed without anhepatic veno-venous bypass. Patients were divided into survivors with no obvious problems related to graft function and those with primary nonfunction of the graft. The neohepatic increase in V̇o2 was significantly higher in survivors (112 + 4 vs 88 + 11 ml.min−1.m2; p 〈 0.05), whereas blood glucose levels after reperfusion were higher (352 + 18 vs. 287+36 mg dl−1) in those with primary non-function of the graft. The calculated metabolic index was also higher (4.02 + 0.93 vs 2.67+ 0.45, p 〈 0.05) in patients with primary nonfunction of the graft. Our principal conclusion was that 92% of normal functioning liver grafts could be classified correctly by the metabolic index immediately after reperfusion, whereas glucose levels and V̇o2 alone classified only 67% and 70% of normal functioning liver grafts correctly.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 3
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: Fourteen patients with severe hypotension and adult respiratory distress syndrome after trauma (n= 7), general surgery (n = 6) or burns (n = 1) were studied. After volume loading with 6 ml.kg-1 hydroxyethyl starch over 30 min (time I), dobutamine was infused intravenously at 5 μg.kg-1.min-1 (time II) and 10 μg.kg-1 .min-1 (time III). A 5 MHz transoesophageal echocardiographic probe was used to image a standard transgastric short axis view of the left ventricle. Haemodynamic data were obtained from thermodilution studies using pulmonary flotation catheterisation. Echocardiographic measurements (off-line from videotape) and qualitative visual assessment of left ventricular function (visual assessment, on-line) were performed. All measurements were made after fluid replacement, and during infusion of the two dobutamine doses. An improvement in mean systemic arterial blood pressure and mean stroke volume occurred from time I to the end of dobutamine infusion (p 〈 0.05). All patients, after volume infusion, were normovolaemic according to transoesophageal echocardiography and there was a good correlation between end-diastolic area and stroke volume (r = 0.73). During dobutamine infusion, echocardiographic measurements showed no significant dose-related increase in mean (SD) percentage left ventricular short axis area change from baseline after hydroxyethyl starch (time I: 60 (2); time II: 63 (2); time III: 64 (2)). However, a significant increase in short axis area change was seen in nine of the 14 patients (67%). Analysis of the end-diastolic area/short axis area change relationship revealed a heterogeneous response to dobutamine. Dobutamine infusion resulted in an improvement in haemodynamics in the majority of patients with sepsis-related adult respiratory distress syndrome, and transoesophageal echocardiography provided important additional information on ventricular performance.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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  • 4
    ISSN: 1365-2044
    Quelle: Blackwell Publishing Journal Backfiles 1879-2005
    Thema: Medizin
    Notizen: In order to identify a critical or an optimal therapeutic value for oxygen delivery and oxygen uptake, we analysed data from 40 publications concerning the relationship between oxygen delivery and consumption in patients with adult respiratory distress syndrome, trauma or during sepsis, and in nonseptic controls. According to the outcome, the patients were allocated to either group 1 (survivors) or group 2 (nonsurvivors). While oxygen delivery and uptake (mean, SEM) were significantly higher in patients with adult respiratory distress syndrome (636, SEM 31 ml.min-1.m-2and 155, SEM 5 ml.min-1.m-2), trauma (782, SEM 77 ml.min-1.m-2 and 167, SEM 10 ml.min-1.m-2) and sepsis (654, SEM 28 ml.min-1.m-2 and 163, SEM 5 ml.min-1.m-2) than in nonseptic controls (452, SEM 18 ml.min-1.m-2 and 126, SEM 3 ml.min-1.m-2, p 〈 0.05), there were no significant differences in these parameters between survivors and nonsurvivors. Although therapeutic manoeuvres were effective in increasing both oxygen delivery and consumption, these improvements were not parallelled by an increase in survival rate. The correlation between oxygen delivery and uptake is generally a result of the use of pooled data and therefore prone to mathematical coupling. This is true particularly for patients with adult respiratory distress syndrome and sepsis. Thus, our study failed to identify either an optimal or a critical value of oxygen delivery or oxygen consumption in critically ill patients.
    Materialart: Digitale Medien
    Bibliothek Standort Signatur Band/Heft/Jahr Verfügbarkeit
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