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  • 1
    Electronic Resource
    Electronic Resource
    Heterogeneous regional vascular responses to simulated transient hypovolemia in man (1994)
    Springer
    Intensive care medicine 20 (1994), S. 414-420 
    Details
    ISSN: 1432-1238
    Keywords: Hypovolemia ; Cardiac output ; Regional blood flows ; Cardiovascular reflexes ; Catechol-amines ; Healthy volunteers
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To describe the evolution of systemic and regional blood flows during and after hypovolemia in humans. Design Simulation of hypovolemia by a prolonged application of lower body negative pressure (LBNP). Setting Laboratory of Clinical Research, Surgical Intensive Care Unit of an University Hospital. Participants 8 healthy male volunteers. Interventions 3 successive and increasing 15min-levels of LBNP were followed by a progressive return (10 min) to atmospheric pressure, then a 60min-recovery period. Measurements and main results Simulated hypovolemia induced a parallel one-third decrease in cardiac output (bioimpedance), musculocutaneous (venous plethysmography) and splanchnic (ICG clearance) blood flows. Adrenergic-mediated peripheral vasoconstriction prevented any change in mean arterial pressure. The decrease in renal blood flow (PAH clearance) was limited, glomerular filtration rate (inulin clearance) unchanged and thus filtration fraction increased. All the cardiovascular and biological variables returned to pre-LBNP values during the recovery period except for splanchnic blood flow which remained below control values 60 min after the return to atmospheric pressure. Conclusions Since a sustained splanchnic vasoconstriction follows a transient normotensive hypovolemia in healthy men despite adequate treatment considering arterial pressure and cardiac output, the therapeutic goals of fluid resuscitation after hypovolemic shock might be revisited and a supranormal value of cardiac output proposed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01710651
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  • 2
    Electronic Resource
    Electronic Resource
    Procalcitonin and C-reactive protein during the early posttraumatic systemic inflammatory response syndrome (1998)
    Springer
    Intensive care medicine 24 (1998), S. 185-188 
    Details
    ISSN: 1432-1238
    Keywords: Key words C-reactive protein ; Hypovolemia ; Infection ; Organ failure ; Procalcitonin ; Trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To describe the initial evolution of serum procalcitonin (PCT) and C-reactive protein (CRP) in previously healthy adult trauma patients and to compare the relationship of the expression of these two proteins with indicators of trauma severity. Design: Prospective, descriptive, longitudinal study. Setting: Surgical ICU in an university hospital. Patients: Twenty-one patients admitted during the first posttraumatic 3 h exhibiting an Injury Severity Score (ISS) between 16 and 50 were enrolled. Measurements: Blood sampling was performed on admission and on posttraumatic days 0.5, 1, 2 and 3 to assess serum levels of PCT and CRP. Total creatine kinase (CKtot) and lactate dehydrogenase (LDHtot) activities in the serum were used as tissue damage indicators. Results: PCT exhibited an early and transient increase in serum levels similar to a more delayed change of CRP levels. Peak PCT and peak CRP were related to the ISS, the extent of tissue damage and the amount of fluid replacement during the first day. During the first 3 posttraumatic days, 90 % of the patients exhibited a generalized inflammatory syndrome without infection. Conclusions: An early and transient release of PCT into the circulation was observed after severe trauma and the amount of circulating PCT seemed proportional to the severity of tissue injury and hypovolemia, yet unrelated to infection. The predictive value of both PCT and CRP for a forthcoming multiple organ failure still remains to be clarified.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050543
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    Paper (German National Licenses)
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  • 3
    Electronic Resource
    Electronic Resource
    Circulating cardiac troponin I in trauma patients without cardiac contusion (1998)
    Springer
    Intensive care medicine 24 (1998), S. 569-573 
    Details
    ISSN: 1432-1238
    Keywords: Key words Cardiac troponin I ; Creatine kinase ; Hypovolemia ; Rhabdomyolysis ; Shock ; Trauma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To describe the evolution and the diagnostic value of cardiac troponin I (cTnI) and to relate its concentrations with the indicators of injury in trauma patients. Design: Prospective, observational study of 17 young, previously healthy, mechanically-ventilated patients during the early post-traumatic period in the Surgical ICU of a University Hospital. Methods: Serial measurements of serum cTnI, total creatine kinase activity (CKtot) and its isoenzyme MB (CK-MB) (on admission, 12 h later, then daily for 7 days), clinical data and repeated electrocardiographic (ECG) and transesophageal echocardiographic (TEE) recordings. Results: Rhabdomyolysis was observed in all the patients with a significant relationship between CK-MB and CKtot. Despite the fact that no patient demonstrated ECG or TEE signs of myocardial contusion, elevated serum levels of cTnI were observed in six patients (35 %) without obvious dilutional interference. As compared with the others, these patients exhibited a more frequent arterial hypotension (83 % vs 18 %, p = 0.035), required greater volume expansion on day 1 (22,000 vs 8,500 ml, p = 0.027) and usually demonstrated early (83 % vs 9 %, p = 0.005) and late (66 % vs 9 %, p = 0.028) multiple organ dysfunction syndrome. Conclusions: Taking into account the high reported sensitivity and specificity of cTnI dosage, the present results suggest cTnI can play a role in the evaluation of indirect myocardial injury following traumatic shock.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050617
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
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