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  • 1
    Digitale Medien
    Digitale Medien
    Heterogeneous regional vascular responses to simulated transient hypovolemia in man (1994)
    Springer
    Intensive care medicine 20 (1994), S. 414-420 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Hypovolemia ; Cardiac output ; Regional blood flows ; Cardiovascular reflexes ; Catechol-amines ; Healthy volunteers
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: 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.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01710651
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  • 2
    Digitale Medien
    Digitale Medien
    Ketanserin and the arterial baroreceptor reflex in normotensive subjects (1987)
    Springer
    European journal of clinical pharmacology 32 (1987), S. 27-33 
    Details
    ISSN: 1432-1041
    Schlagwort(e): ketanserin ; baroreflex sensitivity ; plasma catecholamines ; plasma renin ; alpha1-adrenoceptor blockade ; normotensive subjects ; baroreceptor reflex ; blood pressure ; heart rate
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Chemie und Pharmazie , Medizin
    Notizen: Summary The effects of oral ketanserin 40 and 120 mg on the responses to baroreflex activation and deactivation by phenylephrine and nitroglycerin, respectively, were investigated in normotensive subjects. Plasma catecholamine levels were measured at the same times. Two hours after the administration of ketanserin, and regardless of its effect on arterial pressure (no change after 40 mg, decrease after 120 mg), there was no alteration either in resting heart rate or baroreflex sensitivity during baroreceptor activation or deactivation. The lack of reflex tachycardia in response to the drug-induced hypotension may be related to the α1-adrenoceptor blockade-mediated sympathoinhibitory effect of ketanserin, which leaves unaffected both plasma catecholamines and the normal reactivity of the sympathetic system.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00609954
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  • 3
    Digitale Medien
    Digitale Medien
    Attenuation by diltiazem of arterial baroreflex sensitivity in man (1984)
    Springer
    European journal of clinical pharmacology 26 (1984), S. 675-679 
    Details
    ISSN: 1432-1041
    Schlagwort(e): diltiazem ; baroreflex sensitivity ; plasma catecholamines ; normotensive subjects ; baroreceptor testing ; phenylephrine ; nitroglycerin
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Chemie und Pharmazie , Medizin
    Notizen: Summary The effect of oral diltiazem 120 mg, on the responses to baroreflex activation and deactivation by phenylephrine and nitroglycerin, respectively, were investigated in normotensive subjects, with simultaneous measurement of plasma catecholamine levels. Diltiazem significantly reduced the tachycardia induced by bolus injections of nitroglycerin and abolished the concomitant increase in plasma noradrenaline. It also significantly decreased the bradycardiac response to phenylephrine infusion. Diltiazem reduced, although not significantly so, the bradycardia induced by boluses of phenylephrine. The overall reduction in baroreflex sensitivity, which might contribute to the limited tachycardiac effect of diltiazem in man, is consistent with the drug-induced attenuation of the sympathetic and also of the parasympathetic components of the baroreceptor reflex.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF00541924
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  • 4
    Digitale Medien
    Digitale Medien
    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
    Schlagwort(e): Key words C-reactive protein ; Hypovolemia ; Infection ; Organ failure ; Procalcitonin ; Trauma
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: 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.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340050543
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  • 5
    Digitale Medien
    Digitale Medien
    Role of systemic inflammatory response syndrome and infection in the occurrence of early multiple organ dysfunction syndrome following severe trauma (1995)
    Springer
    Intensive care medicine 21 (1995), S. 813-816 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Trauma ; Multiple organ dysfunction syndrome ; Systemic inflammatory response syndrome ; Infection ; Shock
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective To evaluate the role of infection and systemic inflammatory response syndrome (SIRS) on the occurrence of early posttraumatic MODS. Design Retrospective study. Setting University Teaching Hospital ICU. Patients 163 consecutive patients hospitalized for more than 48 hours following severe trauma. Measurements and main results The patients were classified into two groups in respect to the existence of MODS at day 2. There was 27 patients in the MODS group and 136 patients in the no MODS group. The two groups were similar with respect to age, sex ratio and Simplified Acute Physiology Score. The MODS group had a higher mortality (52 versus 7%), Injury Severity Score (45±14 versus 31±13), hypovolemic shock rate (74 versus 30%), massive volume replacement rate (59 versus 6%) and SIRS rate (81 versus 54%) than the no MODS group (p〈0.05). The rate of infection was similarly low in the MODS and no MODS group (4 versus 6% respectively). Conclusion Early MODS is often associated with hypotension and massive volume administration but very rarely with infection, despite the high rate of SIRS.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01700964
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  • 6
    Digitale Medien
    Digitale Medien
    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
    Schlagwort(e): Key words Brain injury ; Dopamine ; Hemodynamics ; Intracranial pressure ; Kidney function ; Norepinephrine
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: 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.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340050865
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  • 7
    Digitale Medien
    Digitale Medien
    Contribution of bronchoalveolar lavage to the diagnosis of posttraumatic pulmonary fat embolism (1995)
    Springer
    Intensive care medicine 21 (1995), S. 973-980 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Bronchoalveolar lavage ; Fat embolism ; Trauma ; Lung injury ; Hypoxemia ; Intensive care unit
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective To verify whether the determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat inclusions is a useful diagnostic tool of posttraumatic pulmonary fat embolism. Design Prospective study. Setting Surgical Intensive Care Units in two university hospitals. Patients 56 successive trauma patients needing prolonged postinjury mechanical ventilation, including 4 with clinical definite fat embolism syndrome, 5 in whom the diagnosis had been clinically suspected but was impossible to confirm or exclude before bronchoscopy, and 47 with no clinical evidence of the syndrome. Control groups included 8 patients without previous trauma who developed ARDS and 6 healthy surgical patients. Methods Bronchoalveolar lavage was performed within the first posttraumatic 3 days in trauma patients, at the beguining of the pulmonary disease in non trauma ARDS patients and just after anesthesic induction in healthy ortopedic patients. The magnitude of lipid content in alveolar cells was compared with the clinical pattern of the pulmonary fat embolism syndrome retrospectively evaluated at the seventh day postinjury in trauma patients. Results All the patients with definite fat embolism syndrome had more than 70% of lavage cells containing fat droplets. The group of patients in whom the diagnosis of the fat embolism syndrome was suspected had percentages of fat cells above 30% in 4 out of 5 patients. A percentage of fat cells above 30% was only observed in 7 out of the 47 patients without clinical evidence of the syndrome. The percentage varied between 0% to 35% in the group of non trauma ARDS patients and between 0 to 5% in healthy surgical patients. Conclusion Lipid inclusions in alveolar cells are common during traumatic and non-traumatic respiratory failure. Determination of the percentage of cells recovered by bronchoalveolar lavage and containing fat droplets may contribute to the diagnosis of the fat embolism syndrome in mechanically-ventilated trauma patients with respiratory failure provided that the significant threshold would be 30%.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01700658
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  • 8
    Digitale Medien
    Digitale Medien
    Reversible hepatic cytolysis during almitrine bismesylate treatment for posttraumatic ARDS (1996)
    Springer
    Intensive care medicine 22 (1996), S. 173-174 
    Details
    ISSN: 1432-1238
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/BF01720725
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  • 9
    Digitale Medien
    Digitale Medien
    Pharmacokinetics and absolute bioavailability of ciprofloxacin administered through a nasogastric tube with continuous enteral feeding to critically ill patients (1998)
    Springer
    Intensive care medicine 24 (1998), S. 1047-1051 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Intensive care unit ; Ciprofloxacin ; Bioavailability ; Pharmacokinetics ; Enteral nutrition
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: Abstract Objective: To determine the pharmacokinetics and absolute bioavailability of ciprofloxacin in 12 critically ill patients receiving continuous enteral feeding. Design: a prospective, cross-over study. Setting: 12-bed surgical intensive care unit in a University Hospital. Patients: 12 stable critically ill patients on mechanical ventilation and receiving continuous enteral feeding (Normoréal fibres) without diarrhea or excessive residual gastric contents ( 〈 200 ml/4 h). None had gastro-intestinal disease, renal insufficiency (estimated creatinine clearance ≥ 50 ml/min) or was receiving medications that could interfere with ciprofloxacin absorption or metabolism. Measurements and main results: The study was carried out after the fourth (steady state) b. i. d. intravenous (i. v.) 1-h infusion of 400 mg and the second b. i. d. nasogastric (NG) dose of 750 mg (crushed tablet in suspension). Plasma concentrations were measured by high-performance liquid chromatography. The median (range) peak concentration after i. v. infusion was 4.1 (1.5–7.4) mg/l, and that after NG administration was 2.3 (0.7–5.8) mg/l, occurring 1.25 (0.75–3.33) h after dosing. The median [range] areas under plasma concentration-time curves were similar for the two administration routes (10.3 [3.3–34.6] and 8.4 [3.6–53.4] for i. v. infusion and NG administration, respectively). Ciprofloxacin bioavailability ranges from 31 to 82 % (median, 44 %). Conclusions: In tube-fed critically ill patients, a switch to the NG ciprofloxacin after initial i. v. therapy to simplify the treatment of severe infections is restricted to those for whom serial assessments of ciprofloxacin levels are routinely available.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340050714
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  • 10
    Digitale Medien
    Digitale Medien
    Circulating cardiac troponin I in trauma patients without cardiac contusion (1998)
    Springer
    Intensive care medicine 24 (1998), S. 569-573 
    Details
    ISSN: 1432-1238
    Schlagwort(e): Key words Cardiac troponin I ; Creatine kinase ; Hypovolemia ; Rhabdomyolysis ; Shock ; Trauma
    Quelle: Springer Online Journal Archives 1860-2000
    Thema: Medizin
    Notizen: 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.
    Materialart: Digitale Medien
    URL: http://dx.doi.org/10.1007/s001340050617
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