Search results for " Intensive Care Medicine"
showing 10 items of 684 documents
Single shot spinal anesthesia with very low hyperbaric bupivacaine dose (3.75mg) for hip fracture repair surgery in the elderly. A randomized, double…
2014
Single shot spinal anesthesia is used worldwide for hip fracture repair surgery in the elderly. Arterial hypotension is a frequent adverse effect. We hypothesized that lowering local anesthetics dose could decrease the incidence of arterial hypotension, while maintaining quality of surgical anesthesia.In a randomized double blinded study, 66 patients over the age of 65 years, with hip fracture needing surgical repair, were assigned to B0.5 group 7.5mg hyperbaric bupivacaine 5mg/ml (control group), and B0.25 group 3.75mg hyperbaric bupivacaine 2.5mg/ml (study group). Sensory and motor block level, and hemodynamic parameters including blood presure, heart rate and vasopressor dose administrat…
Effects of hypertonic/hyperoncotic treatment and surgical evacuation after acute subdural hematoma in rats*
2007
Objective: The treatment of acute subdural hematoma (ASDH) consists mainly of surgical evacuation of the hematoma. It is conceivable that early preoperative neuroprotection with hypertonic/hyperoncotic treatment (HHT) can improve survival rates. The present study investigated the benefit of treatment with hypertonic/hyperoncotic solution on functional and histologic outcome as supportive therapy accompanying surgical intervention. Design: Laboratory experiment. Setting: University laboratory. Subjects: Male Sprague-Dawley rats weighing 296–350 g (n = 56). Interventions: ASDH was induced through subdural infusion of 400 μL of autologous venous blood. Thirty minutes after subdural blood infus…
Hypertonic saline solution and decompressive craniectomy for treatment of intracranial hypertension in pediatric severe traumatic brain injury.
2002
Experimental data 8 –11 and first clinical results in adults 12,13 suggest that hypertonic saline ( 1.0) may be highly effective in lowering ICP even when mannitol has lost its therapeutic potential after prolonged and repeated use. In children, only limited experience exists with the use of hypertonic saline solutions: a randomized prospective study in children with severe head injury compared the effects on ICP (increased to 15–20 mm Hg) of isotonic (0.9% NaCl) and hypertonic (3% NaCl) saline injections, demonstrating a beneficial effect of the hypertonic solution. 14 Another prospective randomized trial compared the effects of continuous infusion of either lactated Ringer’s solution (277…
Long-term serial kinetics of N-terminal pro B-type natriuretic peptide and carbohydrate antigen 125 for mortality risk prediction following acute hea…
2017
Aim: Baseline values of N-terminal pro B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) predict all-cause mortality in acute heart failure (AHF). However, there is limited information about the added prognostic benefit of using longitudinal values, and how this predictive ability is modified when modelling together. The aim of this study was to determine the mutually-adjusted association between the longitudinal trajectories of NT-proBNP and CA125 with all-cause mortality after an episode of AHF. Methods and results: We included 946 consecutive patients discharged for AHF. NT-proBNP and CA125 were measured at each physician-patient encounter (median (interquartile…
PLASMA PROTEIN LOSS DURING SURGERY: BENEFICIAL EFFECTS OF ALBUMIN SUBSTITUTION
2001
Plasma protein loss during abdominal surgery is a known phenomenon, but its possible pathophysiological relevance has remained unknown. The present study evaluates the effects of albumin substitution on systemic and local hemodynamics and cellular interactions in the mesenteric microcirculation. Rats underwent median laparotomy and exteriorization of an ileal loop for intravital microscopy of the mesenteric microcirculation. Plasma protein concentrations, systemic and local hemodynamics were recorded during the follow up period, with or without albumin substitution. Depending on the time course of plasma protein loss in control experiments, 80% of the calculated protein loss was infused dur…
Empirically-derived food patterns and the risk of total mortality and cardiovascular events in the PREDIMED study.
2015
BACKGROUND & AIMS: There is little evidence on post hoc-derived dietary patterns (DP) and all-cause mortality in Southern-European populations. Furthermore, the potential effect modification of a DP by a nutritional intervention has not been sufficiently assessed. We assessed the association between a posteriori defined baseline major DP and total mortality or cardiovascular events within each of the three arms of a large primary prevention trial (PREDIMED) where participants were randomized to two active interventions with Mediterranean-type diets or to a control group (allocated to a low-fat diet). DESIGN: We followed-up 7216 participants for a median of 4.3 years. A validated 137-item fo…
Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium
2012
Introduction Sepsis-associated delirium (SAD) increases morbidity in septic patients and, therefore, factors contributing to SAD should be further characterized. One possible mechanism might be the impairment of cerebrovascular autoregulation (AR) by sepsis, leading to cerebral hypo- or hyperperfusion in these haemodynamically unstable patients. Therefore, the present study investigates the relationship between the incidence of SAD and the status of AR during sepsis. Methods Cerebral blood flow velocity was measured using transcranial Doppler sonography and was correlated with the invasive arterial blood pressure curve to calculate the index of AR Mx (Mx>0.3 indicates impaired AR). Mx was m…
Plasma Renin Concentration is Associated With Hemodynamic Deficiency and Adverse Renal Outcome in Septic Shock.
2019
International audience; Background: In septic shock, both systemic vasodilatation and glomerular arteriole dilatation are responsible for the drop in glomerular filtration observed in early acute kidney injury. Angiotensin II has been showed to act on both mechanisms. Our objective was to evaluate the impact of renin angiotensin system activation, on hemodynamic deficiency and renal outcome in patient with septic shock and to assess whether urinary sodium could be a reliable test for high plasma renin concentration screening.Methods: This was a prospective and observational study. Inclusion criteria were 1) early septic shock (first episode) 2) dose of norepinephrine ≥ 0.25 μg/kg/min 3) bef…
B-type natriuretic peptide as a marker for sepsis-induced myocardial depression in intensive care patients.
2008
In early stages of septic shock, impaired myocardial function plays an important prognostic role. In this context, B-type natriuretic peptide (BNP) has been shown to be a neurohumoral marker for left ventricular dysfunction, because myocardial strain and ischemia both increase BNP concentration. The present study was designed to test if BNP allows for identification of patients at risk for developing sepsis-induced myocardial depression and if an increased concentration of BNP is associated with an adverse outcome in patients with septic shock.In a prospective study, 93 patients with septic shock were divided into one group with normal ventricular function (left ventricular ejection fractio…
The carotid pulse check revisited: What if there is no pulse?
2000
This study was undertaken to evaluate the diagnostic accuracy and time required by first responders to assess the carotid pulse in potentially pulseless patients. We conducted a prospective, randomized study of first responders (n = 206; four different training levels) and were blinded as to the patients' conditions in the cardiac operating rooms of a university hospital. Sixteen patients underwent coronary artery bypass surgery on nonpulsatile cardiopulmonary bypasses. Carotid pulse check was performed either during pulsatile (spontaneous) or during nonpulsatile (extracorporeal) circulation. Patients' hemodynamic status at the time of assessment, diagnostic accuracy of the first responders…