CORD-19-Sentences  

CORD-19:2e2bc679c8393230bac2af64115bab7ed1ba62c0 JSONTXT 9 Projects

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Id Subject Object Predicate Lexical cue
TextSentencer_T1 0-363 Sentence denotes P1 Comparison of carbamylated versus recombinant erythropoietin during spinal cord ischemia/reperfusion injury P2 Sodium 4-phenylbutylate protects against myocardial ischemia-reperfusion injury by reducing unfolded protein response-mediated apoptosis in mice P3 Time-dependent eff ects of intravenous H 2 S during long-term, resuscitated porcine hemorrhagic shock
TextSentencer_T2 365-373 Sentence denotes Abstract
TextSentencer_T3 374-568 Sentence denotes We previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, however, improving neurological function.
TextSentencer_T4 569-790 Sentence denotes The clinical use of EPO has been cautioned most recently due to serious safety concerns arising from an increased mortality in acute stroke patients treated with EPO and simultaneously receiving systemic thrombolysis [2].
TextSentencer_T5 791-970 Sentence denotes Carbamylated EPO (cEPO) is an EPO derivative without erythropoietic activity and devoid of the EPO side eff ects, but with apparently well maintained cytoprotective qualities [3].
TextSentencer_T6 971-1148 Sentence denotes We therefore tested the hypothesis whether cEPO may be equally effi cient as EPO in reducing morphological as well as functional aortic occlusion-induced spinal cord I/R injury.
TextSentencer_T7 1149-1358 Sentence denotes Methods In a randomized and blinded trial pigs received either vehicle (control, n = 9), EPO or cEPO, respectively (n = 9 each; 5,000 IU/kg over 30 minutes before and during the fi rst 4 hours of reperfusion).
TextSentencer_T8 1359-1530 Sentence denotes Animals underwent 30 minutes of thoracic aortic balloon occlusion with catheters placed immediately downstream of the A. subclavia and upstream of the aortic trifurcation.
TextSentencer_T9 1531-1771 Sentence denotes Spinal cord function was assessed by motor evoked potentials (MEP as percentage of the amplitude before aortic occlusion) and lower limb refl exes (assessed as the subjective strength of response) for a period of 10 hours after reperfusion.
TextSentencer_T10 1772-1821 Sentence denotes Tissue damage was evaluated using Nissl staining.
TextSentencer_T11 1822-2193 Sentence denotes Results Both EPO-treated and cEPO-treated animals presented with attenuated spinal cord injury in the Nissl staining (median (quartile) percentage of damaged neurons in the thoracic segments: control 27 (25,44), cEPO 8 (4,10), and EPO 5 (5,7), P <0.001 vs control group; in the lumbar segments: control 26 (19,32), cEPO 7 (5,13), EPO 8 (5,10), P <0.001 vs control group).
TextSentencer_T12 2194-2458 Sentence denotes However, while only cEPO treatment was associated with recovery of the MEP amplitude to pre-occlusion values when compared with the control group (P <0.05), lower limb refl ex response was comparably restored stronger in both treatment groups (P <0.05 vs control).
TextSentencer_T13 2459-2705 Sentence denotes Conclusions In a clinically relevant porcine model mimicking aortic crossclamping during vascular surgery repair of thoracic aortic aneurysm, cEPO protected spinal cord function and integrity as eff ective as EPO when applied at equipotent doses.
TextSentencer_T14 2706-2788 Sentence denotes Acknowledgements Supported by the Deutsche Forschungs gemeinschaft (SCHE 899/2-2).
TextSentencer_T15 2789-2812 Sentence denotes Figure 1 (abstract P2).
TextSentencer_T16 2813-2866 Sentence denotes Phenylbutyrate reduced the unfolded protein response.
TextSentencer_T17 2867-3190 Sentence denotes Introduction In awake, spontaneously breathing mice, inhaling hydrogen sulfi de (H 2 S) induced a hibernation-like metabolic state characterised by reduced energy expenditure and hypothermia [1], which protected against otherwise lethal hypoxia [2] and hemorrhage [3] as a result of impaired cellular energy metabolism [4].
TextSentencer_T18 3191-3307 Sentence denotes Therefore, we investigated the metabolic eff ects of inhaled H 2 S in our model of resuscitated murine septic shock.
TextSentencer_T19 3308-3555 Sentence denotes Methods Sixteen hours after induction of sepsis by cecal ligation and puncture (CLP) or sham operation, anesthetized and mechanically ventilated mice received 100 ppm H 2 S or vehicle over 5 hours at body temperatures of 38 and 27°C, respectively.
TextSentencer_T20 3556-3685 Sentence denotes During the observation period, hyperdynamic hemodynamics were maintained by colloid resuscitation and noradrenaline infusion [5].
TextSentencer_T21 3686-3911 Sentence denotes Endogenous glucose production was calculated from blood 13 C6-glucose isotope enrichment derived from the rate of appearance of stable, non-radioactive labeled 1,2,3,4,5,6-13 C6 glucose during continuous isotope infusion [6].
TextSentencer_T22 3912-4121 Sentence denotes Whole-body glucose oxidation rate was derived from the total CO 2 -production rate, the mixed expiratory 13 CO 2 / 12 CO 2 isotope ratio and the 13 C6-glucose infusion rate after the steady state was achieved.
TextSentencer_T23 4122-4364 Sentence denotes Results While endogenous glucose production was not aff ected by hypothermia, it was signifi cantly higher in the septic animals when compared with the corresponding sham operated groups, most likely due to the ongoing noradrenaline infusion.
TextSentencer_T24 4365-4528 Sentence denotes In contrast, despite the catecholamine infusion and higher glucose release, whole body glucose oxidation was signifi cantly reduced in normothermic septic animals.
TextSentencer_T25 4529-4663 Sentence denotes During hypothermia, H 2 S shifted substrate towards preferential glucose utilisation, but this eff ect disappeared in the septic mice.
TextSentencer_T26 4664-4841 Sentence denotes Conclusions H 2 S inhalation alone does not infl uence glucose metabolism once temperature is maintained at normothermic levels in anesthetised and mechanically ventilated mice.
TextSentencer_T27 4842-5045 Sentence denotes The H 2 S-related shift of energy metabo lism towards preferential carbohydrate oxidation present during hypothermia is blunted during sepsis, possibly as a result of the ongoing catecholamine treatment.
TextSentencer_T28 5047-5163 Sentence denotes Introduction Unfolded protein response (UPR)-mediated apoptosis plays a pivotal role in ischemia-reperfusion injury.
TextSentencer_T29 5164-5338 Sentence denotes Sodium 4-phenylbutyrate (PBA) has been reported to act as a chemical chaperone inhibiting UPR-mediated apoptosis triggered by ischemia in various organs other than the heart.
TextSentencer_T30 5339-5476 Sentence denotes Therefore we investigated whether PBA reduces UPR-mediated apoptosis and protects against myocardial ischemia-reperfusion injury in mice.
TextSentencer_T31 5477-5564 Sentence denotes Methods C57BL/6 mice were subjected to 30 minutes LAD ischemia followed by reperfusion.
TextSentencer_T32 5565-5655 Sentence denotes PBA (100 mg/kg) or PBS (control) was administrated intraperitoneally just before ischemia.
TextSentencer_T33 5656-5899 Sentence denotes Apoptosis, infarct size and tissue protein levels of Grp78 and caspase-12 (UPR-mediated apoptosisassociated protein) were evaluated by TUNEL, TTC stain and western blot analyses, respectively, at 48 hours after ischemia (n = 5 for each group).
TextSentencer_T34 5900-6016 Sentence denotes Echocardiography was performed at 3 weeks after ischemia and the survival ratio was observed (n = 9 for each group).
TextSentencer_T35 6017-6192 Sentence denotes Results Compared with PBS, PBA reduced apoptotic cells (30.8 ± 0.2% vs 20.5 ± 0.5%, P <0.05) and infarct size (32.0 ± 3.8% vs 13.0 ± 2.1%, P <0.01) after ischemia-reperfusion.
TextSentencer_T36 6193-6323 Sentence denotes Grp78 and caspase-12 were increased in mice with PBS, but PBA attenuated the increase in Grp78 (P <0.05) and caspase-12 (P <0.05).
TextSentencer_T37 6324-6536 Sentence denotes PBA inhibited the deterioration of cardiac parameters including LVEDD (3.35 ± 0.08 mm vs 2.74 ± 0.11 mm, P <0.01), LVESD (2.30 ± 0.08 mm vs 1.54 ± 0.12 mm, P <0.01), and %FS (31.3 ± 2.2% vs 39.4 ± 2.2%, P <0.05).
TextSentencer_T38 6537-6595 Sentence denotes All mice with PBA survived, but 33% animals with PBS died.
TextSentencer_T39 6596-6749 Sentence denotes Conclusions PBA maintained cardiac function and improved survival ratio after myocardial ischemia-reperfusion by reducing UPR-mediated apoptosis in mice.
TextSentencer_T40 6750-7031 Sentence denotes References Introduction In awake, spontaneously breathing mice, inhaling hydrogen sulfi de (H 2 S) induced a hibernation-like metabolic state characterised by reduced energy expenditure and hypothermia [1] , which protected against otherwise lethal hypoxia [2] and hemorrhage [3] .
TextSentencer_T41 7032-7166 Sentence denotes In contrast, other authors reported that inhibition of endogenous H 2 S synthesis attenuated posthemorrhage organ dysfunction [4, 5] .
TextSentencer_T42 7167-7258 Sentence denotes All these data originate, however, from unresuscitated models using a pre-treatment design.
TextSentencer_T43 7259-7415 Sentence denotes Therefore we investigated the time-dependent eff ect of intravenous H 2 S in a clinically relevant, long-term model of porcine hemorrhage and resuscitation.
TextSentencer_T44 7416-7669 Sentence denotes Methods After surgical instrumentation, pigs were subjected to 4 hours of hemorrhagic shock induced by removal of 40% of the calculated blood volume and thereafter by additional removal or retransfusion of blood boli as needed to maintain MAP = 30 mmHg.
TextSentencer_T45 7670-7951 Sentence denotes Animals randomly received vehicle (control, n = 14) or the intravenous H 2 S donor Na 2 S started 2 hours before hemorrhage (pre-treatment, n = 11), at the beginning of blood removal (early post-treatment, n = 10) or at the beginning of resuscitation (late post-treatment, n = 10).
TextSentencer_T46 7952-8040 Sentence denotes In all groups the Na 2 S infusion was continued over the fi rst 10 hours of reperfusion.
TextSentencer_T47 8041-8179 Sentence denotes Resuscitation comprised retransfusion of shed blood, colloid volume expansion, and noradrenaline titrated to keep MAP at pre-shock levels.
TextSentencer_T48 8180-8347 Sentence denotes Systemic, renal and liver perfusion, O 2 exchange, and organ function were assessed before and at the end of hemorrhage as well as at 10 and 22 hours of resuscitation.
TextSentencer_T49 8348-8545 Sentence denotes Results Survival (71% in the control vs 100, 91, and 90% in the pretreatment, early post-treatment and late post-treatment groups, respectively) was signifi cantly improved in all treatment groups.
TextSentencer_T50 8546-8845 Sentence denotes The noradrenaline infusion rate required to maintain hemodynamic targets was signifi cantly reduced in the early post-treatment group only, which coincided with a progressive drop in core temperature and attenuated kidney dysfunction (blood creatinine levels, creatinine clearance) in these animals.
TextSentencer_T51 8846-8925 Sentence denotes Conclusions Na 2 S application improved survival regardless of the drug timing.
TextSentencer_T52 8926-9094 Sentence denotes The less benefi cial eff ect of pre-treatment on organ function may be due to the higher total amount of drug infused, possibly suggesting some toxicity at these doses.
TextSentencer_T53 9095-9206 Sentence denotes Translation of previous animal studies into human ICU clinical trials has frequently produced negative results.
TextSentencer_T54 9207-9355 Sentence denotes Most of these animal studies have had high baseline mortality and have not employed standardised management of sepsis as usually provided in an ICU.
TextSentencer_T55 9356-9538 Sentence denotes The aim of this study was to develop a large animal model of septic shock receiving standardised intensive care management, thus replicating the management of septic shock in humans.
TextSentencer_T56 9539-9776 Sentence denotes Methods Eleven Marino ewes (weight 60 to 70 kg, hemiazygous vein ligated) were anaesthetised and had radiological guided catheters inserted into the iliac, renal, and hepatic veins, coronary sinus, and the pulmonary and carotid arteries.
TextSentencer_T57 9777-9877 Sentence denotes Tracheostomy tubes were inserted and the animals mechanically ventilated while supported in a sling.
TextSentencer_T58 9878-10027 Sentence denotes Six sheep were administered intravenous E. coli (ATCC 25922) 1.0 x 10 8 orgs/kg over 1 hour (septic sheep), fi ve received placebo (nonseptic sheep).
TextSentencer_T59 10028-10170 Sentence denotes For 24 hours, animals were monitored and received sedation (midazolam + ketamine), ventilation, fl uids and inotropes according to a protocol.
TextSentencer_T60 10171-10269 Sentence denotes Primary end-point was noradrenaline (NA) dose to maintain mean arterial pressure (MAP) of 75 mmHg.
TextSentencer_T61 10270-10477 Sentence denotes Secondary end-points included haemodynamic variables, respiratory, hepatic, and renal function, haematology, acid-base status and global, hind-limb, renal, hepatic and coronary oxygen extraction ratio (OER).
TextSentencer_T62 10478-10561 Sentence denotes Results Sheep were successfully instrumented, monitored and supported for 24 hours.
TextSentencer_T63 10562-10743 Sentence denotes Septic sheep required NA (mean dose 0.28 μg/kg/min vs 0.00, P <0.001), developed a higher cardiac index (6.6 l/m 2 vs 4.3, P <0.05) and lower SVRI (769 dynes/m 2 vs 1,804, P <0.05).
TextSentencer_T64 10744-11094 Sentence denotes At 24 hours, septic sheep had renal impairment (creatinine 286 mmol/l vs 76, P <0.05; urea 12 mmol/l vs 7, P <0.05), metabolic acidosis (pH 7.21 vs 7.39, P <0.05; lactate 10.9 mmol/l vs 1.2, P <0.01; pCO 2 32 vs 31, P = 0.63), coagulopathy (INR 5.9 vs 1.9, P <0.05; fi brinogen 0.9 g/l vs 2.7, P <0.05) but preserved respiratory and hepatic function.
TextSentencer_T65 11095-11200 Sentence denotes Global OER was lower in septic sheep (0.16 vs 0.29, P <0.05) as was coronary OER (0.36 vs 0.68, P <0.05).
TextSentencer_T66 11201-11342 Sentence denotes OER did not change with sepsis in the kidney (0.09 vs 0.11, P = 0.52), liver (0.24 vs 0.31, P = 0.48) and hind-limb (0.31 vs 0.42, P = 0.23).
TextSentencer_T67 11343-11475 Sentence denotes Conclusions We have developed a large animal model of septic shock that receives intensive care support and standardised management.
TextSentencer_T68 11476-11575 Sentence denotes This model replicates much of the pathophysiology and management that occurs in human septic shock.
TextSentencer_T69 11576-11687 Sentence denotes It allows a large range of physiological parameters to be assessed when investigating new therapies for sepsis.
TextSentencer_T70 11688-11795 Sentence denotes Introduction Sepsis-induced lymphocyte apoptosis plays a fundamental role in the pathophysiology of sepsis.
TextSentencer_T71 11796-11935 Sentence denotes Recent animal models of sepsis have identifi ed anomalies in the extrinsic apoptotic pathway, a key pathological occurrence in sepsis [1] .
TextSentencer_T72 11936-12161 Sentence denotes Specifi cally apoptosis markers such as caspases 1, 3, 8, 9 and FADD have been shown to be signifi cant in animal models of infection [2] .We investigated mRNA transcription of these markers in a human model of severe sepsis.
TextSentencer_T73 12162-12294 Sentence denotes We hypothesized that ICU mortality from severe sepsis is associated with distinctive gene expression of extrinsic apoptosis markers.
TextSentencer_T74 12295-12382 Sentence denotes Methods A prospective observational study of patients with severe sepsis was performed.
TextSentencer_T75 12383-12451 Sentence denotes Mononuclear cells were isolated from 48 patients with severe sepsis.
TextSentencer_T76 12452-12531 Sentence denotes Total RNA was extracted from samples for day 1 of admission and again on day 7.
TextSentencer_T77 12532-12646 Sentence denotes FADD, caspase 1, 3, 8, and 9 mRNA was quantifi ed with quantitative real-time polymerase chain reaction (qRT-PCR).
TextSentencer_T78 12647-12699 Sentence denotes Standard demographic and outcome data were recorded.
TextSentencer_T79 12700-12767 Sentence denotes Between-group comparisons were performed by Wilcoxon rank sum test.
TextSentencer_T80 12768-12824 Sentence denotes All values are stated as median and interquartile range.
TextSentencer_T81 12825-12876 Sentence denotes Results Sixteen of the 48 patients died in the ICU.
TextSentencer_T82 12877-13095 Sentence denotes Caspase 9 mRNA copy numbers were signifi cantly increased on day 7 in the survivor group (5.4 x 10 6 ; 7.4 x 10 6 to 8.9 x 10 6 ) compared with death in the ICU group (1.9 x 10 6 ; 3.0 x 10 6 to 1.2 x 10 6 ) P = 0.001.
TextSentencer_T83 13096-13272 Sentence denotes FADD, caspase 1, 3 and 8 mRNA copy numbers were not signifi cantly diff erent between patients who died and those discharged from the ICU on either day 1 or day 7 of admission.
TextSentencer_T84 13273-13376 Sentence denotes Conclusions Caspase 9 may be an important regulator of apoptotic mechanisms in humans with late sepsis.
TextSentencer_T85 13377-13453 Sentence denotes Pro-apoptotic mechanisms may have a role in the resolution of severe sepsis.
TextSentencer_T86 13454-13653 Sentence denotes Conclusions Individual variability occurs in both faecal and zymosan peritonitis models as shown by heterogeneous clinical responses and local immune cell numbers to the same dose in similar animals.
TextSentencer_T87 13654-13774 Sentence denotes The cellular immune response in both models is consistent with current understanding of infection-induced infl ammation.
TextSentencer_T88 13775-13859 Sentence denotes Neutrophils, but not macrophages, rose in proportion to worsening clinical severity.
TextSentencer_T89 13860-13947 Sentence denotes The signifi cance of F4/80 + /GR-1 + cells in the FS model requires further evaluation.
TextSentencer_T90 13948-14000 Sentence denotes Introduction T lymphocytes are crucial immune cells.
TextSentencer_T91 14001-14136 Sentence denotes We analysed T-cell subsets phenotypes and tested, on a single cell level, their ability to produce key cytokines in early human sepsis.
TextSentencer_T92 14137-14209 Sentence denotes Methods Whole blood was collected from septic patients on ICU admission.
TextSentencer_T93 14210-14294 Sentence denotes Peripheral blood mononuclear cells (PBMC) were isolated and T-cell subsets analysed.
TextSentencer_T94 14295-14430 Sentence denotes To study cytokine production, PMBC were cultured in the presence of PMA/ionomycin (50/750 ng/ml) in supplemented RPMI 1640 for 5 hours.
TextSentencer_T95 14431-14561 Sentence denotes Intracellular cytokines IL-4, IL-10, IL-17, IFNγ were stained in CD3 + /CD4 + , CD3 + /CD8 + cells using fl ow cytometry for both.
TextSentencer_T96 14562-14660 Sentence denotes The number of cytokine producing cells was compared with age/sex-matched healthy human volunteers.
TextSentencer_T97 14661-14694 Sentence denotes Data are expressed as mean ± SEM.
TextSentencer_T98 14695-14803 Sentence denotes Results There were 12 patients (66 years old, six males, APACHE II-24, eight survivors) and nine volunteers.
TextSentencer_T99 14804-14938 Sentence denotes We found a relative increase in the frequency of Treg cells while the proportion of CD4 + cells remained unchanged in septic patients.
TextSentencer_T100 14939-15061 Sentence denotes The PMA/ionomycin lead to maximal T-cell stimulation, testing the ability of individual cell subsets to produce cytokines.
TextSentencer_T101 15062-15344 Sentence denotes Septic patients displayed reduction of IFNγ (10.5 ± 0.8% vs 14.7 ± 1.9%, P <0.01) and a tendency to higher number of IL-10 (1.7 ± 0.3% vs 0.5 ± 0.1%, P = 0.10) producing CD4 + cells, while the proportion of IFNγ-positive CD8 + cells increased (42.8 ± 5.8% vs 28.1 ± 4.9%, P = 0.03).
TextSentencer_T102 15345-15471 Sentence denotes However, the overall CD8 + T-cell population was reduced (14.29 ± 1.6% vs 25 ± 1.2%) following ex vivo activation in patients.
TextSentencer_T103 15472-15543 Sentence denotes The number of IL-4 and IL-17 staining cells was unchanged ( Figure 1 ).
TextSentencer_T104 15544-15659 Sentence denotes Conclusions Our results confi rm a relative increase of Treg [1] and a skew towards Th2 lineage in the CD4 + cells.
TextSentencer_T105 15660-15756 Sentence denotes The highly activated CD8 + cells appear to be more susceptible to activation-induced cell death.
TextSentencer_T106 15757-16010 Sentence denotes Introduction It is currently being understood that most of the agents modulating host response in sepsis have failed because they act to refrain an over-exaggerated immune response whereas immunoparalysis takes place on the time of their administration.
TextSentencer_T107 16011-16086 Sentence denotes The eff ect of IFNγ on immunoparalysis of monocytes in sepsis was assessed.
TextSentencer_T108 16087-16169 Sentence denotes Introduction Nitric oxide (NO) plays a central role in the pathogenesis of sepsis.
TextSentencer_T109 16170-16412 Sentence denotes Recently, we demonstrated that endothelial NOS (eNOS) contributes to endogenous NO-production and modulates infl ammation, associated with preserved cardiac function resulting in prolonged survival of eNOS -/compared with wild-type (WT) mice.
TextSentencer_T110 16413-16486 Sentence denotes The role of neuronal NOS (nNOS) in septic cardiomyopathy remains unclear.
TextSentencer_T111 16487-16649 Sentence denotes This study's aim is to elucidate the infl uence of nNOS in the presence/absence of eNOS on cardiac function and survival in a clinically relevant model of sepsis.
TextSentencer_T112 16650-16818 Sentence denotes Methods Inhibition of nNOS was achieved via continuous application of the selective nNOS-inhibitor Vinyl-L-NIO (VL-NIO) (0.02 mg/kg BW/hour) using an osmotic mini pump.
TextSentencer_T113 16819-16903 Sentence denotes B6/c57 WT and eNOS -/mice were rendered septic by cecum ligation and puncture (CLP).
TextSentencer_T114 16904-17009 Sentence denotes After 12 hours heart function was analyzed using a pressure-volume catheter placed in the left ventricle.
TextSentencer_T115 17010-17112 Sentence denotes For catecholamine responsiveness, norepinephrine was applied (0.4 μg/kg BW/minute, intraperitoneally).
TextSentencer_T116 17113-17201 Sentence denotes NOx-levels in plasma were measured using high-pressure performing liquid chromatography.
TextSentencer_T117 17202-17428 Sentence denotes Results Inhibition of nNOS via VL-NIO application resulted in signifi cantly reduced nitrate plasma levels and prolonged survival (WT CLP + VL-NIO = 38 Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
TextSentencer_T118 17429-17457 Sentence denotes hours vs WT CLP = 29 hours).
TextSentencer_T119 17458-17570 Sentence denotes However, cardiac function and norepinephrine responsiveness were not improved compared with untreated septic WT.
TextSentencer_T120 17571-17771 Sentence denotes In contrast to WT, application of VL-NIO in eNOS -/had no infl uence on plasma nitrate levels, while cardiac function and survival were signifi cantly impaired compared with untreated septic eNOS -/-.
TextSentencer_T121 17772-17905 Sentence denotes Impaired cardiac function was accompanied by decreased survival time (eNOS -/-CLP + VL-NIO = 29.5 hours vs eNOS -/-CLP = 69.5 hours).
TextSentencer_T122 17906-18107 Sentence denotes Conclusions Pharmacologic inhibition of nNOS result in signifi cant reduction of plasma nitrate levels and prolonged survival compared with untreated septic WT despite unimproved septic cardiomyopathy.
TextSentencer_T123 18108-18244 Sentence denotes In contrast, the signifi cant survival benefi t of septic eNOS -/compared with septic WT was abrogated by pharmacologic nNOS inhibition.
TextSentencer_T124 18245-18308 Sentence denotes Furthermore, the latter developed severe septic cardiomyopathy.
TextSentencer_T125 18309-18408 Sentence denotes Whether eNOS acts as modulator of nNOS in this setting remains to be clarifi ed by further studies.
TextSentencer_T126 18409-18524 Sentence denotes Introduction High mobility group box protein-1 (HMGB) is released by activated monocytes/macrophages during sepsis.
TextSentencer_T127 18525-18650 Sentence denotes Levels correlated with mortality in patients and anti-HMGB antibodies prevented endotoxininduced death in animal models [1] .
TextSentencer_T128 18651-18862 Sentence denotes In marked contrast to these fi ndings are reports of cytoprotective eff ects because HMGB protected liver from ischemia/reperfusion (IR) [2] and HMGB-transgenic mice were resistant to myocardial infarction [3] .
TextSentencer_T129 18863-18935 Sentence denotes Despite these reports, little is known of the role or mechanism of HMGB.
TextSentencer_T130 18936-19025 Sentence denotes We aimed to further evaluate HMGB in rat hearts and in pulmonary and renal cell cultures.
TextSentencer_T131 19026-19127 Sentence denotes Methods Isolated hearts received HMGB/vehicle before 30 minutes ischemia and 120 minutes reperfusion.
TextSentencer_T132 19128-19225 Sentence denotes In separate studies, rats were rendered septic by caecal ligation and puncture (CLP) prior to IR.
TextSentencer_T133 19226-19294 Sentence denotes Left ventricular (LV) function was measured with a latex LV balloon.
TextSentencer_T134 19295-19337 Sentence denotes Infarct size was measured by TTC staining.
TextSentencer_T135 19338-19490 Sentence denotes For human cell culture studies, A549 alveolar cells or HK-2 renal tubular cells were treated with HMGB/vehicle before incubation in normoxia or hypoxia.
TextSentencer_T136 19491-19556 Sentence denotes Fluorimetric caspase-3 activity was used as measure of apoptosis.
TextSentencer_T137 19557-19592 Sentence denotes Cytochrome C was measured by ELISA.
TextSentencer_T138 19593-19650 Sentence denotes For HK-2 cells, the MTT assay was used to test viability.
TextSentencer_T139 19651-19899 Sentence denotes Results HMGB, prior to cardiac IR, preserved developed (d) LVP at 120 minutes reperfusion compared with controls (44 mmHg vs 27 mmHg, P <0.05) and infarct size, expressed as %V weight ± SEM, was reduced (31 ± 5.4 vs 44 ± 4.2, P <0.05), n = 6/group.
TextSentencer_T140 19900-20080 Sentence denotes Hearts from CLP rats had reduced baseline dLVP (59 mmHg ± 5.1 vs 97 ± 5.3, P <0.05) but infarct sizes after IR were signifi cantly reduced (27 ± 8.8, P <0.05 vs 44 ± 6.2, P <0.05).
TextSentencer_T141 20081-20182 Sentence denotes In A549 cells, HMGB inhibited apoptosis (49% reduced caspase-3 activity (8.6 vs 17.1 a.u., P <0.01)).
TextSentencer_T142 20183-20265 Sentence denotes This was associated with reduced cytochrome C release (250 vs 389 pg/ml, P <0.05).
TextSentencer_T143 20266-20377 Sentence denotes Using MTT assay, HMGB protected against hypoxia-induced cell death vs controls (viability 75% vs 61%, P <0.05).
TextSentencer_T144 20378-20458 Sentence denotes Conclusions HMGB, or sepsis, similarly precondition the heart against IR injury.
TextSentencer_T145 20459-20552 Sentence denotes HMGB has anti-apoptotic eff ects that protect against hypoxic renal and alveolar cell injury.
TextSentencer_T146 20553-20692 Sentence denotes We conclude that HMGB has potent anti-ischemic eff ects in multiple organs and may function as an innate cytoprotective mediator in sepsis.
TextSentencer_T147 20693-20922 Sentence denotes The purpose of the study is the evaluation of B-type natriuretic peptide (BNP) as a predictor of septic complications and ICU mortality in patients with a new onset of fever during the fi rst 3 days of hospitalization in the ICU.
TextSentencer_T148 20923-21105 Sentence denotes Methods Thirty-one ICU patients (21 males and 10 females) with new onset of fever and leukocytosis within the fi rst 3 days of ICU admission were prospectively included in the study.
TextSentencer_T149 21106-21208 Sentence denotes Exclusion criteria were heart or renal failure, chronic obstructive pulmonary disease and head trauma.
TextSentencer_T150 21209-21312 Sentence denotes Serial plasma samples were taken on days 1, 2 and 4 after the onset of fever for BNP level measurement.
TextSentencer_T151 21313-21525 Sentence denotes BNP values were correlated with severity scores (Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA)), the progression to septic shock and the fi nal outcome.
TextSentencer_T152 21526-21696 Sentence denotes Results According to the clinical and laboratory fi ndings within the fi rst 3 days of hospitalization, the patients included in the study were divided into three groups:
TextSentencer_T153 21697-21845 Sentence denotes Group A = systemic infl ammatory response syndrome (SIRS) (seven patients), Group B = sepsis (14 patients) and Group C = septic shock (10 patients).
TextSentencer_T154 21846-21941 Sentence denotes The BNP value on days 1 and 2 was signifi cantly associated with the SOFA Max value (P <0.001).
TextSentencer_T155 21942-22026 Sentence denotes The BNP value on day 4 was signifi cantly associated with ICU mortality (P = 0.006).
TextSentencer_T156 22027-22188 Sentence denotes The optimal cutoff BNP value for diff erentiating between nonsurvivors and survivors was estimated to be 203.55 pg/ml (sensitivity = 100%, specifi city = 61.1%).
TextSentencer_T157 22189-22319 Sentence denotes In Group B patients, BNP value on day 2 was signifi cantly higher in patients who fi nally progressed to septic shock (P = 0.001).
TextSentencer_T158 22320-22457 Sentence denotes The optimal cutoff BNP value for identifying these patients was estimated to be 212.45 pg/ml (sensitivity = 85.7%, specifi city = 64.3%).
TextSentencer_T159 22458-22628 Sentence denotes Conclusions In ICU patients with new onset of fever during the fi rst 3 days of ICU hospitalization, the BNP value on day 4 seems to be a good predictor of ICU mortality.
TextSentencer_T160 22629-22751 Sentence denotes In patients with sepsis, a cut-off BNP value of 212.45 pg/ml on day 2 could be a predictor of progression to septic shock.
TextSentencer_T161 22752-22866 Sentence denotes Due to the small number of patients included in our study, further studies are needed to confi rm these fi ndings.
TextSentencer_T162 22867-22923 Sentence denotes Introduction CD64 is the high-affi nity receptor of IgG.
TextSentencer_T163 22924-22984 Sentence denotes It is upregulated by infl ammatory cytokines on neutrophils.
TextSentencer_T164 22985-23058 Sentence denotes The upregulation of CD64 is linked with PMN activation in SIRS or sepsis.
TextSentencer_T165 23059-23099 Sentence denotes Our aim is to verify these correlations.
TextSentencer_T166 23100-23213 Sentence denotes Methods We enrolled 48 ICU critical patients and three groups were created: SIRS -(17), SIRS + (13), Sepsis (17).
TextSentencer_T167 23214-23291 Sentence denotes We evaluated CD64 X-mean values among the three groups as shown in Figure 1 .
TextSentencer_T168 23292-23378 Sentence denotes We used a t test to check the correlation between uprising CD64 and diff erent groups.
TextSentencer_T169 23379-23467 Sentence denotes We verifi ed the correlation CD64/SOFA ( Figure 2 ), WBC, NE, and patients' age using r.
TextSentencer_T170 23468-23595 Sentence denotes Results We found a CD64 higher level in sepsis compared with SIRS -(t = 8.095; P <0.001) and with SIRS + (t = 4.938; P <0.001).
TextSentencer_T171 23596-23764 Sentence denotes There were a high positive linear correlation between CD64 and SOFA score (r = 0.806; Introduction The incidence of sepsis is reported around 37% in European ICUs [1] .
TextSentencer_T172 23765-23872 Sentence denotes The mortality rate depends on the severity of organ failure, up to 65% if four or more organs are involved.
TextSentencer_T173 23873-24031 Sentence denotes Multiple organ failure (MOF) is due to microcirculatory dysfunction with microthrombosis resulting from coagulation disorders including platelets' activation.
TextSentencer_T174 24032-24137 Sentence denotes An early diagnosis should identify the microcirculatory dysfunction before MOF became clinically evident.
TextSentencer_T175 24138-24326 Sentence denotes The diagnosis of sepsis is commonly based on clinical criteria, pathogen identifi cation and use of markers like procalcitonin (PCT) and C-reactive protein (PCR) associated with infection.
TextSentencer_T176 24327-24595 Sentence denotes The aim of our study is to evaluate whether the routine measurement of immature platelet fraction (IPF), considered a precocious marker of platelet production, is associated with sepsis and its severity and/or whether it could be used as a predicting marker of sepsis.
TextSentencer_T177 24596-24731 Sentence denotes Methods We enrolled 66 consecutive patients admitted to the ICU, dividing them into two groups: septic (n = 44) and no septic (n = 22).
TextSentencer_T178 24732-24769 Sentence denotes The severity of sepsis was evaluated.
TextSentencer_T179 24770-24830 Sentence denotes The exclusion criterion was a platelet count <150,000/mm 3 .
TextSentencer_T180 24831-24900 Sentence denotes Blood count, coagulation, PCR, PCT, and IPF were collected every day.
TextSentencer_T181 24901-25005 Sentence denotes The IPF values between septic (4.6 ± 3.1) and no septic patients (3.3 ± 1.5) did not diff er (P = 0.16).
TextSentencer_T182 25006-25192 Sentence denotes No correlation was found between IPF values and the severity of septic condition (no sepsis 11.7 ± 10.1; sepsis 14.3 ± 10.5; severe sepsis 10.5 ± 9.1; septic shock 19.5 ± 12.4; P = 0.3).
TextSentencer_T183 25193-25409 Sentence denotes When we considered only subjects who did not have sepsis at the ICU admission we found that patients who developed sepsis during the recovery had IPF values higher than patients who did not develop sepsis (Table 1) .
TextSentencer_T184 25410-25483 Sentence denotes Conclusions From our results IPF cannot be considered a marker of sepsis.
TextSentencer_T185 25484-25599 Sentence denotes Conversely it could be used as predictive index of sepsis because it can identify patients who will develop sepsis.
TextSentencer_T186 25600-25743 Sentence denotes Introduction The role of matrix metalloproteinases (MMPs) and tissue inhibitors of matrix metalloproteinases (TIMPs) in sepsis remains unclear.
TextSentencer_T187 25744-25839 Sentence denotes Introduction Serum C-reactive protein (CRP) is synthesized in response to infl ammatory status.
TextSentencer_T188 25840-25936 Sentence denotes Elevated CRP levels are associated with an increased risk of multiorgan failure in ICU patients.
TextSentencer_T189 25937-26033 Sentence denotes Preoperative elevation of serum CRP is a prognostic indicator in gastric and colorectal surgery.
TextSentencer_T190 26034-26219 Sentence denotes The aim of this study was to determine serum CRP as prognostic variable in patients undergoing esophagectomy with gastric tube reconstruction in contrast to other ICU admitted patients.
TextSentencer_T191 26220-26374 Sentence denotes Methods Data were collected retrospectively for a total of 208 patients admitted to the ICU following elective surgery from October 2007 to December 2008.
TextSentencer_T192 26375-26528 Sentence denotes Patients included underwent esophagectomy with gastric tube reconstruction, liver transplantation, hemihepatectomy, neuro-and abdominal aneurysm surgery.
TextSentencer_T193 26529-26711 Sentence denotes Postoperative serum markers were measured and the relation between the course of postoperative serum CRP, development of complications and prognosis of the patients was investigated.
TextSentencer_T194 26712-26881 Sentence denotes Results Postoperative serum CRP was signifi cantly higher at T24 in patients undergoing esophagectomy with gastric tube reconstruction, compared with all other patients.
TextSentencer_T195 26882-27035 Sentence denotes Higher serum CRP levels correlated with the occurrence of complications in the heterogeneous ICU population but especially in the esophagectomy patients.
TextSentencer_T196 27036-27221 Sentence denotes Within this group, serum CRP levels at T24 and T48 were signifi cantly higher in patients with a postoperative pneumonia, which in itself was associated with increased 1-year mortality.
TextSentencer_T197 27222-27389 Sentence denotes Conclusions Postoperative serum CRP levels can easily be monitored in the ICU in order to identify patients at risk for the development of postoperative complications.
TextSentencer_T198 27390-27514 Sentence denotes Especially in the esophagectomy patients, the occurrence of postoperative complications is associated with reduced survival.
TextSentencer_T199 27515-27702 Sentence denotes Introduction To examine whether we can safely shorten the periods of antibiotic administration for septic patients with procalcitonin (PCT) measurements compared with no PCT measurements.
TextSentencer_T200 27703-27929 Sentence denotes Methods The participants were septic patients including (1) hospitalized to our ICU from February 2009 to November 2009, (2) administered antibiotics for 4 days and over, and (3) stopped the antibiotics during their ICU stays.
TextSentencer_T201 27930-28011 Sentence denotes We treated the patients from February to June without PCT measurements (Group A).
TextSentencer_T202 28012-28116 Sentence denotes On the other hand, we treated the patients from July to November referring to serum PCT level (Group B).
TextSentencer_T203 28117-28171 Sentence denotes In group B, when : sepsis secondary to hydronephrosis.
TextSentencer_T204 28172-28299 Sentence denotes This graph clearly shows the rise in procalcitonin (PCT) during early onset of sepsis and its fall during antibiotic treatment.
TextSentencer_T205 28300-28388 Sentence denotes Antibiotics were discontinued when the PCT level fell to 80% of its peak value on day 8.
TextSentencer_T206 28389-28469 Sentence denotes Example 2 (right): laparoscopic cholecystectomy complicated by bile peritonitis.
TextSentencer_T207 28470-28584 Sentence denotes Good response to antibiotics initially, but PCT started to rise on day 12 which prompted us to change antibiotics.
TextSentencer_T208 28585-28642 Sentence denotes Serial PCT is useful to assess the response to treatment.
TextSentencer_T209 28643-28792 Sentence denotes Introduction Bloodstream infection is a life-threatening condition with a high mortality rate, especially in intensive care and neutropenic patients.
TextSentencer_T210 28793-28847 Sentence denotes Standard diagnostics is based on blood culturing (BC).
TextSentencer_T211 28848-29009 Sentence denotes However, limitations of BC include relatively low sensitivities and a long time-toresult for the identifi cation of the pathogen, generally over 2 days and more.
TextSentencer_T212 29010-29244 Sentence denotes On the grounds of data from a multicentre study using a universal 16S rRNA gene PCR assay, SepsiTest™, molecular diagnosis is discussed as a rapid and sensitive tool for the detection and identifi cation of pathogens supportive of BC.
TextSentencer_T213 29245-29509 Sentence denotes A new commercial PCR test, SepsiTest™, for direct detection of bacteria in whole blood was compared with BC in terms of sensitivity, specifi city, predictive values and time to positivity (TTP) of bacterial infections of the bloodstream of critically ill patients.
TextSentencer_T214 29510-29654 Sentence denotes Methods The test, SepsiTest™ (Molzym, Bremen), comprises the extraction and 16S rRNA gene PCR detection of bacterial DNA in whole blood samples.
TextSentencer_T215 29655-29738 Sentence denotes Bacteria in positive samples were identifi ed by sequence analysis of the amplicon.
TextSentencer_T216 29739-29908 Sentence denotes In a prospective multicentre study, 342 blood samples from 187 patients with systemic infl ammatory response syndrome (SIRS), sepsis, or neutropenic fever were included.
TextSentencer_T217 29909-30031 Sentence denotes Results Compared with BC, the diagnostic sensitivity and specifi city of PCR/sequencing was 87.0% and 85.8%, respectively.
TextSentencer_T218 30032-30105 Sentence denotes The positivity rate of PCR/sequencing (25.7%) was higher than BC (15.8%).
TextSentencer_T219 30106-30264 Sentence denotes Of 31 PCR/ sequencing-positive, BC-negative patients, most of whom received antibiotics, the PCR results of 25 were judged as true or possible to bacteraemia.
TextSentencer_T220 30265-30444 Sentence denotes Using a routine testing workfl ow, time to positivity of the PCR test was on average decreased by 40 hours for anaerobe/fastidious infections and by 54 hours for yeast infections.
TextSentencer_T221 30445-30585 Sentence denotes Modest diff erences in circulating concentration of coagulation-fi brinolysis markers on ED presentation (day 1) and over the fi rst 7 days.
TextSentencer_T222 30586-30717 Sentence denotes P 1 , day 1 P value from ANOVA model adjusted for sex, race, co-morbidity, and smoking status; Tobit models used for censored data.
TextSentencer_T223 30718-30863 Sentence denotes P 2 , day 1 to 7 P value from mixed eff ects model adjusted for sex, race, comorbidity, and smoking status; Tobmit models used for censored data.
TextSentencer_T224 30864-30978 Sentence denotes Introduction Prompt initiation of appropriate antibiotic therapy improves outcome in critically ill patients [1] .
TextSentencer_T225 30979-31169 Sentence denotes In a tertiary-level ICU, we evaluated the appropriateness of, and adherence to an antibiotic guideline (based on local bacterial epidemiology) in CDC-defi ned hospital-associated infections.
TextSentencer_T226 31170-31418 Sentence denotes Methods We conducted a 6-month prospective observational study (April 2008 to October 2008) in consecutive ICU admissions of patients who satisfi ed investigator-adjudicated classifi cation of ICU-acquired infections according to CDC criteria [2] .
TextSentencer_T227 31419-31657 Sentence denotes We assessed patient characteristics including severity of illness at admission, ICU length of stay (LOS), appropriateness of initial antibiotic choice as judged by in vitro sensitivity results and appropriateness of the current guideline.
TextSentencer_T228 31658-31718 Sentence denotes Results are presented as mean (SD) or median as appropriate.
TextSentencer_T229 31719-31848 Sentence denotes Results During the study period there were 101 antibiotic starts in 65 patients with sepsis secondary to ICU-acquired infections.
TextSentencer_T230 31849-31998 Sentence denotes Medical patients formed 44% of the study cohort; whilst 23% of patients were general surgical and the remaining 33% were post cardiothoracic surgery.
TextSentencer_T231 31999-32095 Sentence denotes The age and admission APACHE II score of the study cohort was 61.8 (16.3) years and 18.4 (5.6) .
TextSentencer_T232 32096-32165 Sentence denotes The median LOS and ICU mortality of the cohort was 24 days and 27.6%.
TextSentencer_T233 32166-32386 Sentence denotes The most common CDC reportable diagnosis was clinical or microbiological confi rmed pneumonia (PNU1/PNU2/LRI) (n = 57), followed by intra-abdominal infection (SSI-GIT) (n = 10) and urinary tract infection (SUTI) (n = 8).
TextSentencer_T234 32387-32425 Sentence denotes The culture positivity rate was 71.2%.
TextSentencer_T235 32426-32504 Sentence denotes The appropriateness of the ICU antibiotic guideline is summarised in Table 1 .
TextSentencer_T236 32505-32547 Sentence denotes Monotherapy was used in 52.5% of episodes.
TextSentencer_T237 32548-32666 Sentence denotes The median length of antibiotic treatment with positive cultures was 7 days, and 5 days for culture negative episodes.
TextSentencer_T238 32667-32771 Sentence denotes In sepsis episodes with negative culture, antibiotics were stopped within 3 days in 17% of the episodes.
TextSentencer_T239 32772-32914 Sentence denotes Introduction Secondary peritonitis is the most frequent form of peritonitis, characterized by a high disease burden and a high mortality rate.
TextSentencer_T240 32915-32984 Sentence denotes Choice of adequate antibiotics is an independent factor for survival.
TextSentencer_T241 32985-33137 Sentence denotes The aim of this study was to compare treatment of secondary peritonitis with tigecycline (TG) with standard regimens (SR) from an economical standpoint.
TextSentencer_T242 33138-33284 Sentence denotes Methods After ethics committee approval, the study was performed as prospective, non-interventional cohort trial in 23 medical centers in Germany.
TextSentencer_T243 33285-33378 Sentence denotes Patients could be included if suff ering from severe secondary peritonitis treated in an ICU.
TextSentencer_T244 33379-33493 Sentence denotes Patients with pregnancy, aged below 18 years and milder forms of diseases (APACHE II score <15) were not eligible.
TextSentencer_T245 33494-33692 Sentence denotes In order to compare treatment with TG with SR, the following data were documented: demographic data, disease severity scores, causing microorganisms, laboratory parameters, and length of stay (LOS).
TextSentencer_T246 33693-33792 Sentence denotes Patients were analysed according to initial antibiotic choice except for perioperative prophylaxis.
TextSentencer_T247 33793-33950 Sentence denotes In order to balance for diff erences in co-morbidities and severity of disease, a matched-pairs analysis was performed based on logistic regression analysis.
TextSentencer_T248 33951-34012 Sentence denotes Results A total of 178 patients were enrolled (49 TG/129 SR).
TextSentencer_T249 34013-34222 Sentence denotes After logistic regression analysis and matching for gender, age ± 3 years, APACHE II score ± 1 and (non)existence of liver cirrhosis, arterial sclerosis and coronary heart disease, 15 matched pairs were built.
TextSentencer_T250 34223-34455 Sentence denotes Compared with the SR group, in the TG group was a tendency for higher creatinine, urea and glucose levels, higher number of co-morbidities (3.3 vs 3.0, NS) and higher number of pathogens isolated on initial surgery (2.2 vs 1.6, NS).
TextSentencer_T251 34456-34574 Sentence denotes There was a higher number of discharges 9/15 in the TG group (vs 7/15 SR, NS) and 6/15 patients died (vs 4/15 SR, NS).
TextSentencer_T252 34575-34857 Sentence denotes Considering these factors, there was a trend for shorter LOS in patients treated with TG (11 days vs 18 days and 8 days vs 16 days for survivors and nonsurvivors, respectively, NS) and total costs of ICU stay were signifi cantly lower in the TG group (€8,832 vs €15,482, P = 0.023).
TextSentencer_T253 34858-34977 Sentence denotes Conclusions In our non-interventional study, tigecycline tended to be used in patients with more severe co-morbidities.
TextSentencer_T254 34978-35167 Sentence denotes In spite of this, there was a trend for shorter LOS and treatment costs were signifi cantly lower, which make tigecycline an attractive treatment, also from a pharmacoeconomical standpoint.
TextSentencer_T255 35168-35358 Sentence denotes Introduction The purpose of our study was to compare the eff ectiveness of colistin monotherapy and colistin combination in the treatment of nosocomial infections with multi-resistant germs.
TextSentencer_T256 35359-35541 Sentence denotes Methods Retrospective study including 63 patients realized during 3 years from January 2006 to December 2008 in the medical ICU of University Hospital Ibn Rochd, Casablanca, Morocco.
TextSentencer_T257 35542-35676 Sentence denotes The study includes only the patients who suff er from nosocomial infection with multi-resistant germs, all of the sites are concerned.
TextSentencer_T258 35677-35858 Sentence denotes The patients have been divided into groups: group 1 including 30 patients treated by colistin only, and group 2 including 33 patients treated by the association colistin-rifampicin.
TextSentencer_T259 35859-36005 Sentence denotes The colistin has been administered intravenously and/or in nebulization and/ or in an intrathecal way according to the considered infectious site.
TextSentencer_T260 36006-36229 Sentence denotes The main criterion of judgment was the rate of mortality in the resuscitation unit, the second criteria of judgment were the ventilator weaning, the introduction of the vasoactive drugs and the supervening of side eff ects.
TextSentencer_T261 36230-36301 Sentence denotes Results Sixty-three patients judged as appropriate, have been included.
TextSentencer_T262 36302-36417 Sentence denotes The mean age of the patients was about 43.62 ± 17.34 years and APACHE 2 score at the admission was about 15 ± 5.69.
TextSentencer_T263 36418-36475 Sentence denotes The total mortality caused by infection was about 41.27%.
TextSentencer_T264 36476-36533 Sentence denotes The basic characteristics of the two groups were similar.
TextSentencer_T265 36534-36727 Sentence denotes The mortality in group 1 was about 36.66%, and about 69.69% in group 2 (P = 0.001), the rate of introduction of vasoactive drugs was about 23.33% in group 1 versus 48.48% in group 2 (P = 0.03).
TextSentencer_T266 36728-36840 Sentence denotes In group 1, 6,66% of the patients developed renal failure, against 12.12% of the patients in group 2 (P = 0,46).
TextSentencer_T267 36841-36916 Sentence denotes With the rifampicin, 27.27% of the patients of group 2 presented cytolysis.
TextSentencer_T268 36917-37074 Sentence denotes Conclusions This study suggests that colistin represents a good therapeutic alternative for the treatment of nosocomial infection with multi-resistant germs.
TextSentencer_T269 37075-37205 Sentence denotes However, our study is not without limits; it is a retrospective study, absence of randomization and the control group of patients.
TextSentencer_T270 37206-37462 Sentence denotes This study compared the eff ect on renal function of fl ucloxacillin and vancomycin antibiotic prophylaxis for elective fi rsttime coronary artery bypass grafting (CABG) surgery, using both direct biochemical markers and indirect clinical outcome measures.
TextSentencer_T271 37463-37567 Sentence denotes Recent evidence has suggested that vancomycin may be nephrotoxic in patients undergoing cardiac surgery.
TextSentencer_T272 37568-37703 Sentence denotes Methods A retrospective observational study of patients undergoing elective fi rst-time CABG was performed, covering a 13-month period.
TextSentencer_T273 37704-37825 Sentence denotes All patients received prophylactic antibiotics: fl ucloxacillin 1 g pre-operatively and three 1 g doses post-operatively.
TextSentencer_T274 37826-37984 Sentence denotes Patients who were MRSA-positive, MRSA unknown or penicillin allergic received an alternative regimen: vancomycin 1 g pre-operatively and 1 g post-operatively.
TextSentencer_T275 37985-38135 Sentence denotes Exclusion criteria: preoperative creatinine >133mmol/l, any antibiotics other than prophylaxis and haemodynamic support except <5 μg/kg/hour dopamine.
TextSentencer_T276 38136-38210 Sentence denotes Results Of 1,413 patients in the study period, 415 met the study criteria:
TextSentencer_T277 38211-38285 Sentence denotes 360 patients received fl ucloxacillin and 55 patients received vancomycin.
TextSentencer_T278 38286-38467 Sentence denotes There were no signifi cant diff erences between the two groups in sex, age, BMI, euroSCORE, diabetes status, ejection fraction, pre-operative creatinine, eGFR, sodium, or potassium.
TextSentencer_T279 38468-38769 Sentence denotes Comparing change in renal function pre-operatively to post-operatively, there were no signifi cant group diff erences in change in: creatinine (mmol/l; VAN median 0 (IQR 11); FLU -2 (19); P = 0.22), eGFR (ml/min; VAN 0 (14); FLU 2.4 (19.3); P = 0.22), sodium (mmol/l; VAN 1 (4) ; FLU 1 (4); P = 0.28).
TextSentencer_T280 38770-38863 Sentence denotes Change in potassium diff ered signifi cantly (mmol/l; VAN 0.7 (0.9); FLU 0.5 (0.7); P <0.05).
TextSentencer_T281 38864-38918 Sentence denotes In clinical outcome measures, the groups were similar.
TextSentencer_T282 38919-39114 Sentence denotes Most patients in both groups stayed in ITU for 1 day and there was no signifi cant diff erence in the number of patients staying for longer than 1 day (VAN 7/55 (13%); FLU 29/360 (8%); P = 0.30).
TextSentencer_T283 39115-39207 Sentence denotes There was no diff erence in hospital length of stay (days; VAN 7 (4) ; FLU 6 (3); P = 0.19).
TextSentencer_T284 39208-39513 Sentence denotes Conclusions In elective fi rst-time CABG patients, there is no signifi cant diff erence in change in renal function between those given vancomycin antibiotic prophylaxis and those given fl ucloxacillin prophylaxis, as assessed by creatinine, eGFR and sodium levels, and indirect clinical outcome measures.
TextSentencer_T285 39514-39613 Sentence denotes Potassium increased more in the vancomycin group but the clinical signifi cance of this is unclear.
TextSentencer_T286 39614-39719 Sentence denotes Our data suggest that prophylactic vancomycin does not impair renal function relative to fl ucloxacillin.
TextSentencer_T287 39720-39850 Sentence denotes Introduction Antibiotic dosing recommendations are usually based on plasma or cerebral spinal fl uid pharmacokinetic (PK) studies.
TextSentencer_T288 39851-40023 Sentence denotes However, as infections mainly occur in extracellular tissue fl uid (ECF), corresponding unbound ECF antibiotic concentrations are responsible for the antimicrobial eff ect.
TextSentencer_T289 40024-40178 Sentence denotes Because of the blood-brain barrier, the cerebral antibiotic distribution is thought to be reduced compared with tissues without any physiological barrier.
TextSentencer_T290 40179-40387 Sentence denotes This study aims to determine meropenem (MPM) unbound concentrations in the brain and compare them with MPM concentrations in plasma to explore cerebral distribution of MPM in patients with acute brain injury.
TextSentencer_T291 40388-40709 Sentence denotes Methods After local ethic approval and written informed consent, two brain-injured patients, sedated, mechanically ventilated, receiving MPM for an infection and monitored by cerebral microdialysis (CMA 71, membrane length 10 mm, membrane diameter 0.6 mm, molecular cut-off 100 kDa; CMA, Stockholm, Sweden) were enrolled.
TextSentencer_T292 40710-40837 Sentence denotes The PK study succeeded to 1 g meropenem over 30 minutes and brain dialysates and blood samples were collected over 420 minutes.
TextSentencer_T293 40838-40900 Sentence denotes Probe recoveries were evaluated individually by retrodialysis.
TextSentencer_T294 40901-40974 Sentence denotes MPM was assayed by HPLC coupled with tandem mass spectrometry (LC-MS/MS).
TextSentencer_T295 40975-41172 Sentence denotes Results For each of the two patients, the MPM brain AUC is much lower than plasma AUC and accordingly brain to serum AUC ratios are respectively 0.73 for Patient 1 (P1) and 0.14 for Patient 2 (P2).
TextSentencer_T296 41173-41374 Sentence denotes MPM concentration versus time curves in brain are delayed (time-to-peak in P1 = 100 minutes, in P2 = 80 minutes) and present a smooth peak compared with the corresponding curves in plasma ( Figure 1 ).
TextSentencer_T297 41375-41448 Sentence denotes Mean probe recoveries are respectively 19 ± 7% for P1 and 29 ± 7% for P2.
TextSentencer_T298 41449-41622 Sentence denotes Conclusions The MPM brain AUC is much lower than plasma AUC for the two patients enrolled, consistent with the PK theory in the presence of tissue with effl ux transporters.
TextSentencer_T299 41623-41714 Sentence denotes More patients are needed to better understand MPM brain distribution characteristics. [1] .
TextSentencer_T300 41715-41843 Sentence denotes The aim of this study was to explore the eff ect of changing this antibiotic prophylaxis protocol on microbial fl ora in sputum.
TextSentencer_T301 41844-41872 Sentence denotes Methods Retrospective study.
TextSentencer_T302 41873-42081 Sentence denotes All patients admitted >10 days on the ICU after elective CV surgery between 1 June 2006 and 1 June 2007 (Group 1) were compared with the same group of patients between 1 July 2007 and 1 August 2008 (Group 2).
TextSentencer_T303 42082-42196 Sentence denotes Patients received single-dose prophylaxis (bypass surgery), or 2 days of prophylaxis (cardiac prosthetic surgery).
TextSentencer_T304 42197-42256 Sentence denotes Group 1 received cefuroxime and Group 2 received cefazolin.
TextSentencer_T305 42257-42324 Sentence denotes Patients did not receive selective digestive tract decontamination.
TextSentencer_T306 42325-42537 Sentence denotes Isolated pathogens from elective sputum cultures of all patients were registered and compared between groups after dividing pathogens into six classes based on the profi le of intrinsic antibiotic susceptibility.
TextSentencer_T307 42538-42606 Sentence denotes Comparative data between groups were analyzed with Pearson's Χ test.
TextSentencer_T308 42607-42682 Sentence denotes Results One hundred and fi fty-eight patients had positive sputum cultures.
TextSentencer_T309 42683-42884 Sentence denotes Comparing total amounts of positive cultures, there was no signifi cant diff erence between colonization with pathogenic micro-organisms between Group 1 (n = 77 patients) and Group 2 (n = 76 patients).
TextSentencer_T310 42885-43071 Sentence denotes In Group 1 more colonization with pathogens from class 4 (β-lactamase-producing Enterobacteriaceae and Pseudomonas aeruginosa) was observed compared with Group 2 (45% vs 34%, P = 0.079).
TextSentencer_T311 43072-43194 Sentence denotes This nonsignifi cant diff erence between groups was mainly attributable to a diff erence in colonization with Pseudomonas.
TextSentencer_T312 43195-43260 Sentence denotes In the other classes of pathogens, no diff erences were observed.
TextSentencer_T313 43261-43335 Sentence denotes No diff erence in postoperative wound infections was noted between groups.
TextSentencer_T314 43336-43659 Sentence denotes Conclusions Prophylactic use of cefazolin instead of cefuroxime after CV surgery resulted in a trend towards reduction of colonization of the respiratory tract with intrinsic β-lactam-resistant microbial fl ora in patients with prolonged ICU stay, without adverse eff ects on the incidence of postoperative wound infection.
TextSentencer_T315 43660-43669 Sentence denotes Reference
TextSentencer_T316 43670-43841 Sentence denotes Introduction We sought to study the characteristics and outcomes of ICU patients with carbapenem-resistant (CRKp) and carbapenem-sensitive (CSKp) K. pneumoniae infections.
TextSentencer_T317 43842-43869 Sentence denotes Fifty-one (49%) were males.
TextSentencer_T318 43870-43910 Sentence denotes The mean APACHE II score was 17.9 ± 6.9.
TextSentencer_T319 43911-43980 Sentence denotes The median duration of hospital stay until the infection was 28 days.
TextSentencer_T320 43981-44156 Sentence denotes Fortyeight patients (46.2%) had bacteremia, 27 (30%) urinary tract infections, 15 (14.4%) pneumonia, seven (6.7%) peritonitis and seven (6.7%) skin and soft tissue infections.
TextSentencer_T321 44157-44252 Sentence denotes Fifty-eight (56.9%) and 39 (39%) patients had previous and concurrent infections, respectively.
TextSentencer_T322 44253-44287 Sentence denotes Seventy-six patients (73.1%) died.
TextSentencer_T323 44288-44499 Sentence denotes The univariate analysis showed that prior hospitalization (P = 0.049), dialysis (P = 0.034), and history of urologic neoplasia (P = 0.041) were associated with the development of carbapenem-resistant infections.
TextSentencer_T324 44500-44568 Sentence denotes No independent risk factors were found in the multivariate analysis.
TextSentencer_T325 44569-45030 Sentence denotes APACHE II score (P = 0.003), need for dialysis (P = 0.034), shock prior and after the infection (P = 0.006 and P <0.001, respectively), respiratory distress prior and after the infection (P = 0.021 and P = 0.032, respectively), multiorgan failure prior and after the infection (P = 0.02 and P = 0.003, respectively), treatment failure (P <0.001), and acidosis after the development of infection (P = 0.003) were associated with death in the univariate analysis.
TextSentencer_T326 45031-45173 Sentence denotes Shock after the infection (P = 0.016) and treatment failure (P = 0.001) were independent predictors of mortality in the multivariate analysis.
TextSentencer_T327 45174-45257 Sentence denotes No diff erence in mortality was found between patients with CRKp and CSKp isolates.
TextSentencer_T328 45258-45346 Sentence denotes Conclusions Infection due to K. pneumoniae in the ICU is associated with high mortality.
TextSentencer_T329 45347-45507 Sentence denotes Infection treatment and hemodynamic support of the patient may be important determinants of the clinical course in critically ill patients with such infections.
TextSentencer_T330 45508-45645 Sentence denotes Reference Introduction Multidrug-resistant (MDR) pathogens constitute an emerging threat with increasing incidence and uncertain outcome.
TextSentencer_T331 45646-45738 Sentence denotes On the other hand, patients undergoing open heart surgery represent a vulnerable population.
TextSentencer_T332 45739-45872 Sentence denotes Methods Evaluation of the incidence and identifi cation of MDR pathogens after cardiac surgery in 2,803 patients for a 2-year period.
TextSentencer_T333 45873-45941 Sentence denotes Examination of the clinical features of patients with MDR infection.
TextSentencer_T334 45942-45983 Sentence denotes Elucidation of the impact on the outcome.
TextSentencer_T335 45984-46086 Sentence denotes In 18 patients (0.64%) consisting of 12 males and six females, at least one MDR pathogen was isolated.
TextSentencer_T336 46087-46192 Sentence denotes Gram-positive pathogen was certifi ed in fi ve patients (27.8%) and Gram-negative in 13 patients (72.2%).
TextSentencer_T337 46193-46424 Sentence denotes Specifi cally, four patients were infected with vancomycin-resistant enterococcus (VRE), six with Klebsiella pneumoniae, three with Acinetobacter spp., one with VRE and Acinetobacter spp., four with Acinetobacter and K. pneumoniae.
TextSentencer_T338 46425-46707 Sentence denotes Low output syndrome (CI <2.0l/min/m 2 ) was common in all these patients and essentially contributed to the deterioration of clinical situation with dependence on inotropic support, prolonged mechanical ventilation (>10 days), acute renal failure and need for haemodilution (66.6%).
TextSentencer_T339 46708-46867 Sentence denotes Therefore, the ICU and hospital stay is prolonged (>20 days and >30 days, accordingly) and pathogenesis of MDR infection is provoked after 20 days of ICU stay.
TextSentencer_T340 46868-46926 Sentence denotes Consequently, nine patients with MDR infection (50%) died.
TextSentencer_T341 46927-47087 Sentence denotes All were critically ill patients with multiple organ dysfunction syndrome under broad-spectrum antimicrobials with hospital-acquired bloodstream MDR bacteremia.
TextSentencer_T342 47088-47227 Sentence denotes Conclusions Infection with MDR pathogens, while rare, constitutes a notable prognostic marker of increased mortality after cardiac surgery.
TextSentencer_T343 47228-47369 Sentence denotes It is worth noting that the higher mortality rate is mainly attributable to the severe co-morbidity in haemodynamically compromised patients.
TextSentencer_T344 47370-47458 Sentence denotes Management must concentrate on the implementation of eff ective preventative strategies.
TextSentencer_T345 47459-47581 Sentence denotes Introduction Prior antimicrobial therapy is one of the most important factors leading to the acquisition of MDR organisms.
TextSentencer_T346 47582-47780 Sentence denotes Formulating antibiotic policy and choice of empirical antibiotic selection will be helped by knowing the association of MDR Gram-negative organisms with a previous exposure of particular antibiotic.
TextSentencer_T347 47781-47898 Sentence denotes Methods Prospective observational study during January 2008 to June 2009 in a 50-bed ICU in a tertiary care hospital.
TextSentencer_T348 47899-48034 Sentence denotes Specimens sent after 2 days of the start of the antibiotic and no more than 90 days from the stop date have been included in the study.
TextSentencer_T349 48035-48131 Sentence denotes Analyses were based on those specimens that resulted in detection of MDR Gram-negative organism.
TextSentencer_T350 48132-48229 Sentence denotes Observed relative risk (RR) of an antibiotic class was computed with respect to an MDR infection.
TextSentencer_T351 48230-48368 Sentence denotes RR was computed as the ratio of the risk of the event (acquiring the infection) occurring in the exposed group vs in the nonexposed group.
TextSentencer_T352 48369-48446 Sentence denotes A logistic regression model was used where multiple antibiotics were applied.
TextSentencer_T353 48447-48537 Sentence denotes Results A total of 1,072 specimens from 500 patients met the criteria as specifi ed above.
TextSentencer_T354 48538-48732 Sentence denotes Of these, 423 (39.4%) specimens resulted in detection of MDR bacteria, 186 (17.4%) resulted in detection of non-MDR bacteria and no bacteria were detected in the remaining 463 (43.2%) specimens.
TextSentencer_T355 48733-48866 Sentence denotes Of the total 423 cases of MDR acquisitions, ESBL Enterobacteriaceae (151 or 35%), MDR Acineto (89 or 21%) and MDR Pseudo (58 or 14%).
TextSentencer_T356 48867-49015 Sentence denotes Risk of isolating ESBL Enterobacteriaceae was highly signifi cant with the prior exposure to third-generation cephalosporin (RR = 5.8 and P <0.001).
TextSentencer_T357 49016-49150 Sentence denotes Risk of isolating MDR Acinetobacter spp. was highly signifi cant with the exposure to piperacillin-tazobactam (RR = 2.7 and P <0.001).
TextSentencer_T358 49151-49271 Sentence denotes Risk of isolating MDR Pseudomonas spp. was signifi cant with the exposure to Group 2 carbapenem (RR = 2.2 and P >0.001).
TextSentencer_T359 49272-49395 Sentence denotes Group 1 carbapenem, aminoglycosides have not been found to have signifi cant association with any individual MDR organisms.
TextSentencer_T360 49396-49489 Sentence denotes Conclusions Previous exposure to antibiotics leads to increased acquisition of MDR organisms.
TextSentencer_T361 49490-49623 Sentence denotes There is a signifi cant association of isolating diff erent MDR organisms with previous exposure to a particular class of antibiotic.
T85725 49624-49751 Sentence denotes Introduction The emergence of multidrug-resistant Acinetobacter baumanii (MDRAB) poses a serious threat to patients on the ICU.
T2764 49752-49837 Sentence denotes The production of metallo-β-lactamase leaves colistin as the only therapeutic option.
T11219 49838-49884 Sentence denotes Outbreaks due to MDRAB can persist for months.
T67593 49885-49997 Sentence denotes Traditional decontamination methods fail to deal with this level of colonisation and contamination eff ectively.
T73711 49998-50069 Sentence denotes We tackled a recent outbreak of MDRAB eff ectively using gaseous ozone.
T81602 50070-50161 Sentence denotes To our knowledge it is the fi rst time ozone has been used to control an outbreak of MDRAB.
T20104 50162-50256 Sentence denotes Methods An external company (Hydrozone Environmental Ltd) was hired to perform the fumigation.
T30962 50257-50344 Sentence denotes The ICU was divided into three decontamination areas using heavy-duty polythene sheets.
T79592 50345-50452 Sentence denotes Patients were in turn relocated from contaminated to clean areas before each area was sealed and fumigated.
T22982 50453-50521 Sentence denotes Humidity levels within were raised to 70 to 80% using a humidifi er.
T89125 50522-50687 Sentence denotes An Ozone Ultra Pro 16 g/hour ozone generator with ozone destruct capability, operated remotely, delivered ozone to a target concentration of >2.0 ppm for 15 minutes.
T83241 50688-50729 Sentence denotes A fan was used to achieve even dispersal.
T81957 50730-50840 Sentence denotes For safety reasons perimeter ozone concentrations were monitored with a UV photometer and kept below 0.05 ppm.
T88019 50841-50956 Sentence denotes The effi cacy of the fumigation was measured by environmental microbiological sampling before and after fumigation.
T94763 50957-51056 Sentence denotes Results All fumigated areas received ozone concentrations of 4.62 to 5.66 ppm for 21 to 32 minutes.
T59518 51057-51108 Sentence denotes Ozone was not detected outside the treatment areas.
T95646 51109-51188 Sentence denotes Prior to fumigation, 72 (38%) of 188 environmental samples were MDRAB-positive.
T19246 51189-51250 Sentence denotes Following fumigation, nine (5%) of 158 samples were positive.
T56042 51251-51398 Sentence denotes Most of these samples were from nontouch areas, for example ceiling, above door frame with signifi cant dust collection and without daily cleaning.
T59741 51399-51614 Sentence denotes Considering that dust may impede ozone penetration, Introduction In the current pandemic it is likely that some patients will be admitted to hospital and require respiratory support including mechanical ventilation.
T93679 51615-51825 Sentence denotes These patients are likely to have a profound systemic infl ammatory response syndrome (SIRS); consequently they may have multiorgan failure (MOF) requiring renal replacement therapy (RRT) with haemofi ltration.
T13132 51826-51964 Sentence denotes Two questions then arise -what dose of oseltamivir (Tamifl u) should we give these patients to shorten the duration of the H1N1 infection?
T65683 51965-52066 Sentence denotes How should we modify the dose in response to altered renal drug clearance and in those requiring RRT?
T79986 52067-52179 Sentence denotes Methods A young adult female patient with H1N1 infection and MOF was given oseltamivir 75 mg BD nasogastrically.
T82626 52180-52321 Sentence denotes Failure to respond changed the risk: benefi t ratio and justifi ed doubling the dose despite uncertainties over an overall reduced clearance.
T45700 52322-52492 Sentence denotes Enteral nutrition absorption was uncertain, and thus we sampled her blood to ensure adequate oseltamivir absorption and that activation of the pro-drug was not inhibited.
T19179 52493-52624 Sentence denotes We undertook serial sampling for blood concentration assay to determine the pharmacokinetic parameters in this diffi cult scenario.
T20073 52625-52702 Sentence denotes Blood samples were collected in plain serum tubes (without sodium fl uoride).
T84337 52703-52834 Sentence denotes The samples were spun and refrigerated within half an hour, then batched and shipped to Bangkok for drug concentration measurement.
T1182 52835-52959 Sentence denotes Results We report both the parent oseltamivir phosphate (OP) and that of the active metabolite oseltamivir carboxylate (OC).
T26280 52960-53054 Sentence denotes OP levels were low at 10 to 77 ng/ml. but OC concentrations were high at 2,600 to 5,000 ng/ml.
T35810 53055-53156 Sentence denotes Conclusions The population normal parameter for half-life OP is 1 hour and for OC it is 3 to 5 hours.
T34082 53157-53278 Sentence denotes A single dose of 150 mg OP is expected to achieve an OP level of 50 to 150 ng/ml and an OC level of 1,000 to 1,500 ng/ml.
T64070 53279-53408 Sentence denotes Our slightly low OP levels are likely to be due to ex vivo hydrolysis in the collection tube due to a lack of esterase inhibitor.
T24238 53409-53513 Sentence denotes The high OC levels are most probably due to reduced renal elimination despite being on haemofi ltration.
T44897 53514-53651 Sentence denotes Our concerns were focused on the possibility of viral mutation (subsequently shown to be negative) or poor enteral absorption/activation.
T91879 53652-53747 Sentence denotes What we found was that 150 mg BD produces more than adequate OC levels to treat H1N1 infection.
T81653 53748-53868 Sentence denotes Introduction Invasive candidiasis (IC) is associated with increasing morbidity and mortality in critically ill patients.
T51306 53869-54040 Sentence denotes This, in conjunction with diffi culties in diagnosis, underscores the need for novel treatment strategies based on the identifi cation of signifi cant risk factors for IC.
T20691 54041-54155 Sentence denotes The aim of the study was to evaluate the effi cacy and safety of a protocol for pre-emptive antimycotic treatment.
T13466 54156-54251 Sentence denotes Methods A randomized prospective controlled trial was carried out in a general ICU for 2 years.
T48129 54252-54431 Sentence denotes After the implication of the inclusion and exclusion criteria, patients were submitted to block randomization and stratifi ed on the basis of their initial SAPS II expanded score.
T33815 54432-54499 Sentence denotes We have developed a protocol for pre-emptive antimycotic treatment.
T23740 54500-54740 Sentence denotes Having reviewed the current literature, we combined the most signifi cant risk factors for IC with tree major clinical criteria for persistent nonbacterial sepsis and assumed this algorithm as an indication for starting pre-emptive therapy.
T14737 54741-54892 Sentence denotes According to the protocol, antimycotic therapy was started on the day of inclusion in the treatment group and only with proven IC in the control group.
T25426 54893-55138 Sentence denotes Initial data were gathered on demographic characteristics of the patients, proven risk factors for IC-related mortality (malnutrition, non-albicans colonization, creatinine clearance) and severity of infl ammatory response and organ dysfunction.
T42313 55139-55290 Sentence denotes Dynamics of SIRS and SOFA, subsequent Candida isolates, ventilator-free days, length of ICU stay, outcome and eventual adverse reactions were followed.
T84220 55291-55360 Sentence denotes Results A total of 110 patients (equal in both groups) were enrolled.
T3694 55361-55519 Sentence denotes No statistically signifi cant diff erences in the basal characteristics of the patients, length of ICU stay and the number of ventilator-free days were found.
T43144 55520-55702 Sentence denotes The delta SOFA score was signifi cantly lower in the treatment group (P = 0.019).The in-hospital mortality was 38.2% in the treatment group vs 61.8% in the control group (P = 0.013).
T502 55703-55789 Sentence denotes The associated with pre-emptive therapy relative risk was 0.62 (95% CI = 0.4 to 0.94).
T35413 55790-55900 Sentence denotes Signifi cant diff erences between the Kaplan-Meyer estimates of survival were found (log-rank test P = 0.007).
T41365 55901-56045 Sentence denotes A total of 15 (13.6%) adverse reactions were observed among treated patients in both groups which was not associated with higher mortality risk.
T34761 56046-56207 Sentence denotes Conclusions The implementation of the developed protocol reduced the degree of organ dysfunction severity and was associated with signifi cant survival benefi t.
T40025 56208-56349 Sentence denotes The 2009 IDSA Treatment Guidelines for Candidiasis favor an echinocandin for initial treatment of candidemia in patients with severe illness.
T78034 56350-56510 Sentence denotes In a prospective, randomized study anidulafungin resulted in improved global response (GR) and a trend toward improved survival compared with fl uconazole [1] .
T60153 56511-56708 Sentence denotes Methods Retrospective analysis in patients classifi ed as severely ill at study entry: treatment initiated in an ICU (Group 1), APACHE II score ≥15 (Group 2) or presence of severe sepsis (Group 3).
T2294 56709-56847 Sentence denotes Within groups, anidulafungin was compared with fl uconazole for GR rate at the end of intravenous therapy and 14-day and 28-day mortality.
T93871 56848-56972 Sentence denotes Results In Group 1 (n = 89), GR was 63.3% vs 45.0% (95% CI: -2.2 to 38.8); Group 2 (n = 113), GR was 68.3% vs 46.0% (95% CI:
T7307 56973-57125 Sentence denotes 4.3 to 40.2); and Group 3 (n = 118), the GR was 67.7% vs 51.8% (95% CI: -1.6 to 33.5), in patients with MOD (n = 45), the GR was 76.2% vs 29.2% (95% CI:
T96993 57126-57188 Sentence denotes 21.3 to 72.8) anidulafungin versus fl uconazole, respectively.
T465 57189-57397 Sentence denotes Across groups, an association with anidulafungin use and lower day 14 mortality was suggested (12.2% to 14.3% for patients receiving anidulafungin vs 19.6% to 28.0% for those receiving fl uconazole) (P = NS).
T61893 57398-57412 Sentence denotes See Figure 1 .
T62400 57413-57619 Sentence denotes Conclusions In patients with severe illness, anidulafungin was associated with greater GR than fl uconazole, signifi cantly so for those with APACHE II score ≥15 or with MOD, supporting the IDSA Guidelines.
T9040 57620-57834 Sentence denotes Introduction Direct hemoperfusion using a polymyxin B-immobilized fi ber column (DHP-PMX; Toray Industries Inc., Tokyo, Japan) was fi rst developed in 1994 and has since been used for the treatment of septic shock.
T12406 57835-58100 Sentence denotes Methods A total of 47 patients with septic shock who received DHP-PMX for 2 to 6 hours were retrospectively reviewed to examine any improvement in sepsis-related factors after DHP-PMX and to analyze the relationship between any such improvement and increase in SBP.
T89496 58101-58239 Sentence denotes Introduction Direct hemoperfusion using a polymyxin B-immobilized fi ber column (DHP-PMX) has been used for the treatment of septic shock.
T74349 58240-58512 Sentence denotes As an alternative method for acute blood purifi cation therapy, continuous venovenous hemodiafi ltration (CVVHDF) has been reported to be an eff ective clinical treatment for critically ill patients; however, the optimal column for performing CVVHDF remains controversial.
T48546 58513-58716 Sentence denotes On the other hand, recently, one of the lipid mediators, endocannabinoids (N-arachidonoylethanolamine (AEA) and 2-arachidonoyl glycerol (2-AG)) have been reported with a blood pressure decreased eff ect.
T97364 58717-58892 Sentence denotes Methods We investigated 14 polymethylmethacrylate (PMMA) membrane hemofi lters and three polyacrylonitrile (PAN) membrane hemofi lters after use in patients with septic shock.
T80741 58893-58991 Sentence denotes Therefore, in clinical study, we used CVVHDF after DHP-PMX to treat 32 patients with septic shock.
T64445 58992-59291 Sentence denotes To determine the optimal acute blood purifi cation therapy, we subsequently divided the patients into two groups: group A underwent CVVHDF using a PMMA membrane hemofi lter after undergoing DHP-PMX (n = 25); group B underwent CVVHDF using a PAN membrane hemofi lter after undergoing DHP-PMX (n = 7).
T43095 59292-59362 Sentence denotes In addition, the levels of endocannabinoids (AEA, 2-AG) were measured.
T47868 59363-59460 Sentence denotes The severity scores and the improvement of endocannabinoids were compared between the two groups.
T4153 59461-59673 Sentence denotes Results Endocannabinoids (AEA, 2-AG) were adsorbed more in the PMMA column (AEA; 506.3 ± 680.2 ng/column, 2-AG; 23.0 ± 38.5 μg/column) than in the PAN column (AEA; 1.5 ± 0.7 ng/column, 2-AG; 0.1 ± 0.1 μg/column).
T17870 59674-59874 Sentence denotes The average Acute Physiology and Chronic Health Evaluation (APACHE) II score and the average sepsis-related organ failure assessment (SOFA) score did not diff er signifi cantly between the two groups.
T16998 59875-59940 Sentence denotes Group A showed a better outcome compared with Group B (P = 0.05).
T25273 59941-60046 Sentence denotes In addition, only group A showed a signifi cant improvement in the blood AEA level on day 1 (P = 0.0185).
T3065 60047-60248 Sentence denotes Conclusions Our study suggests that the PMMA column might be the better column for performing CVVHDF after DHP-PMX treatment, as suggested by the adsorption and blood purifi cation of endocannabinoids.
T76459 60249-60258 Sentence denotes Reference
T83476 60259-60374 Sentence denotes Introduction Diagnosis and treatment of acute pneumonia (Pn) is a problem of high signifi cance in modern medicine.
T68821 60375-60443 Sentence denotes The incidence of complicated and lethal acute Pn has increased [1] .
T16609 60444-60540 Sentence denotes Candidate genes are of great importance in the course of acute diseases and their complications.
T88017 60541-60611 Sentence denotes Cytokines and xenobiotic detoxication genes are the most investigated.
T80931 60612-60689 Sentence denotes The aim of the investigation was to study genetic predisposition to acute Pn.
T65158 60690-60861 Sentence denotes Methods Results of the associative DNA polymorphism studies in 243 patients with acute community-acquired Pn are presented; 178 healthy individuals formed a control group.
T71512 60862-61065 Sentence denotes Genetic variability of the candidate loci was studied: renin-angiotensin ACE system gene, chemokine receptor CCR5 gene and four genes controlling xenobiotic detoxifi cation (CYP1A1, GSTM1, GSTT1, GSTP1).
T68578 61066-61243 Sentence denotes Multiplex polymerase chain reaction was utilized for genotyping of insertion-deletion polymorphism on loci ACE (287 nucleotide pairs) and CCR5 (deletion of 32 nucleotide pairs).
T44305 61244-61347 Sentence denotes The odds ratio index was used to describe the degree of association of the genotypes with the diseases.
T2476 61348-61475 Sentence denotes Statistical analysis was done by means of Fisher's exact test and the online program SNPStats (http://bioinfo.iconcologia.net).
T96941 61476-61744 Sentence denotes Results An increased predisposition to Pn development was registered in homozygotes in deletion at the ACE locus (OR = 1.8; P = 0.013), positive genotypes of the GSTM1 locus (OR = 1.7; P = 0.010) and homozygotes in allele 606T of the CYP1A1 gene (OR = 1.6; P = 0.020).
T14592 61745-61962 Sentence denotes Conclusions A combination of positive genotypes of the GSTM1 locus and homozygotes in allele 606T of the CYP1A1 gene (OR = 1.9, P = 0.006; incidence in controls >20%) presented with a most eff ective prognostic power.
T95819 61963-62183 Sentence denotes Reference associated with the progression of airway colonization (AC) to ventilatorassociated tracheobronchitis (VAT) and from VAT to ventilator-associated pneumonia (VAP) has been analyzed but not been fully elucidated.
T36554 62184-62306 Sentence denotes We endeavored to study the relationship between AC and development of infections (VAT and VAP) of the LRT in ICU patients.
T68056 62307-62408 Sentence denotes Methods Retrospective study of 400 consecutive ICU patients ventilated >48 hours in the past 4 years.
T24449 62409-62612 Sentence denotes Patients age, gender, APACHE II, prior illness, cause of admittance, length of stay (LOS), time of mechanical ventilation (MV), outcome, time of appearance of AC and infection of the LRT were registered.
T35505 62613-62690 Sentence denotes MODS and CPIS were measured at onset of infection (VAT-VAP) and 3 days after.
T12823 62691-62739 Sentence denotes MODS was also calculated on the day AC appeared.
T1871 62740-62928 Sentence denotes Bronchial secretions were cultured at admission, at least once a week and whenever there was a change in the amount and quality of bronchial secretions or clinical infection was suspected.
T29551 62929-63034 Sentence denotes The Mann-Whitney test was used for statistical analysis and statistical signifi cance was set at P <0.05.
T37571 63035-63135 Sentence denotes Results From the 400 studied patients 68 (17%) were colonized and 153 (48.25%) developed infections:
T14123 63136-63170 Sentence denotes 54 (13.5%) VAT and 99 (24.7%) VAP.
T70945 63171-63277 Sentence denotes Colonization appeared after 3.1 ± 0.8 days of ICU admission exclusively with Gram-negative microorganisms.
T47070 63278-63382 Sentence denotes Twenty-fi ve (36.7%) of the colonized patients developed infections of the LRT (with the same pathogen):
T55386 63383-63476 Sentence denotes 8 (11.7%) VAT after 4.6 ± 2.7 days and 17 (25%) were diagnosed with VAP after 9.8 ± 1.8 days.
T26311 63477-63552 Sentence denotes From the eight VAT patients, four developed VAP (50%) after 5.4 ± 0.4 days.
T19433 63553-63589 Sentence denotes None of the colonized patients died.
T94479 63590-63862 Sentence denotes The colonized patients who developed infections were elderly (P <0.05), more severely ill (P <0.04) and had at the time of infection a diagnosis higher temperature (P <0.01), more severe leukocytosis (P <0.02) but not statistically signifi cant organ dysfunction (P >0.3).
T18758 63863-64022 Sentence denotes The appearance of VAP caused more severe organ dysfunction (P <0.002), longer MV duration (P <0.01) and longer LOS (P <0.001) but did not infl uence mortality.
T75553 64023-64147 Sentence denotes On the day of AC detection MODS was 2.4 ± 0.5, on VAT detection MODS was 4.8 ± 0.9 and on VAP appearance MODS was 9.6 ± 0.7.
T79655 64148-64250 Sentence denotes CPIS at VAT detection was 3.9 ± 0.9 and at VAP detection 6.1 ± 0.5 (day I) and 7.2 ± 0.8 (on day III).
T45996 64251-64385 Sentence denotes Conclusions AC resulted in LRT infections in only one-third of our patients and the majority of LRT infections are not preceded by AC.
T55720 64386-64498 Sentence denotes Introduction In our murine model of infl uenza, signifi cant weight loss occurs up to day 7 post-infection [1] .
T11521 64499-64643 Sentence denotes We sought to determine whether weight loss from infl uenza could be altered by rehydration and whether this aff ects pulmonary immune responses.
T84965 64644-64953 Sentence denotes Methods Adult BALB/c mice were infected with X31 (H3N2) infl uenza (1:80) via the intranasal route and randomized to intraperitoneal rehydration with 20 ml/kg compound sodium lactate (CSL), normal saline (NS) or no rehydration (NR) starting on day 3 following infection and continued for 4 days (n = 5/group).
T76928 64954-65037 Sentence denotes On day 7, mice were challenged with 1 x 10 6 Streptococcus pneumoniae (serotype 2).
T15653 65038-65218 Sentence denotes Two further cohorts of mice were challenged with diff erent doses of infl uenza and rehydrated from day 3 to 7 to investigate pulmonary immune responses in the absence of bacteria.
T71042 65219-65392 Sentence denotes Mice were infected with 1:80 (n = 10/group) infl uenza and rehydrated once daily or 1:60 (n = 5/group) infl uenza and rehydrated twice (1:60) daily with 20 ml/kg CSL or not.
T50732 65393-65620 Sentence denotes Daily weight, survival following secondary bacterial pneumonia, number of colony-forming units (48 hours after bacterial challenge) from peripheral blood, lung, and nasal wash and cellularity in lung compartments were measured.
T82671 65621-65843 Sentence denotes Results Rehydration did not aff ect weight loss following 1:80 infl uenza infection (naïve mice (+0.3 ± 0.4 g), infl uenza plus NR (-1.58 ± 0.4 g), infl uenza plus CSL (-1.1 ± 0.7 g) and infl uenza with NS (-1.3 ± 0.4 g)).
T17755 65844-65952 Sentence denotes A repeat experiment with CSL once daily or twice daily did not alter weight loss compared with NR (P >0.05).
T83939 65953-66051 Sentence denotes Survival or CFU counts following bacterial pneumonia did not diff er between the groups (P >0.05).
T82208 66052-66294 Sentence denotes The total number or activational status of bronchoalveolar, lung macrophages/monocytes and lymphocytes was not aff ected by rehydration following infl uenza infection or 48 hours following bacterial pneumonia (P >0.05; P <0.05 vs naïve mice).
T49114 66295-66403 Sentence denotes Conclusions Rehydration does not aff ect immunity or pathophysiology in a murine infl uenza infection model.
T52357 66404-66578 Sentence denotes Assuming these results can be extrapolated to the clinical setting, our fi ndings support the use of conservative fl uid resuscitation strategies in patients with infl uenza.
T83069 66579-66683 Sentence denotes Reference Introduction Bacteremic pneumonia is associated with worse outcome including higher mortality.
T53673 66684-66872 Sentence denotes The ATTAIN program compared telavancin (TLV), a lipoglycopeptide antibiotic, with vancomycin (VAN) for treatment of nosocomial pneumonia (NP) due to Gram-positive pathogens including MRSA.
T70984 66873-66980 Sentence denotes This subgroup analysis examined the baseline characteristics and clinical outcomes in bacteremic HAP cases.
T63418 66981-67079 Sentence denotes Methods ATTAIN 1 and 2 were methodologically identical, randomized, double-blind, phase 3 studies.
T51909 67080-67323 Sentence denotes Adult patients with NP due to presumed or confi rmed Gram-positive pathogens were randomized (1:1) to TLV 10 mg/ kg intravenously every 24 hours or VAN 1 g intravenously every 12 hours (adjusted per site-specifi c guidelines) for 7 to 21 days.
T38398 67324-67497 Sentence denotes The modifi ed alltreated (MAT) population consisted of patients who received ≥1 dose of study medication and who had a respiratory pathogen recovered from baseline cultures.
T16378 67498-67675 Sentence denotes Bacteremic NP was defi ned by the identifi cation of a pneumonia-causing pathogen in the blood or of the same pathogen in lung and blood with identical susceptibility profi les.
T35139 67676-67772 Sentence denotes Clinical outcomes were assessed at test-of-cure (TOC) 7 to 14 days after end of study treatment.
T97451 67773-67857 Sentence denotes Results All MAT patients with bacteremic NP (n = 73) were included in this analysis.
T32073 67858-68083 Sentence denotes At baseline, more TLV patients than VAN patients were in the ICU (TLV 74%, VAN 62%) and had ventilator-associated pneumonia (TLV 59%, VAN 44%); APACHE II scores were similar between groups (mean ± SD, TLV 16 ± 6, VAN 17 ± 6).
T23582 68084-68179 Sentence denotes S. aureus was the most common pathogen (TLV 76%, VAN 69%) and included MRSA (TLV 41%, VAN 49%).
T21424 68180-68293 Sentence denotes Cure rates for TLV and VAN were 44% and 36%, respectively (diff erence TLV -VAN (95% CI) = 7.3% (-15.9%, 30.5%)).
T17949 68294-68354 Sentence denotes On-study mortality was similar, 41% in each treatment group.
T14609 68355-68486 Sentence denotes Incidences of adverse events (AE) were similar between groups, except for nausea (TLV 21%, VAN 3%) and vomiting (TLV 15%, VAN, 0%).
T88382 68487-68592 Sentence denotes Proportions of patients who discontinued the study medication due to AEs were similar (TLV 12%, VAN 13%).
T54347 68593-68692 Sentence denotes Conclusions TLV and VAN had similar cure rates in a subgroup of ATTAIN patients with bacteremic NP.
T94746 68693-68770 Sentence denotes The safety profi les of TLV and VAN were mostly comparable in these patients.
T68186 68771-69023 Sentence denotes modifi ed all-treated population (MAT; patients with baseline respiratory pathogen(s) who received ≥1 dose of study medication) and the microbiologically evaluable population (ME; protocol adherent MAT patients with baseline Gram-positive pathogen(s)).
T39150 69024-69114 Sentence denotes Patients with mixed Gram-positive/Gram-negative infections were excluded in this analysis.
T28807 69115-69167 Sentence denotes Results A total of 197 late VAP cases were analyzed.
T6719 69168-69282 Sentence denotes Baseline characteristics, including the APACHE II scores, were balanced between the treatment groups ( Figure 1 ).
T40854 69283-69507 Sentence denotes At least one adverse event (AE) was reported by 95% (106/112) and 93% (79/85) of MAT patients in the TLV and VAN groups, respectively, and 21% (23/112) of the TLV group and 22% (19/85) of the VAN group died during the study.
T62877 69508-69651 Sentence denotes Conclusions In this exploratory sub-group analysis, numerically higher cure rates were observed for TLV than for VAN in patients with late VAP.
T27036 69652-69743 Sentence denotes Incidences of reported AEs and mortality rates were similar between the TLV and VAN groups.
T80677 69744-69825 Sentence denotes Introduction VAP rates in Brazil are higher than those related in Europe and USA.
T37758 69826-70022 Sentence denotes The study objective was to examine the eff ect of the Institute for Healthcare Improvement's ventilator bundle plus oral decontamination with chlorhexidine (ODC) in the incidence of VAP in an ICU.
T26023 70023-70089 Sentence denotes Methods The study was conducted in a 20-bed, medical-surgical ICU.
T57025 70090-70147 Sentence denotes Criteria for nosocomial pneumonia are those from the CDC.
T13378 70148-70211 Sentence denotes Strategy was to implement the IHI's ventilator bundle plus ODC.
T29506 70212-70346 Sentence denotes The goals were the ICU team adhesion of 80% achieved in the ninth month after bundle implementation and 98% after 1 year of follow-up.
T5028 70347-70431 Sentence denotes These measures included fi ve strategies to prevent ventilator-associated pneumonia:
T18096 70432-70611 Sentence denotes 30 to 45° elevation of the head of the bed, adequate sedation level (Ramsay 2 or 3), DVT/PE prevention, peptic ulcer prophylaxis and oral decontamination with chlorhexidine 0.12%.
T8557 70612-70750 Sentence denotes From February 2009 onwards, the ICU nursing staff and ICT performed a daily checklist in order to observe the fi ve issues accomplishment.
T95626 70751-70816 Sentence denotes If any item was found to be inadequate it was promptly corrected.
T97987 70817-71037 Sentence denotes Introduction This systematic review aims to evaluate evidence from randomised controlled trials (RCTs) for oral chlorhexidine in preventing nosocomial pneumonia in intubated mechanically ventilated critically ill adults.
T9705 71038-71136 Sentence denotes Use of oral chlorhexidine appeals since it should reduce bacterial aspiration from the orophayrnx.
T29132 71137-71197 Sentence denotes A number of RCTs have recently been published on this topic.
T87293 71198-71434 Sentence denotes Methods Search of Medline, Embase, Cochrane library, grey literature registers, conference proceedings and reference lists for RCTs comparing chlorhexidine with placebo or standard care for prevention of pneumonia in the critically ill.
T32441 71435-71586 Sentence denotes Outcomes: episode of nosocomial respiratory tract infection (RTI), mortality, duration of mechanical ventilation (MV) and length of ITU stay (ITU LOS).
T77283 71587-71659 Sentence denotes Review Manager 4.2 (Nordic Cochrane Centre) was used for data synthesis.
T41273 71660-71803 Sentence denotes Eff ect estimates (odds ratio for dichotomous and weighted mean diff erence for continuous data) were calculated using a random eff ects model.
T16835 71804-71991 Sentence denotes Fourteen studies were identifi ed, three involving patients undergoing cardiac surgery (1,841 patients) and 11 involving patients in noncardiothoracic ITUs (1,497 patients; see Table 1 ).
T39910 71992-72165 Sentence denotes Five studies (including two cardiac studies) found a signifi cant reduction in episodes of nosocomial RTI in the chlorhexidine-treated group versus placebo or standard care.
T6414 72166-72415 Sentence denotes Pooled data indicated a signifi cant reduction in nosocomial RTI in the treatment group among all patients, and among cardiac and noncardiac sub-groups (odds ratio 0.57 (95% CI 0.42 to 0.77), 0.52 (0.37 to 0.75) and 0.6 (0.4 to 0.89), respectively).
T17133 72416-72533 Sentence denotes However, no signifi cant diff erences in mortality, duration of mechanical ventilation or ITU stay were demonstrated.
T44220 72534-72629 Sentence denotes Signifi cant heterogeneity (I 2 statistic >40%) was detected for all outcomes except mortality.
T7697 72630-72798 Sentence denotes Conclusions Use of oral chlorhexidine is associated with reduction in nosocomial respiratory tract infection in intubated mechanically ventilated critically ill adults.
T97165 72799-73110 Sentence denotes We have shown that a the combination of selective digestive decontamination with topical antibiotics (SDD) and a decontamination regimen using nasal mupirocin with chlorhexidine bodywashing (M/C) markedly reduced acquired infections (AI) in intubated patients as compared with SDD alone, M/C alone or none [1] .
T55107 73111-73264 Sentence denotes We report the surveillance of AI in our ICU before and after the implementation of multiple site decontamination (MSD) as a routine prevention procedure.
T86287 73265-73536 Sentence denotes Introduction The aim of this study was to analyze the correlation between antiviral therapy effi cacy and the negative profi le of the RT-PCR made on pharyngeal swab, subglottic aspiration, and bronchoalveolar lavage in patient aff ected by ARDS caused by H1N1 infection.
T5985 73537-73692 Sentence denotes Methods A prospective analysis was performed on 11 patients admitted to the ICU of a tertiary referral center (Careggi Teaching Hospital, Florence, Italy).
T40194 73693-73810 Sentence denotes All patients underwent daily RT-PCR monitoring on pharyngeal swab, subglottic aspiration, and bronchoalveolar lavage.
T9628 73811-73959 Sentence denotes All patients were treated with oral administration of oseltamivir (75 mg twice daily) and inhaled zanamivir (10 mg twice daily) since ICU admission.
T83396 73960-74079 Sentence denotes Six patients were treated with extracorporeal membrane oxygenation (ECMO) due to their critical respiratory conditions.
T81170 74080-74139 Sentence denotes Two of them resulted co-infected by legionella pneumophila.
T59006 74140-74345 Sentence denotes Results As shown in Figure 1 , RT-PCR from pharyngeal swab at ICU admission failed to demonstrate the viral infection in four patients, whereas RT-PCR from bronchoalveolar lavage had a sensibility of 100%.
T91708 74346-74595 Sentence denotes Similarly, the time course showed that RT-PCR from pharyngeal swab resulted negative in an average time of 3 days after therapy start, while RT-PCRs from bronchoalveolar lavage continued to permit infection monitoring and therapy regimen conduction.
T95840 74596-74663 Sentence denotes None of RT-PCRs on subglottic aspiration samples resulted positive.
T382 74664-74747 Sentence denotes All patients recovered and were discharged alive from ICU in spontaneous breathing.
T28300 74748-75015 Sentence denotes Conclusions In our experience, the most reliable method to diagnose and monitor H1N1 infection was RT-PCR from bronchoalveolar lavage, since pharyngeal swab do not off er enough sensibility, either for antiviral therapy initiation or for antiviral therapy management.
T8469 75016-75091 Sentence denotes Samples from subglottic aspiration can be avoided due to a low sensibility.
T52944 75092-75278 Sentence denotes Bedside lung ultrasound is able to identify with high sensibility and sensitivity most pulmonary pathological patterns and is widely adopted in critically ill patients' daily management.
T25154 75279-75410 Sentence denotes It is a feasible and reliable method for the identifi cation of the lung pathological patterns caused by H1N1 infl uenza infection.
T23175 75411-75575 Sentence denotes Methods The study took place in the ICU of a regional referral center, with ECMO availability, for respiratory failure (Careggi Teaching Hospital, Florence, Italy).
T89428 75576-75681 Sentence denotes Eight patients admitted for H1N1-induced ARDS (September to October 2009) underwent daily LU examination.
T49272 75682-75809 Sentence denotes The examination was standardized with a procedure ad hoc in order to achieve complete and comparable reports for every patient.
T18253 75810-75905 Sentence denotes Patients were examined supine, taking lateral and anterior views and, if possible, on one side.
T10378 75906-75955 Sentence denotes Intercostal spaces were used as acoustic windows.
T35516 75956-76037 Sentence denotes Every single examination and its fi nding have been reported in our ICU database.
T16937 76038-76155 Sentence denotes Results Pleural thickness was present in 100% of cases, mostly related to little and multiple pleural consolidations.
T15602 76156-76266 Sentence denotes Anyway, pleural gliding was present most of the time (87.5%), even if with a visible decrease of its movement.
T38336 76267-76358 Sentence denotes This was replaced with the lung pulse only in the presence of important lung consolidation.
T55971 76359-76527 Sentence denotes Alveolar interstitial syndrome (AIS) was always present on the whole lung, ranging from moderate to severe (100%), with high positivity at the base, posteriorly (100%).
T48917 76528-76627 Sentence denotes White lung appeared in every patient, most at the lung base and in the middle fi elds, posteriorly.
T95090 76628-76801 Sentence denotes As far as consolidation is concerned, its presence was confi rmed in 100% of the patients, associated with satellite multiple subpleural consolidations in 37.5% of patients.
T18494 76802-76890 Sentence denotes Basal lung was always involved (100%), followed by middle (50%) and apical fi elds(25%).
T61878 76891-76960 Sentence denotes Bronchogram was present in 100% of patients in bigger consolidations.
T81866 76961-77063 Sentence denotes Their aspect was aerial and only in one patient, with severe consolidations, turned into a fl uid one.
T14379 77064-77124 Sentence denotes Anechoic pleural eff usions were found in 37.5% of patients.
T35974 77125-77164 Sentence denotes No cases of pneumothorax were detected.
T4434 77165-77424 Sentence denotes Conclusions In this group of patients, H1N1 infection shows diff erent lung patterns altogether, where the most frequent seemed to be severe basal posterior AIS, multiple subpleural lung consolidations, and multiple parenchymal consolidation with bronchogram.
T77847 77425-77497 Sentence denotes The presence of spared areas did not seem to belong to H1N1 LU patterns.
T75909 77498-77712 Sentence denotes Introduction Pneumocystis pneumonia (PCP) in HIV-negative patients frequently presents as fulminant respiratory failure and is associated with a high mortality rate when the patient requires mechanical ventilation.
T74771 77713-77864 Sentence denotes The aims of this study were to evaluate the outcome and prognostic factors in the patients with HIV-negative PCP requiring mechanical ventilation (MV).
T9424 77865-78088 Sentence denotes Methods We retrospectively reviewed the medical records and collected the HIV-negative patients who were microbiologically confi rmed as PCP and required MV in ICU over a 10-year period in a tertiary care teaching hospital.
T5435 78089-78137 Sentence denotes Results A total of 51 patients were identifi ed.
T80848 78138-78169 Sentence denotes Mean age was 55.4 ± 15.0 years.
T15170 78170-78223 Sentence denotes Mean APACHE II score at ICU admission was 25.7 ± 5.8.
T3814 78224-78306 Sentence denotes The 28-day mortality and in-hospital mortality were 45.8% and 66.7%, respectively.
T76783 78307-78501 Sentence denotes Between survivors and nonsurvivors, there were no signifi cant diff erences in baseline characteristics, APACHE II score, PaO 2 /FiO 2 ratio, and absolute neutrophil counts on ICU admission day.
T58743 78502-78811 Sentence denotes Also the mortality was not diff erent in relation to the presence of barotrauma, application of noninvasive ventilation, timing of susceptible antibiotic administration, changing or not to salvage regimens, presence of cytomegalovirus coinfection and even the microbiologic persistency in follow-up specimens.
T48238 78812-79312 Sentence denotes Based on the types and intensity of previous immunosuppressive therapy, we classifi ed patients into three subgroups: patients receiving low-dose steroid maintenance ± other immunosuppressive agents (LS), which represent previously stable organ transplants; another group consisting of patients receiving recent intensive chemotherapy (CTx); and the other group refers to patients receiving high dose (defi ned as >2 weeks at least 1 mg/kg dose) steroid therapy ± other immunosuppressive agents (HS).
T47443 79313-79529 Sentence denotes Signifi cant diff erences of outcome were observed among the three diff erent groups (28-day mortality: LS = 22.2%, CTx = 29.4%, HS = 71.4%, P = 0.01; 60-day mortality: LS = 33.3%, CTx = 64.7%, HS = 81.0%, P = 0.04).
T78313 79530-79678 Sentence denotes Methods BSA was derived using the Mosteller formula on the metric equivalent of simulated patients ranging from 5 ft to 7 ft and 100 lbs to 700 lbs.
T13502 79679-79801 Sentence denotes A priori, we defi ned normal CO = 4 to 8, normal CI = 2.5 to 5.0, normal SV = 60 to 100 ml/beat, and normal SI = 33 to 47.
T76218 79802-79898 Sentence denotes Algebraic analysis was used to determine BSA levels that would classify an SV or CO as abnormal.
T8335 79899-79961 Sentence denotes Results Critical BSA thresholds (T) are presented in Table 1 .
T54088 79962-80087 Sentence denotes For example, at SV = 100, a BSA higher than 3.03 (to the second decimal place) would classify the patient as having a low SI.
T67976 80088-80210 Sentence denotes Conclusions Patients with extreme BSAs are increasingly encountered in the ICU, especially larger BSAs related to obesity.
T50071 80211-80315 Sentence denotes We provide threshold values where extreme BSAs will classify high SV or CO values as low indexed values.
T90958 80316-80438 Sentence denotes The ranges considered normal for SI and CI may be inappropriate for patients with extreme BSAs, particularly in the obese.
T83472 80439-80524 Sentence denotes We caution against relying solely on the SI and CI to assess hemodynamic performance.
T38916 80525-80652 Sentence denotes Instead, the SV and CO along with other physiological parameters should also be considered before making therapeutic decisions.
T29259 80653-80839 Sentence denotes Introduction It remains a great challenge to measure systemic blood fl ow in critically ill newborns, especially during the transitional period with intracardiac and extracardiac shunts.
T64812 80840-81136 Sentence denotes Due to technical restraints, size limitations, the necessity for a relatively large amount of blood withdrawn and possible indicator toxicity, many methods of cardiac output monitoring are not feasible, hence cardiac output is generally estimated from indirect parameters of systemic blood fl ow.
T94857 81137-81367 Sentence denotes In a former study we assessed the agreement for cardiac output using the ultrasound dilution method (UDCO) and ultrasound transit time-based measurement of main pulmonary blood fl ow in a juvenile piglet model without shunts [1] .
T71607 81368-81546 Sentence denotes In the present study we analyzed the infl uence of a left-to-right shunt on the agreement between UDCO and ultrasonic transit time pulmonary blood fl ow in a juvenile lamb model.
T717 81547-81839 Sentence denotes Methods In this prospective, experimental animal study, which was approved by the Ethical Committee on Animal Research of the Radboud University Nijmegen, we placed a Gore-Tex® shunt between the left pulmonary artery and the descending aorta in eight randombred newborn lambs (3.5 to 8.3 kg).
T30369 81840-81976 Sentence denotes This aortopulmonary shunt was intermittently opened and closed while cardiac output was manipulated by creating hemorrhagic hypotension.
T51620 81977-82228 Sentence denotes Ultrasound dilution cardiac output (Q-UDCO) -using repeated injection of 1.0 ml/kg isotonic saline at body temperature -was compared with pulmonary blood fl ow (Q-MPA) invasively measured by a perivascular fl ow probe around the main pulmonary artery.
T89594 82229-82240 Sentence denotes Figure 1 ).
T64835 82241-82355 Sentence denotes An increase in NICOM SV >8% showed a sensitivity of 76% and a specifi city of 75% to predict PulseCO changes >10%.
T33457 82356-82522 Sentence denotes Conclusions NICOM demonstrated a moderate agreement with LiDCO but showed excellent agreement with PulseCO in tracking CO changes following therapeutic interventions.
T45849 82523-82601 Sentence denotes Introduction Arrhythmias are common among high-risk surgical and ICU patients.
T98304 82602-82792 Sentence denotes The PulseCO pressure waveform algorithm is used for both LiDCO™plus and LiDCOrapid hemodynamic monitors, which are frequently used to estimate cardiac output (CO) in critically ill patients.
T55919 82793-82909 Sentence denotes Cardiac arrythmias could increase the variation of both the lithium dilution (LiDCO) and/or the PulseCO measurement.
T88491 82910-83088 Sentence denotes At set-up the algorithm is calibrated by comparing the PulseCO CO estimate, averaged over 30 seconds, with a known CO (normally LiDCO) to generate a calibration factor (CF) [1] .
T36613 83089-83206 Sentence denotes This study was designed to explore the eff ect of arrythmias on the accuracy of CF generation in the PulseCO monitor.
T612 83207-83329 Sentence denotes Methods LiDCO™plus hemodynamic data fi les were obtained retro spectively from a university hospital medical/surgical ICU.
T55701 83330-83505 Sentence denotes Files were separated into those records with and without arrhythmia -defi ned as heart rate variation >5% during at least one additional CF determination after monitor set-up.
T55709 83506-83658 Sentence denotes Previous studies have established the coeffi cient of variation (CV) of a single LiDCO determination at 8% [2] and the PulseCO measurement at 2.4% [3] .
T44380 83659-83789 Sentence denotes A combined CV, refl ecting the eff ect of calibration, is estimated at 8.5%, resulting in an expected precision for the CF of 17%.
T17935 83790-83891 Sentence denotes Data were analysed for variation in CF against HRV using linear regression and the Student' s t test.
T23464 83892-83949 Sentence denotes Results Twenty-eight records were collected and analysed.
T48103 83950-84013 Sentence denotes Twenty-one records contained 32 post set-up calibration events.
T13387 84014-84068 Sentence denotes Of these 17 occurred with HRV ≤5% (median = 1%, range:
T54724 84069-84116 Sentence denotes 0 to 5%) and 15 occurred while HRV >5% (median:
T6170 84117-84128 Sentence denotes 19%, range:
T34014 84129-84139 Sentence denotes 7 to 26%).
T81649 84140-84247 Sentence denotes The average variation in CF during HRV was 5.4 ± 4.0% and for high HRV was 8.9 ± 8.1% of the initial value.
T59762 84248-84334 Sentence denotes The t test indicated no diff erence in the mean variation of CF (P = 0.162) or median.
T40244 84335-84403 Sentence denotes There was no correlation between HRV and CF variation (r 2 = 0.002).
T10123 84404-84504 Sentence denotes Ninety-one per cent (29/32) of the observed CF variation were less than 17% of the initial CF value.
T55223 84505-84575 Sentence denotes Conclusions CF determinations are not signifi cantly aff ected by HRV.
T78990 84576-84807 Sentence denotes The validity of an arterial waveform-based device for measuring cardiac output (CO) without the need for invasive calibration x COe x MTt, where S1 and S2 are respectively the maximum upslopes and down-slopes of the dilution curve.
T16299 84808-85023 Sentence denotes One hundred and thirty-seven measurements were done during inotropic stimulation (dobutamine), during hypovolemia (bleeding), during hypervolemia (fl uid overload), and after inducing acute lung injury (oleic acid).
T3128 85024-85315 Sentence denotes Introduction As the need for recalibration and the best time point to recalibrate has been a matter of debate since the introduction of the PiCCO monitor (Pulsion, Germany), we set out to analyze the performance of its pulse contour (PC) analysis without recalibration over a 24-hour period.
T368 85316-85431 Sentence denotes Methods We studied the cardiac index (CI) over a 24-hour period in eight nonoperative patients admitted to our ICU.
T29893 85432-85599 Sentence denotes Seven CI measurements (median number; every 4 hours) by thermodilution (TD) were performed in each patient (in triplicate), PC-derived data were recorded continuously.
T99732 85600-85750 Sentence denotes We used a special PiCCOplus monitor with a disabled auto-recalibrate feature; that is, TD did not lead to an automatic calibration of the PC analysis.
T35878 85751-85842 Sentence denotes Calibration was only performed manually once at the start of the analysis for each patient.
T64181 85843-85910 Sentence denotes Later TD measurements were recorded but had no eff ect on the CIPC.
T9233 85911-86120 Sentence denotes An additional comparison was performed using the FloTrac/Vigileo System (Edwards, USA), which does not need manual recalibration and instead recalibrates itself every 60 seconds based on the arterial waveform.
T36697 86121-86208 Sentence denotes The FloTrac/Vigileo monitor used was a secondgeneration device (software version 1.14).
T66131 86209-86329 Sentence denotes Both the pressure transducers of the PiCCO and the FloTrac were connected in series to the same femoral artery catheter.
T73298 86330-86516 Sentence denotes Introduction Cardiac output (CO) monitoring is one of the key points in the hemodynamic evaluation of critically ill patients, and can be useful in various settings of high-risk surgery.
T46386 86517-86707 Sentence denotes There is a lack of evidence that the extensive use of invasive devices in the hemodynamic monitoring has a good impact in terms of outcome [1] , and less invasive systems have been proposed.
T53005 86708-86953 Sentence denotes Our aim was to compare the CO estimated by Vigileo/FloTrac with the blood fl ow in thoracic aorta as measured by transoesophageal Doppler in patients undergoing open abdominal aortic aneurysm repair, during the aortic cross-clamping (AoX) phase.
T13204 86954-87170 Sentence denotes We have measured the Augmentation Index (AI), a parameter related to vascular stiff ness, using the applanation tonometry method, in order to have a better understanding of the eff ect of AoX on blood pressure waves.
T66152 87171-87319 Sentence denotes Methods We enrolled 10 consecutive patients (10 men; age 66 ± 6 years) undergoing elective open AAA repair (ASA II to III) under general anesthesia.
T87744 87320-87434 Sentence denotes Radial arterial access was used for semi-invasive determination of blood pressures and CO (APCO) with the Vigileo.
T26896 87435-87501 Sentence denotes An esophageal Doppler was positioned after clinical stabilization.
T33291 87502-87579 Sentence denotes Applanation tonometry was measured just before and after the aortic clamping.
T11160 87580-87903 Sentence denotes We found a signifi cant (P <0.05) increase in CO reported by Vigileo/FloTrac system in the post-clamping phase, when compared with the pre-clamping and basal phases, while the blood fl ow in thoracic aorta resulted decreased, according with the theory of redistribution of fl uids in the splanchnic venous vasculature [2] .
T8865 87904-88063 Sentence denotes There was an important contribution of the wave refl ection to the aortic pulse pressure wave after the AoX, as expressed by a signifi cant increase in the AI.
T74680 88064-88294 Sentence denotes The Vigileo/FloTrac system appears to overestimate CO after AoX when compared with the measure of blood fl ow in thoracic aorta, and this result could be infl uenced by the pulse pressure wave refl ection occurring after clamping.
T97864 88295-88486 Sentence denotes In high-risk surgical settings, other situations of rapid change of systemic resistance vessels could be similarly misread, thus suggesting the necessity of a more tailored Vigileo algorithm.
T69781 88487-88602 Sentence denotes Introduction Postoperative hemodynamic optimization has been proved to reduce morbidity in high-risk patients [1] .
T85664 88603-88804 Sentence denotes Nowadays stroke volume index (SVI) monitoring is available with diff erent less invasive techniques that have shown diff erent levels of agreement and precision with the pulmonary artery catheter [2] .
T69151 88805-89115 Sentence denotes The aim of this study was to evaluate agreement and precision between SVI obtained with a calibrated (LiDCO™plus; LiDCO Ltd, Cambridge, UK) and an uncalibrated pulse contour analysis device (FloTrac/Vigileo; Edwards Lifesciences, Irvine, CA, USA), in patients undergoing postoperative hemodynamic optimization.
T11405 89116-89345 Sentence denotes Methods Patients undergoing a hemodynamic optimization protocolized care according to a previous published trial [1] to reach an oxygen delivery Methods Prospective study in the respiratory critical care of a university hospital.
T72065 89346-89432 Sentence denotes Eleven patients with spontaneously breathing activity considered for volume expansion.
T44748 89433-89541 Sentence denotes An increase in stroke volume index (SVi) of 15% or more after volume expansion defi ned a responder patient.
T17528 89542-89656 Sentence denotes We measured the response of the bioreactance stroke volume to PLR and to saline infusion (500 ml over 15 minutes).
T87137 89657-89818 Sentence denotes The proportional changes in NiCOM-SVi induced by PLR were correlated with the proportional changes in NICOM-SVi induced by volume expansion (r = 0.67, P = 0.02).
T31179 89819-89999 Sentence denotes The proportional changes in NICOM-cardiac index (CI) induced by PLR were also correlated with the proportional changes in NICOM-CI induced by volume expansion (r = 0.63, P = 0.03).
T7853 90000-90184 Sentence denotes A PLR-induced increase in stroke volume of 9% or more predicted an increase in stroke volume of 15% or more after volume expansion with a sensitivity of 100% and a specifi city of 80%.
T51832 90185-90286 Sentence denotes Conclusions The response of NICOM-stroke volume to PLR was a good predictor of volume responsiveness.
T46580 90287-90453 Sentence denotes In our hemodynamically unstable patients with spontaneous breathing activity, fl uid responsiveness can be assessed totally non-invasively with a bioreactance device.
T27531 90454-90693 Sentence denotes Introduction Transpulmonary thermodilution (TPTD)-derived volumetric parameters such as global end-diastolic volume (GEDI) and ELWI have been established as hemodynamic cornerstones for assessment of preload (GEDI) and pulmonary hydration.
T66414 90694-90799 Sentence denotes Normal values of GEDI have been created more than a decade ago based on studies in pre-selected patients.
T91263 90800-90932 Sentence denotes Therefore, it was the aim of our prospective study to investigate the correlation of GEDI to cardiac index (CI) in clinical routine.
T87578 90933-91037 Sentence denotes Methods Over a 6-month period all 1,574 routine TPTD measurements in 78 consecutive patients (APACHE II:
T86208 91038-91202 Sentence denotes 23.5 ± 8.6) of an internal ICU with a PiCCO catheter were prospectively documented and analysed: correlation (Spearman) and multiple regression analysis; SPSS 17.0.
T11499 91203-91412 Sentence denotes Results Including all 1,574 measurements, CI was univariately correlated to GEDI (r = 0.251; P <0.001), dP max (r = 0.221; P <0.001) and heart rate (r = 0.102; P <0.001), but not to CVP (r = 0.001; P = 0.962).
T80771 91413-91541 Sentence denotes The correlation of GEDI, dP max and heart rate to CI was confi rmed in multivariate analysis (P <0.001 for all three variables).
T34370 91542-91698 Sentence denotes Changes in CI (Delta-CI) were univariately correlated to changes in GEDI (r = 0.414), dP max (r = 0.240) and ELWI (r = 0.152; P <0.001 for all comparisons).
T73021 91699-91856 Sentence denotes In a multivariate analysis of all measurements, Delta-CI was independently associated with changes in GEDI (P <0.001), dP max (P <0.001) and CVP (P = 0.017).
T24114 91857-92068 Sentence denotes Subgroup analysis of all measurements with GEDI below the lower normal level 680 ml/kg/m 2 demonstrated an independent association of CI to GEDI (P <0.001), dP max (P <0.001) and ELWI (P = 0.041) but not to CVP.
T85319 92069-92161 Sentence denotes Similarly, Delta-CI was independently associated with changes in GEDI and dP max (P <0.001).
T86620 92162-92358 Sentence denotes Similar results were found for the measurements with GEDI within the normal range (680 to 800 ml/kg/ m 2 ): signifi cant and independent correlation of CI to GEDI (P <0.017) and dP max (P <0.001).
T52058 92359-92472 Sentence denotes Changes in CI were independently correlated to changes in GEDI (P <0.001), dP max (P <0.001) and CVP (P = 0.035).
T44266 92473-92610 Sentence denotes Interestingly, even in measurements with GEDI >800 ml/kg/m 2 , CI was independently correlated to GEDI (P = 0.009) and dP max (P <0.001).
T94837 92611-92925 Sentence denotes Changes in CI in this group were independently associated with changes in dP max and GEDI (P <0.001).In the subgroup of measurements with GEDI >1,000 ml/kg/m 2 there was no correlation of any parameter to CI, however changes in CI were independently correlated to changes in GEDI (P <0.001) and dP max (P = 0.003).
T67103 92926-93076 Sentence denotes Conclusions GEDI and dP max and their changes have an independent and positive correlation to CI and its changes even in patients with increased GEDI.
T67404 93077-93427 Sentence denotes Relationship of stroke volume variation, pulse pressure variation and global end-diastolic volume in patients undergoing brain surgery A Rieß 1 , S Wolf 2 , C Lumenta 2 , L Schürer 2 , P Friederich 1 Introduction Monitoring intravascular volume in patients with intracranial pathology is often mandatory for maintaining hemodynamic stability [1, 2] .
T58002 93428-93649 Sentence denotes Cyclic changes in cardiac stroke volume [1, 3] and pulse pressure induced by positive pressure ventilation as well as target values of global end-diastolic volume index (GEDVI) (ml/m 2 ) [2] allow volume therapy guidance.
T6089 93650-93864 Sentence denotes The relationship between stroke volume variation (SVV) (%) and pulse pressure variation (PPV) (%), as well as between SVV or PPV and values of GEDVI has not been established in patients with intracranial pathology.
T74850 93865-94025 Sentence denotes Methods In this prospective investigation the correlation between dynamic and static hemodynamic parameters of 38 patients undergoing brain surgery was studied.
T43577 94026-94081 Sentence denotes Measurements were performed using the PiCCO technology.
T27133 94082-94179 Sentence denotes For statistical analysis, nonparametric correlation analysis and hypothesis testing were applied.
T59584 94180-94250 Sentence denotes Results SVV correlated signifi cantly with PPV (r 2 = 0.87, P <0.001).
T9396 94251-94339 Sentence denotes Neither SVV (r 2 = 0.14, P = 0.13) nor PPV (r 2 = 0.07, P = 0.81) correlated with GEDVI.
T68632 94340-94598 Sentence denotes Threshold values for SVV (9.5%, 11.6%) as well as for PPV (12.5%) allowed discrimination between groups with signifi cantly diff erent values of stroke volume index, while failing to discriminate between groups with signifi cantly diff erent values of GEDVI.
T88823 94599-94861 Sentence denotes Dichotomizing the patients into groups of GEDVI ≤680 ml/m 2 and >680 ml/m 2 resulted in groups with signifi cantly diff erent values of stroke volume index as well while failing to discriminate between groups with signifi cantly diff erent values of SVV and PPV.
T15915 94862-95006 Sentence denotes Conclusions Static (GEDVI) and dynamic (SVV, PPV) parameters of cardiac preload may refl ect diff erent properties of the cardiovascular system.
T10469 95007-95139 Sentence denotes The combination of SVV, PPV, and GEDVI may off er more precise information on the cardiovascular system than either parameter alone.
T68204 95140-95250 Sentence denotes The prediction value of pulse pressure variation (ΔPP) in patients ventilated with low VT is not well studied.
T72219 95251-95381 Sentence denotes A ΔPP of 12 to 13% is validated as a predictor of volume response in several studies, but in patients ventilated with VT >8 ml/kg.
T33123 95382-95498 Sentence denotes One study has shown that the ΔPP of 12 to 13% does not predict volume response in patients ventilated with a low VT.
T99191 95499-95602 Sentence denotes We hypothesized that a lower cut-off value for ΔPP can predict volume response in patients with low VT.
T63071 95603-95810 Sentence denotes Methods Thirty-seven adult patients mechanically ventilated with a tidal volume <8 ml/kg (PBW), without cardiac arrhythmias, with a pulmonary artery catheter and a peripheral arterial catheter were included.
T74981 95811-95971 Sentence denotes An increase in cardiac index (thermodilution)) >15% output after a fl uid challenge (Crystalloid 1,000 ml or Colloid 500 ml) was considered a positive response.
T1814 95972-96015 Sentence denotes Results Seventeen patients were responders.
T56430 96016-96106 Sentence denotes The ROC curve showed that the best cut-off value for ΔPP was 10% (ROC area = 0.74, 95% CI:
T35336 96107-96322 Sentence denotes 0.51 to 0.9; sensitivity 53%, specifi city 95%, positive likelihood ratio 9.4 and negative 0.34).Twelve patients consisted of a heterogeneous group of patients (liver transplant, acute pancreatitis, aortic surgery).
T73935 96323-96428 Sentence denotes Among 25 septic shock patients, a ΔPP >10% showed a ROC area of 0.84 (sensitivity 78%, specifi city 93%).
T73165 96429-96541 Sentence denotes In any case, the greater ΔPP, the greater the fl uid response. ΔPP >10% was a better predictor than CVP or PAOP.
T61380 96542-96613 Sentence denotes Conclusions ΔPP has a limited value in patients ventilated with low VT.
T60477 96614-96714 Sentence denotes However, a ΔPP >10% may help identify septic shock patients that will respond to a fl uid challenge.
T94987 96715-96947 Sentence denotes We have already demonstrated that in mechanically ventilated patients, the respiratory change in the pre-ejection period (ΔPEP) is a reliable dynamic index for the prediction of increase in cardiac output after volume infusion [1] .
T66023 96948-97103 Sentence denotes However, in an animal study, Kubitz and colleagues showed that the pre-ejection period is not sensitive to the changes in intravascular volume status [2] .
T14578 97104-97201 Sentence denotes Methods This study investigated the infl uence of changes in intravascular volume status on ΔPEP.
T29015 97202-97304 Sentence denotes In 17 pigs, ECG, arterial pressure and cardiac output derived from a Swan-Ganz catheter were recorded.
T40703 97305-97507 Sentence denotes Measurements were performed during normovolaemic conditions, after haemorrhage (25 ml/ kg) and following re-transfusion (25 ml/kg) with constant tidal volume (10 ml/kg) and respiration rate (15/minute).
T14579 97509-97641 Sentence denotes After the early phase of sepsis, excessive fl uid administration may worsen pulmonary edema and prolong mechanical ventilation [1] .
T86004 97642-97793 Sentence denotes Accurately predicting fl uid responsiveness obviates unnecessary fl uid loading, and helps to detect patients who may benefi t from a volume expansion.
T11042 97794-97958 Sentence denotes Pulse pressure variation (DPP) is a reliable predictor of fl uid responsiveness in mechanically ventilated patients only when tidal volume is at least 8 ml/kg [2] .
T60003 97959-98138 Sentence denotes The aim of this study was to evaluate the predictive value of DPP for fl uid responsiveness after a maneuver to change tidal volume to 8 ml/kg in patients ventilated with 6 ml/kg.
T93167 98139-98273 Sentence denotes Methods Prospective clinical study in 40 patients ventilated with 6 ml/kg after resuscitation phase of severe sepsis and septic shock.
T63227 98274-98375 Sentence denotes Fluid challenge was indicated by the attending physician (7 ml/kg of 6% hydroxyethyl starch 130/0.4).
T10986 98376-98464 Sentence denotes Complete hemodynamic measurements including DPP (DPP 6 ml/kg) were obtained at baseline.
T19416 98465-98565 Sentence denotes The tidal volume was then changed to 8 ml/kg and the DPP (DPP 8 ml/kg) was measured after 5 minutes.
T84461 98566-98640 Sentence denotes The ventilatory settings were returned to 6 ml/kg before fl uid challenge.
T93989 98641-98734 Sentence denotes Patients whose cardiac output (CO) increased by ≥15% were considered to be fl uid responders.
T7202 98735-98839 Sentence denotes Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of DPP.
T57174 98840-98912 Sentence denotes In 19 patients (responders), CO increased by >15% after fl uid infusion.
T93351 98913-99101 Sentence denotes Fluid responsiveness was better predicted with DPP 6 ml/kg (ROC curve area 0.92 ± 0.05) than with pulmonary artery occluded pressure (0.56 ± 0.09) and right atrial pressures (0.74 ± 0.08).
T1706 99102-99220 Sentence denotes Increasing tidal volume to 8 ml/kg did not improved prediction as the ROC curve area with DPP 8 ml/kg was 0.94 ± 0.03.
T50218 99221-99345 Sentence denotes The best cut-off values defi ned by the ROC curve analysis was 6.5% and 10.5% for DPP 6 ml/kg and DPP 8 ml/kg, respectively.
T2728 99346-99519 Sentence denotes Conclusions The maneuver to change tidal volume to 8 ml/kg in patients ventilated with protective ventilatory strategy to better predict fl uid responsiveness is not useful.
T30076 99520-99620 Sentence denotes Fluid responsiveness can be correctly predicted in patients ventilated with tidal volume of 6 ml/kg.
T81912 99621-99814 Sentence denotes Major head and neck surgery involving reconstructive free fl aps for oropharyngeal cancers are complex and prolonged operations during which appropriate fl uid management can become diffi cult.
T5006 99815-100052 Sentence denotes Potential adverse eff ects of fl uid mismanagement in this group of patients include fl ap hypoperfusion related to hypovolaemia or fl ap oedema and deterioration in alveolar-arterial gradients related to excessive fl uid administration.
T76414 100053-100217 Sentence denotes This study looked at ongoing standard practice, to determine whether the use of a cardiac output monitor could improve fl uid management in this subset of patients.
T7915 100218-100379 Sentence denotes Methods Single-blinded, prospective observational study conducted on consecutive adult patients undergoing major head and neck reconstructive free fl ap surgery.
T60627 100380-100467 Sentence denotes All patients were anaesthetised by the same individual, using a standardised technique.
T37369 100468-100546 Sentence denotes Volume-controlled positive pressure ventilation was initiated in all patients.
T12688 100547-100623 Sentence denotes Patients received maintenance crystalloid fl uids at a rate of 5 ml/kg/hour.
T34702 100624-100759 Sentence denotes Additional fl uid challenges (250 ml crystalloid boluses given over 5 minutes) were administered at the discretion of the anaesthetist.
T5644 100760-100916 Sentence denotes A priori criterion of fl uid responsiveness was defi ned as an increase in stroke volume (SV) >10% as measured with the LiDCOrapid after a fl uid challenge.
T1654 100917-101027 Sentence denotes The anaesthetist was blinded to the LiDCOrapid data and observations were made by an independent investigator.
T82559 101028-101132 Sentence denotes Data were collected on: heart rate (HR), mean arterial pressure (mAP) and central venous pressure (CVP).
T65150 101133-101182 Sentence denotes Results Forty-seven fl uid boluses were assessed.
T51821 101183-101306 Sentence denotes The median age of the patients was 72 years (range 68 to 81 years) and their median weight was 71.2 kg (range 63 to 88 kg).
T27244 101307-101390 Sentence denotes The ventilatory set-up used a median tidal volume of 7 ml/kg (range 450 to 600 ml).
T87831 101391-101504 Sentence denotes Fifteen out of 47 (32%) of the fl uid challenges were positive when assessed against the change in stroke volume.
T93320 101505-101697 Sentence denotes When comparing the fl uid responders with the nonresponders, there were no diff erences in HR (62 ± 10 bpm vs 62 ± 10 bpm), mAP (63 ± 6 mmHg vs 63 ± 7 mmHg) or CVP (8 ± 3 mmHg vs 10 ± 3 mmHg).
T48495 101698-101915 Sentence denotes Conclusions This preliminary report suggests that only 32% of fl uid challenges given in theatre were eff ective in increasing the SV >10% and potentially two-thirds of the fl uid challenges may have been detrimental.
T82241 101916-101970 Sentence denotes This can be seen only if SV is monitored continuously.
T53494 101971-102134 Sentence denotes If further data confi rm this, LiDCOrapid may be useful to guide fl uid administration in order to optimise the SV, thereby minimizing the risk of fl uid overload.
T16724 102135-102341 Sentence denotes Introduction Patients undergoing elective abdominal aortic surgery (EAAS) are at risk of developing complications due to preoperative co-morbidity, surgical trauma, blood loss and infl ammatory injury [1] .
T75219 102342-102469 Sentence denotes Individualized goal-directed therapy (IGDT) has been proposed to improve outcome in patients undergoing high-risk surgery [2] .
T46660 102470-102615 Sentence denotes The aim of this study was to investigate whether IGDT, targeting stroke volume (SV) and oxygen delivery (DO 2 ), can be performed safely in EAAS.
T21840 102616-102698 Sentence denotes Methods Sixty-three EAAS patients were randomized to IGDT or conventional therapy.
T20433 102699-102757 Sentence denotes The LiDCO™plus system was used for SV and DO 2 monitoring.
T92504 102758-102859 Sentence denotes SV was optimized by 250 ml fl uid challenges intraoperatively and the fi rst 6 hours postoperatively.
T55420 102860-102988 Sentence denotes DO 2 was optimized 6 hours postoperatively targeting a DO 2 I level of 600 ml/min/m 2 , by infusion of dobutamine, if necessary.
T87448 102989-103172 Sentence denotes Hemodynamic data were collected at baseline (t0) preoperatively (t1), before aortic cross-clamping (t2), at the end of surgery (t3), and the fi rst 6 hours postoperatively (p1 to p6).
T53300 103173-103325 Sentence denotes All patients were monitored with fi velead ECG during dobutamine infusion and dosage was reduced at signs of ischemia or heart rate >20% above baseline.
T65118 103326-103388 Sentence denotes Dobutamine dosage was limited to a maximum of 10 μg/kg/minute.
T9669 103389-103572 Sentence denotes The mean SVI level was 19.4% higher at p4 to p6 in the IGDT group compared with the control group (P = 0.02), and 12.1% higher in the entire intervention period (t1 to p6) (P = 0.07).
T33196 103573-103720 Sentence denotes The mean DO 2 I was 18.0% higher at p4 to p6 (P = 0.01) and 12.9% higher in the entire intervention period (t1 to p6) in the IGDT group (P = 0.03).
T25689 103721-103814 Sentence denotes Mean arterial pressure and heart rate did not diff er signifi cantly (P = 0.12 and P = 0.21).
T68922 103815-103915 Sentence denotes There was no diff erence in the frequency of postoperative cardiac complications between the groups.
T74901 103916-104050 Sentence denotes Conclusions The results of this study demonstrate that IGDT targeting SV and DO 2 can be performed safely in patients undergoing EAAS.
T18340 104051-104132 Sentence denotes Whether this intervention is benefi cial is being evaluated in the current study.
T55149 104133-104330 Sentence denotes Introduction Studies have suggested that tissue oxygenation (StO 2 ) measured on the thenar muscle is not sensitive to track acute changes in hemodynamics due to reductions in central blood volume.
T83011 104331-104548 Sentence denotes We aimed to investigate the feasibility of StO 2 measurements in the mouth as a quantitative indicator comparable with StO 2 measurements obtained from the thenar eminence during changes in central blood volume (CBV).
T19346 104549-104660 Sentence denotes Methods We performed a head-up tilt (HUT) test in 10 healthy volunteers as an experimental model to reduce CBV.
T46574 104661-104857 Sentence denotes StO 2 was continuously measured using two devices (InSpectra model 650): a multiple depth optical probe was placed over the thenar eminence (15 and 25 mm) and a 1-mm probe was placed in the mouth.
T51268 104858-104933 Sentence denotes Subjects were placed on an electrically driven tilt table with a footboard.
T57858 104934-105079 Sentence denotes After 5 minute baseline measurements in the supine position, the table was tilted up to 70° and returned to the supine position after 10 minutes.
T83422 105080-105143 Sentence denotes StO 2 readings were analyzed at the lowest stroke volume value.
T37785 105144-105175 Sentence denotes Results All subjects (mean age:
T0 105176-105243 Sentence denotes 23 ± 6; six males) tolerated well the supine and head-up positions.
T49236 105244-105385 Sentence denotes Cardiac output signifi cantly decreased in the HUT position; simultaneous decrease in StO 2 was observed in the mouth, but not in the thenar.
T22488 105386-105452 Sentence denotes The general results of the HUT test are shown in Tables 1 and 2 .
T36829 105453-105633 Sentence denotes Introduction Hemodynamic optimisation based on fl ow variables allows an early detection and correction of possible occult organ hypoperfusion in patients undergoing major surgery.
T99692 105634-105801 Sentence denotes Shoemaker described a markedly decreased cardiac index (CI) in nonsurvivors, which remained signifi cantly below the values compared with survivors during the surgery.
T93352 105802-106059 Sentence denotes The aim of this study was to evaluate the length of ICU stay, overall in-hospital stay and the postoperative outcome in a group of patients undergoing major urological surgery, while the CI is maintained within the normal range during intraoperative period.
T80635 106060-106311 Sentence denotes Methods Patients were randomised into groups the day before surgeryconventional management group (decision about fl uid therapy and vasoactive support was based on internal guidelines to preserve normal macrohemodynamic variables), and protocol group.
T70891 106312-106635 Sentence denotes Each patient in the protocol group received an oesophageal Doppler probe (TED) (Hemosonic 100; Arrow International, USA) after the start of general anaesthesia and then hemodynamic optimisation (fl uid management and vasoactive drugs), according to TED variables, was performed to keep CI between 2.6 and 3.8 l/minute/m 2 .
T30428 106636-106661 Sentence denotes We enrolled 230 patients.
T9595 106662-106721 Sentence denotes The control group: n = 115 and the protocol group: n = 115.
T11363 106722-106823 Sentence denotes High-risk criteria surgery was fulfi lled in 43% patients in protocol group and 45% in control group.
T16881 106824-107021 Sentence denotes There were no signifi cant diff erences in baseline variables between both groups (age, gender, length of surgical procedure, estimated blood loss and also in intraoperative values of MAP and CVP).
T99652 107022-107157 Sentence denotes In the protocol group was observed a high frequency of CI <2.6 l/minute/m 2 after induction of anesthesia 75% with fast recovery of CI.
T73985 107158-107348 Sentence denotes Introduction Fluid therapy in ICU patients serves to maintain tissue perfusion and is directed at increasing cardiac stroke volume (SV) through an increase in preload: fl uid responsiveness.
T65042 107349-107551 Sentence denotes Although there is increasing evidence that the regional blood fl ow cannot be predicted from global hemodynamic measurements, the relation between SV and parameters of peripheral perfusion is not clear.
T24212 107552-107679 Sentence denotes The aim of our study was to evaluate the eff ect of an increase in preload on commonly used parameters of peripheral perfusion.
T61446 107680-107972 Sentence denotes Methods Hemodynamically unstable patients with clinically suspected fl uid responsiveness underwent a passive leg raising (PLR) test, which consisted of 5 minutes of rest in a semirecumbent position of 30°, followed by 5 minutes PLR (lower limbs elevated at 30° and trunk in supine position).
T70387 107973-108050 Sentence denotes SV was measured continuously by pulse contour analysis using PiCCO (Pulsion).
T36035 108051-108197 Sentence denotes Peripheral perfusion was measured continuously with sidestream dark fi eld imaging (sublingual area) and laser Doppler fl owmetry (LDF) (fi nger).
T60014 108198-108228 Sentence denotes Results Sixteen patients (age:
T52182 108229-108260 Sentence denotes 63 years (55 to 72), APACHE II:
T36170 108261-108281 Sentence denotes 25 (20 to 28), SOFA:
T99092 108282-108323 Sentence denotes 10 (7 to 13)) were included in our study.
T14756 108324-108404 Sentence denotes Of these 16 patients, six (38%) increased their SV by >10% in response to a PLR.
T22560 108405-108478 Sentence denotes Flow indices (LDF and sublinguale microcirculatory fl ow) did not change.
T34350 108479-108588 Sentence denotes However, there was a trend in increase of the functional capillary density in the responders (see Figure 1 ).
T27047 108589-108772 Sentence denotes Conclusions These data suggest that increasing SV in hemodynamically unstable patients might improve peripheral perfusion, however only in the sublingual area and not in all patients.
T35738 108773-108948 Sentence denotes There was no relation between systemic circulation and peripheral perfusion: it remains to be investigated whether optimizing SV actually results in improved tissue perfusion.
T82132 108949-109047 Sentence denotes Among all patients, at baseline, median CI and dIVC% were 2.6 l/minute/ m 2 and 29%, respectively.
T82006 109048-109217 Sentence denotes Volume expansion signifi cantly increased the median CI from 2.6 (2 to 3.3) to 3 (2.1 to 4) l/minute/m 2 (P = 0.005) and decreased dIVC% from 29.4% to 12.6% (P = 0.003).
T6083 109218-109259 Sentence denotes The median dIVC% in R was higher than NR:
T41907 109260-109283 Sentence denotes 31.3% vs 17% (P <0.05).
T99111 109284-109335 Sentence denotes Fluid therapy decreased more dIVC% in R than in NR:
T62969 109336-109386 Sentence denotes R 31% to 12% (P = 0.03), NR 17% to 12% (P = 0.04).
T33972 109387-109609 Sentence denotes The dIVC% showed similar trend in both groups of septic shock (SS) and trauma shock (TS) patients before and after fl uid therapy: dIVC% 27% in SS and 24% in TS before fl uid therapy; 15% in SS and 11% in TS after therapy.
T81288 109610-109736 Sentence denotes Conclusions Our data suggest that dIVC% is a sensitive index of fl uid responsive ness in septic and trauma patients in shock.
T52670 109737-109763 Sentence denotes Limitations: few patients.
T25349 109764-109848 Sentence denotes Introduction Myocardial depression occurs in 40% of patients presenting with sepsis.
T13674 109849-110095 Sentence denotes In critically ill patients, the peak fi rst derivative of aortic pressure (Ao_dP/dt max ) derived from a fl uid-fi lled catheter has been commonly used by clinicians for decades to assess directional change in left ventricular (LV) contractility.
T40048 110096-110176 Sentence denotes However, this parameter remains questionable because of its preload sensitivity.
T55428 110177-110358 Sentence denotes The aim of this study was to test whether Ao_dP/dt max represents an accurate method for assessing LV contractility when preload independence, based on dynamic indices, is achieved.
T68220 110359-110578 Sentence denotes Methods LV pressure-volume data obtained with a conductance catheter and invasive aortic pressure obtained with a fl uid-fi lled catheter were continuously recorded in six anaesthetized and mechanically ventilated pigs.
T98445 110579-110654 Sentence denotes After a stabilization period, endotoxin was infused to induce septic shock.
T73870 110655-110777 Sentence denotes Fluid administration was continuously controlled by preload responsiveness by holding pulse pressure variation (PPV) <13%.
T84318 110778-110837 Sentence denotes Catecholamines were transiently administrated during shock.
T56950 110838-110957 Sentence denotes Ao_dP/dt max was compared with end-systolic elastance (E es ), the gold standard method for assessing LV contractility.
T51853 110958-111076 Sentence denotes Results Endotoxin-induced septic shock and catecholamine infusion lead to signifi cant variations in LV contractility.
T71313 111077-111196 Sentence denotes The best correlation (r 2 = 0.76) and agreement between Ao_dP/dT max and E es were obtained when PPV <11% ( Figure 1 ).
T18794 111197-111369 Sentence denotes Conclusions Ao_dP/dT max is a minimally invasive and accurate method for assessing LV contractility when eff ective preload independence, defi ned as PPV <11%, is achieved.
T37962 111370-111597 Sentence denotes Introduction The pressure recording analytical method (PRAM) is the only pulse contour method that does not need any calibration since it estimates in vivo, beat to beat, the impedance of the cardiovascular system [1] [2] [3] .
T39480 111598-111708 Sentence denotes Cardiac cycle effi ciency (CCE) is a novel parameter that is directly related to the cardiovascular impedance.
T55091 111709-111933 Sentence denotes Since the aortic valve contributes to impedance, we hypothesized during an aortic valvuloplasty, performed for severe aortic stenosis, the cardiovascular impedance may decrease by the reduction of the transvalvular gradient.
T15741 111934-112095 Sentence denotes Methods In a cath lab, fi ve consecutive patients undergoing aortic valve plasty for severe aortic stenosis were monitored by means of PRAM during the procedure.
T7460 112096-112293 Sentence denotes Systolic (SAP), diastolic, and mean (MAP) arterial pressures, stroke volume (SV), heart rate (HR), cardiac output (SV x HR), CCE, and dP/ dt max were continuously collected and afterwards analyzed.
T42482 112294-112377 Sentence denotes The stroke work (SW = SV x MAP) and minute work (MW = SBP x CO) were also measured.
T93753 112378-112442 Sentence denotes Results In all cases of NOMI, they were diagnosed at laparotomy.
T18055 112443-112527 Sentence denotes The mean age was 69.7 years (50 to 83 years old), and the male:female ratio was 1:1.
T32401 112528-112635 Sentence denotes One patient received off -pump coronary artery bypass surgery, and fi ve underwent thoracic aortic surgery.
T74162 112636-112790 Sentence denotes Hemodialysis was initiated in one of six patients before operation, while the continuous hemodiafi ltration was initiated in all patients postoperatively.
T48455 112791-112920 Sentence denotes After operation, high-dose catecholamines were necessary in fi ve of six patients for long periods because of severe hypotension.
T71057 112921-112988 Sentence denotes In four of six patients, abdominal pain was the presenting symptom.
T15713 112989-113087 Sentence denotes The rest of two patients had a nonspecifi c presentation because they were ventilated and sedated.
T36009 113088-113191 Sentence denotes All patients presented abdominal distension and their abdominal X-rays showed paralytic ileus features.
T94382 113192-113278 Sentence denotes The serum values of AST, LDH, CK, and lactate were slightly elevated in most patients.
T18328 113279-113405 Sentence denotes Five of six patients died from septic shock and multiple organ failures, and the mortality rate of patients with NOMI was 83%.
T47365 113406-113694 Sentence denotes Potential risk factors contributing to the occurrence of NOMI and sensitive markers might be the following: continuous hemodiafi ltration (6/6); hypotension (5/6); high-dose catecholamines (5/6); dehydration (6/6); abdominal pain (4/6); paralytic ileus patterns of abdominal X-rays (6/6).
T16210 113695-113885 Sentence denotes Conclusions The increase of NOMI incidence following cardiothoracic surgery might be related to continuous hemodiafi ltration, hypotension, dehydration, and uses of high-dose catecholamines.
T81083 113886-114033 Sentence denotes Identifi cation of patients at NOMI risk and prevention of hypovolemic hypotension and use of vasodilator may help to reduce the incidence of NOMI.
T91690 114034-114077 Sentence denotes increased prevalence of CHF in the elderly.
T13798 114078-114201 Sentence denotes The aim of present study was to investigate the major causes, comorbidities and in-hospital mortality of patients with CHF.
T74724 114202-114447 Sentence denotes Methods A retrospective study was performed in 6,960 patients (4,352 males, 2,608 females) with a validated primary discharge diagnosis of CHF hospitalized from 1 January 1993 through 31 December 2007, at Chinese PLA General Hospital in Beijing.
T24975 114448-114581 Sentence denotes The patients were divided into fi ve groups based on the number of etiologies and comorbidities from one to fi ve or more than fi ve.
T29694 114582-114717 Sentence denotes A comparative analysis was performed to explore the major causes, comorbidities and in-hospital mortality of patients among the groups.
T26899 114718-114979 Sentence denotes The mean (± SD) age of patients was 53 ± 17 years in the onecomorbidity group, 60 ± 16 years in the two-comorbidity group, 65 ± 14 years in the three-comorbidity group, 70 ± 13 years in the fourcomorbidity group and 72 ± 11 years in the fi ve-comorbidity group.
T11545 114980-115097 Sentence denotes Introduction Sildenafi l is a phosphodiesterase-type-5 inhibitor and selectively decreases pulmonary artery pressure.
T92885 115098-115369 Sentence denotes So far, the mechanism underlying sildenafi l's eff ects on pulmonary vascular remodeling and potassium channel activity in pulmonary artery smooth muscle cells (PASMCs) has not been clearly addressed in pulmonary hypertension secondary to increased pulmonary blood fl ow.
T8652 115370-115516 Sentence denotes Methods A total of 27 male SD rats were randomly divided into a sham group (n = 9), a shunt group (n = 9) and a shunt + sildenafi l group (n = 9).
T57333 115517-115677 Sentence denotes A left-to-right shunt was established by performing an abdominal aorta to inferior vena cava fi stula both in the shunt group and the shunt + sildenafi l group.
T33536 115678-115859 Sentence denotes Rats in the shunt + sildenafi l group received oral sildenafi l 10 mg/kg/ day, whereas the rats in the sham group and the shunt group were fed with normal saline of the same volume.
T76080 115860-115931 Sentence denotes Eleven weeks later, mean pulmonary artery pressure (mPAP) was measured.
T50035 115932-116100 Sentence denotes Meanwhile, the ratio of right ventricular mass to left ventricular plus septal mass (RV/(LV+S)) was detected as a marker of the degree of right ventricular hypertrophy.
T98255 116101-116263 Sentence denotes The relative medial thickness (RMT) of middle and small pulmonary muscularized arteries was calculated as a sign of pathological changes of pulmonary vasculature.
T37342 116264-116380 Sentence denotes The voltage-gated potassium channel Kv1.5 mRNA expression of pulmonary vasculature was detected using real-time PCR.
T50512 116381-116617 Sentence denotes Results Eleven weeks later, the rats in the shunt group developed pulmonary hypertension as evidenced by signifi cantly increased mPAP, RV/(LV+S), as well as higher RMT of middle and small pulmonary muscularized arteries (all P = 0.01).
T83716 116618-116727 Sentence denotes In addition, the rats in shunt group had decreased Kv1.5 mRNA expression in pulmonary vasculature (P = 0.01).
T9724 116728-116955 Sentence denotes The rats in the shunt + sildenafi l group had a signifi cantly decreased mPAP, and RV/(LV+S) ratio, and a lower RMT as well (all P = 0.01), whereas the levels of Kv1.5 mRNA expression were signifi cantly upregulated (P = 0.01).
T48931 116956-117203 Sentence denotes Furthermore, there were no statistically signifi cant diff erence in mPAP, in RV/(LV+S) ratio, RMT of middle and small pulmonary muscularized arteries and Kv1.5 mRNA expression between the shunt + sildenafi l group and the sham group (all P = NS).
T50102 117204-117385 Sentence denotes Conclusions Oral sildenafi l attenuated pulmonary vascular remodeling and upregulated Kv1.5 mRNA expression in the rats with pulmonary hypertension secondary to left-to-right shunt.
T74542 117386-117536 Sentence denotes Methods Eleven anesthesized pigs were instrumented for the measurement of arterial blood pressure, central venous pressure, RV and pulmonary pressure.
T14865 117537-117653 Sentence denotes An ultrasonic fl owprobe (MA14PAX; Transonic) was positioned on the main pulmonary artery to obtain pulmonary fl ow.
T60517 117654-117772 Sentence denotes Distal to the fl owprobe, a balloon-occluder was positioned facilitating gradual constriction of the pulmonary artery.
T29501 117773-117917 Sentence denotes To obtain a stepwise pressure diff erence increment over the banding of 10 mmHg at each measurement, we gradually infl ated the balloonoccluder.
T81923 117918-118117 Sentence denotes After 10 minutes, all invasive hemodynamic data were registered and an epicardial echocardiography was performed to obtain tricuspid fl ow velocities, isovolumetric and isovolumetric relaxation time.
T41306 118118-118269 Sentence denotes To calculate the TEI index during one heartbeat, echocardiographic measurements were synchronized with fl owprobe measurements to obtain ejection time.
T38533 118270-118368 Sentence denotes The E/E΄ ratio was obtained with tissue Doppler echocardiography of the lateral tricuspid annulus.
T96508 118369-118442 Sentence denotes All echocardiographic measurements were performed in triple and averaged.
T92698 118443-118600 Sentence denotes The ejection period and mean pulmonary acceleration and cardiac output were calculated from the pulmonary fl ow curve derived from the ultrasonic fl owprobe.
T68459 118601-118701 Sentence denotes Resistance over the pulmonary banding was calculated by pressure gradient divided by cardiac output.
T5546 118703-118867 Sentence denotes The pathobiology of persistent right ventricular (RV) failure observed after an acute increase in pulmonary artery pressure (P pa ) remains incompletely understood.
T82568 118868-118972 Sentence denotes We hypothesized that these severe complications might be related to an activation of apoptotic pathways.
T43462 118973-119458 Sentence denotes Methods Fourteen anesthetized dogs were randomised to a transient 90 minutes pulmonary artery constriction or to a SHAM operation, followed 30 minutes later by hemodynamic measurements including eff ective arterial elastance (E a ) to estimate RV afterload and end-systolic elastance (E es ) to estimate RV contractility, and sampling of cardiac tissue to assess apoptosis by real-time quantitative polymerase chain reaction, enzyme-linked immunosorbent assay and immunohistochemistry.
T77059 119459-119747 Sentence denotes Results Transient increase in P pa persistently increased E a from 0.75 ± 0.08 to 1.37 ± 0.18 mmHg/ml, and decreased E es from 1.06 ± 0.09 to 0.49 ± 0.09 mmHg/ml, E es /E a from 1.44 ± 0.06 to 0.34 ± 0.03 and cardiac output from 3.78 ± 0.16 to 1.46 ± 0.10 l/minute, indicating RV failure.
T4324 119748-120019 Sentence denotes As compared with the SHAM-operated group, and with left ventricular tissue in animals with persistent RV failure, there were decreased gene expressions of RV and septal Bcl-2, with no changes in the gene expressions of Bax and Bak, and an increase in the Bax/Bcl-2 ratio.
T12194 120020-120128 Sentence denotes RV and septal Bcl-XL, and RV Bcl-w gene expressions were decreased as compared with the SHAM-operated group.
T86936 120129-120207 Sentence denotes There were activations of RV caspases 8 and 9, and of RV and septal caspase 3.
T45463 120208-120274 Sentence denotes Diff use RV and septal apoptosis was confi rmed by TUNEL staining.
T73031 120275-120343 Sentence denotes There were also increased RV and septal protein expressions of TNFα.
T65040 120344-120507 Sentence denotes Conclusions Acute afterload-induced persistent RV failure appears to be related to an early activation of apoptotic pathways, and to a myocardial increase of TNFα.
T71052 120508-120595 Sentence denotes Currently approved treatments such as nicardipine (N) and dihydralazine have drawbacks.
T72914 120596-120805 Sentence denotes Since hypertension in PE is associated with increased sympathetic activity, urapidil (U), a peripheral α 1 antagonist, has potential for BP control in PE, but no controlled comparison of U with N is available.
T2956 120806-120925 Sentence denotes This preliminary randomized controlled trial aims to compare effi cacy and safety of U and N to reduce BP in severe PE.
T46401 120926-121083 Sentence denotes Methods After IRB approval and signed informed consent, 18 women with severe PE without previous antihypertensive treatment were randomized to U or N groups.
T82161 121084-121161 Sentence denotes The therapeutic goal was to achieve a mean BP (MBP) between 105 and 125 mmHg.
T68192 121162-121326 Sentence denotes The U patients fi rst received U 6.25 mg boluses every 5 minutes until the diastolic BP dropped below 105 mmHg, followed by a 4 mg/hour infusion adjusted as needed.
T20844 121327-121490 Sentence denotes In the N group, patients fi rst received a N 1 γ/kg/minute infusion until a 15% reduction in mean BP, followed by a N 0.75 γ/kg/minute infusion adjusted as needed.
T27494 121491-121589 Sentence denotes Non-invasive BP was assessed every 5 minutes during treatment titration and then every 15 minutes.
T33947 121590-121651 Sentence denotes The time needed to reach the therapeutic goal was registered.
T46880 121652-121724 Sentence denotes The main endpoint was the achievement of the BP goal in 2 hours or less.
T82797 121725-121845 Sentence denotes Tolerance was assessed by the number of episodes of hypotension (HO) (defi ned as MBP below 100 mmHg) and side eff ects.
T67669 121846-121967 Sentence denotes Severe HO, defi ned as MBP below 80 mmHg or two episodes of HO, was considered as treatment failure and led to exclusion.
T88989 121968-122106 Sentence denotes Further assessment was limited to safety, amount of ocytocics used and neonatal evaluation by ICU paediatricians until discharge from ICU.
T826 122107-122156 Sentence denotes Results were compared using analysis of variance.
T7368 122157-122210 Sentence denotes Side eff ects were compared with the chi-square test.
T4168 122211-122304 Sentence denotes Results One U patient was excluded from the effi cacy assessment due to a protocol violation.
T79872 122305-122387 Sentence denotes The main endpoint was reached in all 17 patients, after 50 minutes in both groups.
T41933 122388-122522 Sentence denotes During the fi rst 2 hours, the needed treatment adjustment median value was 1 (0 to 10) in the U group and 1 (0 to 13) in the N group.
T6517 122523-122681 Sentence denotes Side eff ects attributable to the study treatment were observed in six of the nine cases in the N group and in one of the nine cases in the U group (P <0.02).
T86605 122682-122743 Sentence denotes There were no severe side eff ects or neonatal side eff ects.
T31106 122744-122826 Sentence denotes Conclusions No diff erence in effi cacy could be shown in this preliminary series.
T7873 122827-122864 Sentence denotes Both treatments were easy to titrate.
T40847 122865-122914 Sentence denotes Fewer side eff ects were recorded in the U group.
T82883 122915-122970 Sentence denotes Further studies are needed in order to compare U and N.
T35839 122971-123078 Sentence denotes Introduction Patients frequently refer to the emergency department with hypertension and related disorders.
T42795 123079-123172 Sentence denotes If hypertensive crisis is not diagnosed in these patients, urgent treatment is not necessary.
T41533 123173-123352 Sentence denotes However, taking patient satisfaction into consideration, the emergency physicians usually discharge these patients after lowering the blood pressure with various medications [1] .
T8824 123353-123555 Sentence denotes This prospective, randomized, placebo-controlled study is designed in order to compare the eff ects of captopril, furosemide and lorazepam on lowering blood pressure and increasing patient satisfaction.
T27850 123556-123644 Sentence denotes Methods One hundred patients with uncomplicated hypertension were included in the study.
T5650 123645-123765 Sentence denotes All were randomized into four groups: (1) captopril group, (2) furosemide group, (3) lorazepam group, (4) placebo group.
T15701 123766-123838 Sentence denotes The blood pressure was measured at baseline, 30th, 60th and 90th minute.
T61520 123839-123938 Sentence denotes The patient satisfaction was assessed with a visual analog scale (VAS) at baseline and 90th minute.
T61377 123939-124203 Sentence denotes Results Captopril (23.64 mmHg), lorazepam (24.90 mmHg) and furosemide (24.10 mmHg) were found similarly eff ective in lowering blood pressure when we compare baseline and 90th minute, but all three drugs were superior to placebo (15.94 mmHg) (P <0.05) ( Table 1 ).
T9658 124204-124409 Sentence denotes When patient satisfaction was assessed with the VAS, captopril (30.12 mm), furosemide (28.04 mm) and lorazepam (32.88 mm) were statistically similar and all three drugs were superior to placebo (22.76 mm).
T78125 124411-124535 Sentence denotes In conclusion, all three drugs can be used in subjects referred to the emergency department with uncomplicated hypertension.
T12226 124536-124638 Sentence denotes They are similarly eff ective in both lowering the blood pressure and increasing patient satisfaction.
T15480 124639-124736 Sentence denotes Introduction Hypertensive crises (HC) are common among patients admitted to emergency rooms [1] .
T28019 124737-124822 Sentence denotes However, data are lacking about prevalence in the critically ill admitted to the ICU.
T72869 124823-125006 Sentence denotes The aim of the study was to assess the rate of HC in a cohort of patients admitted to a medicalsurgical ICU, to look for risk factors for HC and to assess outcome of patients with HC.
T11993 125007-125325 Sentence denotes Patients were divided into two groups: the fi rst group included patients who underwent electrical cardioversion (CVE group, n = 10) and were discharged in sinus rhythm; the second included patients who did not undergo electrical cardioversion and were discharged with chronic atrial fi brillation (CAF group, n = 40).
T30958 125326-125429 Sentence denotes In both groups, mortality, antiarrhythmic drug therapy and oral anticoagulation regimen were monitored.
T41744 125430-125497 Sentence denotes The fi rst group's follow-up evaluated maintenance of sinus rhythm.
T55185 125498-125615 Sentence denotes The number of DC shocks required for the maintenance of sinus rhythm in patients of the CVE group was also collected.
T31202 125616-125675 Sentence denotes The main outcome parameter considered was 28-day mortality.
T37453 125676-125764 Sentence denotes Results Patients of both groups resulted in similar demographic and clinical parameters.
T34969 125765-125938 Sentence denotes In patients included in the CVE group, the maintenance of sinus rhythm was achieved with one DC shock in 66.6%, two DC shocks in 22.2% and three DC shocks in 11.1% of cases.
T74347 125939-126074 Sentence denotes The mortality rate at 24 hours was 0% while at 28 days was 11.1%, whereas patients in the CAF group had a 28-day mortality rate of 35%.
T34259 126075-126089 Sentence denotes See Figure 1 .
T84183 126090-126263 Sentence denotes Conclusions Our pilot study indicates that the improvement of ventricular performance with the contribution of atrial systole might improve critically ill patients' outcome.
T43860 126264-126371 Sentence denotes Considering the small number of cases, a prospective study, based on these preliminary results, is ongoing.
T67613 126372-126526 Sentence denotes The incidence of acute cardiogenic pulmonary edema (ACPE) is increasing and it is now one of the leading causes of morbidity and mortality in our society.
T76107 126527-126749 Sentence denotes As the global population of European countries is getting older, the impact of arterial stiff ness is becoming more and more important in the pathophysiology of ACPE, besides coronary vascular disease and valvular disease.
T3415 126750-126893 Sentence denotes The aim of the study was to evaluate whether acute modifi cations in elastic artery distensibility can be involved in the pathogenesis of ACPE.
T36280 126894-127033 Sentence denotes Methods Six consecutive patients (four men and two women; age 76 ± 7.1 years) were admitted to our ICU with the clinical diagnosis of ACPE.
T15010 127034-127274 Sentence denotes All patients were studied with transthoracic echocardiography (TTE) and by evaluation of pulse wave analysis (PWA) and pulse wave velocity (PWV) with the applanation tonometry method, performed at admission and after clinical stabilization.
T43630 127275-127464 Sentence denotes In all patients, left ventricular systolic function was not signifi cantly reduced when evaluated with transthoracic echocardiography, while a diastolic dysfunction was always demonstrated.
T74960 127465-127570 Sentence denotes We have recorded a signifi cant (P <0.05) decrease in blood pressure values after clinical stabilization.
T73750 127571-127704 Sentence denotes Estimation of the central aortic pressure waveform by mathematical transformation of radial tonometry pressure was similarly reduced.
T8289 127705-128014 Sentence denotes Other tonometric parameters, such as the Augmentation Index, which represents the contribution of the wave refl ection to the global pulse pressure wave, and PWV, which is inversely correlated to the arterial compliance, were also signifi cantly decreased, when compared with the values at the admission time.
T74761 128015-128176 Sentence denotes The subendocardial viability ratio (SEVR), an indirect index of myocardial perfusion relative to cardiac workload, increased after treatment with vasodilatators.
T95232 128177-128418 Sentence denotes Conclusions Our data confi rm the determining role of the increased arterial stiff ness in the pathogenesis of ACPE, and how a therapeutic strategy able to ameliorate this target can be associated with a clinical improvement for the patient.
T68893 128419-128522 Sentence denotes The applanation tonometry could be an interesting method to evaluate these patients in the ICU setting.
T76165 128523-128775 Sentence denotes Introduction Several studies using angiographic or echocardiographic methods have shown that in septic shock (SSh) or severe sepsis (SeS), cardiac abnormalities, which are often documented [1] , seem to have a relevant prognostic signifi cance [2, 3] .
T90389 128776-129080 Sentence denotes Conclusions This study reinforces the concept that changes in systolic and diastolic functions are common in septic shock and severe septic patients, and that the development of these changes (as an adaptation mechanism) seems to correlate inversely with the acute mortality rate during ICU stay [2, 4] .
T50134 129081-129329 Sentence denotes Introduction While advantages of pulsatile perfusion (PP) during cardiopulmonary bypass (CPB) in terms of clinical outcome remain the subject of debate, possible benefi ts are generally thought to occur via improvements in microvascular fl ow [1] .
T14657 129330-129394 Sentence denotes However, this is currently not supported by human clinical data.
T43254 129395-129537 Sentence denotes Therefore we used real-time human microvascular imaging to test our hypothesis that pulsatile perfusion would enhance microvascular perfusion.
T43362 129538-129695 Sentence denotes Methods We used sidestream dark fi eld imaging to record video clips of the human microcirculation in 16 patients undergoing routine CPB for cardiac surgery.
T36911 129696-129814 Sentence denotes Following administration of cardioplegia, CPB was continued in either pulsatile (PP, n = 8) or nonpulsatile (NP) mode.
T85329 129815-129868 Sentence denotes After 10 minutes, microvascular recordings were made.
T53340 129869-129934 Sentence denotes The perfusion mode was then switched from PP to NP or vice versa.
T7107 129935-130018 Sentence denotes Ten minutes later, a second series of microvascular video recordings were obtained.
T68657 130019-130205 Sentence denotes Global hemodynamic and laboratory data were recorded and the energy equivalent pressure (EEP) and pulse pressure (both mean ± SD) were calculated to quantify PP generated surplus energy.
T99219 130206-130317 Sentence denotes Microvascular analysis was performed both for smaller and larger microvessels with a diameter cut-off of 20 μm.
T765 130318-130530 Sentence denotes Assessments included perfused vessel density (PVD) (mean ± SD, 95% confi dence intervals of the diff erence between NP and PP (95% CID)) and the Microvascular Flow Index (MFI) (mean ± SD and interquartile range).
T79733 130531-130794 Sentence denotes Results Pulsatile perfusion resulted in higher pulse pressure (27 ± 6 vs 7 ± 2 mmHg, P <0.0001) and CPB circuit EEP (184 ± 33 vs 150 ± 27 mmHg, P <0.0001) as compared with NP while MAP was similar between these perfusion modes (52 ± 11 vs 56 ± 13 mmHg, P = 0.09).
T184 130795-130916 Sentence denotes Both for small and larger microvessels, we found no diff erences in indices of microvascular perfusion between PP and NP.
T10107 130917-131037 Sentence denotes Small microvessel PVD was similar between PP and NP (6.65 ± 1.39 vs 6.83 ± 1.23/mm; 95% CID -0.50 to 0.87/mm, P = 0.58).
T32854 131038-131146 Sentence denotes Conclusions In our study, a complete echocardiographic assessment was possible using TTE in 97% of patients.
T45799 131147-131251 Sentence denotes Two-thirds of our population had echocardiographic abnormalities, 62.1% of whom were previously unknown.
T61678 131252-131354 Sentence denotes The presence of LV asynergies and reduced RV systolic function were associated with a worse prognosis.
T55410 131355-131457 Sentence denotes Detection of cardiac abnormalities increased prediction of ICU mortality based on logistic regression.
T95217 131458-131615 Sentence denotes Introduction B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are routine diagnostic and monitoring markers in patients with heart failure.
T43750 131616-131721 Sentence denotes LV function and prognosis of these patients have been shown to be refl ected by BNP and NT-proBNP levels.
T88734 131722-131867 Sentence denotes However, in patients with cardiogenic shock after myocardial infarction, the relationship and relevance of these markers has not been elucidated.
T85998 131868-132184 Sentence denotes Methods The IABP Shock trial was as a monocentric, randomised and prospective clinical trial to determine the role of therapeutic intraaortic balloon pump (IABP) counterpulsation after primary percutaneous transluminal coronary angioplasty (PCI) in acute myocardial infarction (AMI) complicated by cardiogenic shock.
T63301 132185-132290 Sentence denotes Cardiac catheterization was performed in 40 patients within 12 hours of onset of hemodynamic instability.
T85776 132291-132355 Sentence denotes Creatinine, hemodynamic parameters and survival were determined.
T77655 132356-132459 Sentence denotes Further, BNP and NT-proBNP levels were measured on admission as well as 24, 48 and 72 hours afterwards.
T49593 132460-132595 Sentence denotes Results BNP levels detected diff erences in treatment regarding LVunloading under IABP (632 ± 194 pg/ml vs 1,370 ± 475 pg/ml, P <0.05).
T93874 132596-132723 Sentence denotes However, there was no signifi cant diff erence between the group treated with IABP and no IABP with regard to NT-proBNP levels.
T98368 132724-132977 Sentence denotes Interestingly, NT-proBNP levels clearly diff erentiated between survivors and nonsurvivors (4,590 ± 1,230 pg/ml vs 14,370 ± 4,886 pg/ml, P <0.05), contrary to no signifi cant diff erence between survivors and nonsurvivors with regard to BNP levels (NS).
T8919 132978-133194 Sentence denotes Elevated levels of NT-proBNP in patients with cardiogenic shock might be more dependent on impaired renal function, which might refl ect additional organ dysfunction (creatinine >200 μmol/l vs creatinine ≤200 μmol/l:
T27956 133195-133249 Sentence denotes 24,965 ± 9,567 pg/ml vs 7,246 ± 2,650 pg/ml, P <0.05).
T21656 133250-133394 Sentence denotes Conclusions In myocardial infarction complicated by cardiogenic shock, levels of BNP and NT-proBNP both provide valuable additional information.
T70131 133395-133597 Sentence denotes BNP seems to closely refl ect the cardiac status and eff ects of therapy, while NT-pro-BNP seems a good indicator for prognosis in patients with cardiogenic shock by its dependency on organ dysfunction.
T48717 133599-133825 Sentence denotes We have previously shown how a data fusion index, based on the integration of vital signs continuously monitored in a stepdown unit (SDU), can identify the cardiorespiratory instability that often precedes adverse events [1] .
T1398 133826-134011 Sentence denotes We show how the correlations between vital signs, captured in a data fusion index based on a probabilistic model of normality [2] , change during times of cardiorespiratory instability.
T81418 134012-134147 Sentence denotes Methods An observational study was carried out in a 24-bed SDU, in which vital signs from 326 patients were continuously recorded [1] .
T3112 134148-134304 Sentence denotes The existing standard of care used single-channel Medical Emergency Team (MET) activation criteria to determine when individual vital signs became abnormal.
T13662 134305-134440 Sentence denotes Retrospective evaluation of the continuous vital sign data identifi ed that MET criteria were exceeded on 238 nonartefactual occasions.
T58227 134441-134595 Sentence denotes One hundred and eleven of these were indicative of suffi cient cardiorespiratory instability that they should have required an MET call (critical events).
T70938 134596-134728 Sentence denotes Vital-sign dynamics during these events were compared with data from stable periods, using order statistics and covariance analysis.
T26675 134729-134851 Sentence denotes We found the probability distributions of the most extreme and the median data for each parameter over 1-minute intervals.
T98314 134852-135178 Sentence denotes The bivariate Gaussian distributions of best fi t for data from critical events (abnormal respiratory rate (RR) or heart rate (HR)) show signifi cant diff erences in covariance when compared with those calculated for data intervals from stable patients (see Figure 1 , in which covariance is indicated by ellipse orientation).
T55366 135179-135246 Sentence denotes Under normal conditions (black ellipses), RR is correlated with HR.
T84633 135247-135408 Sentence denotes During critical events, tachycardia occurs with little or no variation in RR (red ellipses); tachypnoea occurs with little or no variation in HR (blue ellipses).
T37126 135409-135553 Sentence denotes Conclusions Dynamics and correlations that exist in vital signs during periods of stability change signifi cantly during periods of abnormality.
T3959 135554-135697 Sentence denotes A statistical approach that integrates vital signs and captures correlations between them will be sensitive to cardiorespiratory deterioration.
T46669 135698-135870 Sentence denotes Introduction In vivo microdialysis (MD) is a bedside sampling method that permits continuous analysis of a patient's extracellular tissue chemistry without consuming blood.
T48939 135871-135989 Sentence denotes MD is performed by implanting a commercially available catheter that mimics a blood capillary at the site of interest.
T56004 135990-136106 Sentence denotes Methods A total of 35 (20 men) mechanically ventilated septic patients having a median age of 60 years were studied.
T97979 136107-136169 Sentence denotes All patients met the ACCP/ SCCM consensus criteria for sepsis.
T80725 136170-136312 Sentence denotes Upon sepsis onset, a microdialysis catheter (CMA 60; CMA, Solna, Sweden) was inserted into the subcutaneous adipose tissue of the upper thigh.
T88422 136313-136473 Sentence denotes The dialysate samples were collected in microvials and were analyzed immediately for glucose, pyruvate, lactate, and glycerol using a mobile CMA ISCUS analyzer.
T41378 136474-136536 Sentence denotes The lactate/pyruvate (L/P) ratio was automatically calculated.
T30525 136537-136626 Sentence denotes Measurements were performed six times per day during the fi rst 6 days from sepsis onset.
T55689 136627-136701 Sentence denotes The daily mean values of MD measurements were calculated for each patient.
T79335 136702-136832 Sentence denotes Results Sepsis severity of the study group was graded as follows: sepsis (n = 5), severe sepsis (n = 2) and septic shock (n = 28).
T88063 136833-136907 Sentence denotes APACHE and SOFA scores at study entry were 23 ± 4 and 8 ± 3, respectively.
T18168 136908-136972 Sentence denotes Overall, 18 patients died yielding an ICU mortality rate of 51%.
T16602 136973-137191 Sentence denotes MD revealed that at study entry patients with septic shock had higher lactate (3.5 ± 1.6 vs 1.8 ± 0.9, P = 0.01), and higher pyruvate (204 ± 137 vs 95 ± 68, P = 0.04) levels compared with septic patients without shock.
T85575 137192-137379 Sentence denotes In contrast, the two groups had similar values for glucose (5.9 ± 2.7 vs 4.3 ± 2.9, P = 0.18), glycerol (369 ± 225 vs 252 ± 171, P = 0.21), and L/P ratio (83 ± 289 vs 75 ± 150, P = 0.92).
T67936 137380-137648 Sentence denotes Septic shock correlated with SOFA on day 1 (r = 0.55, P = 0.001), APACHE II (r = 0.42, P = 0.01), lactate on day 1 (r = 0.48, P = 0.004), lactate on day 2 (r = 0.50, P = 0.002), pyruvate on day 1 (r = 0.040, P = 0.018), and with pyruvate on day 2 (r = 0.35, P = 0.04).
T85387 137649-137804 Sentence denotes Nonsurvivors had higher glycerol (426 ± 236 vs 253 ± 157, P = 0.01) at study entry and on day 1 (437 ± 260 vs 282 ± 169, P = 0.04) compared with survivors.
T8158 137805-137937 Sentence denotes Nonsurvivors also had higher pyruvate levels on day 1 (170 ± 99 vs 104 ± 65, P = 0.03) and on day 2 (150 ± 81 vs 97 ± 61, P = 0.04).
T61926 137938-138097 Sentence denotes Logistic regression analysis showed that APACHE II (OR = 1.312, P = 0.06) and glycerol on day 1 (OR = 1.005, P = 0.04) independently predicted patient outcome.
T5015 138098-138239 Sentence denotes Conclusions MD seems to be a safe and promising tool in grading sepsis severity and in predicting early mortality in critically ill patients.
T4915 138241-138430 Sentence denotes The muscle-specifi c infl ammatory response after strenuous exercise has some similarity with those observed in sepsis and it is used as a mirror of sepsis-specifi c infl ammatory response.
T6221 138431-138628 Sentence denotes Near-infrared spectroscopy (NIRS) has been used to quantify sepsis-induced metabolic alterations by measuring variations of tissue oxygen saturation (StO 2 ) during a vascular occlusion test (VOT).
T47740 138629-138790 Sentence denotes We aimed to investigate whether NIRS dynamic variables could refl ect the magnitude of infl ammatory process that follows strenuous exercise in marathon runners.
T71725 138791-138957 Sentence denotes Methods VOT-NIRS (InSpectra Model 650) measurement was performed before, at the fi nish line and on the day after the marathon in 13 runners (10 males/three females).
T70334 138958-139064 Sentence denotes VOT-derived NIRS traces were analyzed for StO 2downslope (R dec StO 2 ) and StO 2 -upslope (R inc StO 2 ).
T29154 139065-139211 Sentence denotes Blood samples were collected to measure C-reactive protein (CRP), procalcitonin (PCT), white blood cells (WBC), creatine kinase (CK), and lactate.
T19560 139212-139259 Sentence denotes Data are mean ± SD (in Table 1 , median (IQR)).
T47493 139260-139310 Sentence denotes P <0.05 was considered statistically signifi cant.
T72406 139311-139387 Sentence denotes The results of NIRS dynamic and hemodynamic variables are shown in Table 1 .
T40520 139388-139459 Sentence denotes R dec StO 2 was signifi cantly increased in the day after the marathon.
T31138 139460-139610 Sentence denotes Signifi cant increases in lactate (2.7 ± 0.5 vs 1.2 ± 0.3) and WBC (14 x 10 3 ± 4 vs 5 x 10 3 ± 2) were observed after the completion of the marathon.
T50385 139611-139853 Sentence denotes Serum CRP, PCT and CK were signifi cantly increased on the day after the marathon (0.6 ± 0.6 vs 12 ± 8; 0.09 ± 0.2 vs 0.7 ± 0.9; 398 ± 198 vs 1,932 ± 1,620), indicating the muscle-specifi c infl ammatory response as a result of muscle damage.
T60075 139854-140014 Sentence denotes Conclusions Delayed increase in thenar VO 2 is associated with musclespecifi c infl ammatory response after strenuous exercise as a result of the muscle damage.
T26697 140015-140158 Sentence denotes Introduction Current clinical parameters on effi ciency of resuscitation are often insuffi cient, and unable to reliably assess tissue hypoxia.
T35066 140159-140251 Sentence denotes Considerable interest has been aimed to direct monitoring of tissue oxygen tension (ptO 2 ).
T12274 140252-140299 Sentence denotes However, no golden standard has yet been found.
T73254 140300-140441 Sentence denotes Animal experimental models have shown interesting results in hypovolemic and septic shock and have lead to some interesting clinical studies.
T77063 140442-140597 Sentence denotes The purpose of this review is to evaluate the current value of ptO 2 monitoring in animal experimental studies under various pathophysiological conditions.
T55620 140598-140771 Sentence denotes Methods An electronic literature search on Pubmed and Embase databases was conducted to fi nd relevant articles on tissue oxygenation and hemorrhage, trauma and endotoxemia.
T8660 140772-140823 Sentence denotes An initial amount of 7,876 articles were retrieved.
T78220 140824-140947 Sentence denotes After applying inclusion and exclusion criteria and critical appraisal, 48 articles were ranked on their level of evidence.
T66128 140948-141049 Sentence denotes Results After screening of the 48 articles, 19 articles were found to be suitable to answer our goal.
T14607 141050-141159 Sentence denotes Ten articles discussed tissue oxygenation in a hemorrhagic model and nine articles in a model of endotoxemia.
T14630 141160-141233 Sentence denotes No relevant articles concerning ptO 2 and experimental trauma were found.
T91982 141234-141392 Sentence denotes Eight articles compared splanchnic ptO 2 measurements in relation to ptO 2 measured in several peripheral sites, like subcutaneous and skeletal muscle tissue.
T19307 141393-141468 Sentence denotes A positive correlation between these locations was found in seven articles.
T78603 141469-141571 Sentence denotes A decrease in both peripheral and central tissue oxygen pressure (ptO 2 ) was found during hemorrhage.
T90811 141572-141673 Sentence denotes Importantly, peripheral ptO 2 changed earlier during hemorrhage before any hemodynamic parameter did.
T6761 141674-141780 Sentence denotes In contrast, only one article found an earlier change in hemodynamic parameters than in peripheral ptO 2 .
T80856 141781-141838 Sentence denotes Nine articles discussed ptO 2 in a model of septic shock.
T41231 141839-141930 Sentence denotes Only two studies compared peripheral ptO 2 measurements with splanchnic ptO 2 measurements.
T52367 141931-142059 Sentence denotes Both sites had decreased ptO 2 values in endotoxemia and both were found to change before any changes in hemodynamic parameters.
T74968 142060-142218 Sentence denotes Conclusions A signifi cant relation between intestinal ptO 2 and peripheral ptO 2 was found in studies on experimental models of hemorrhagic and septic shock.
T43655 142219-142361 Sentence denotes This suggests that peripheral sites like the subcutaneous tissue or skeletal muscles tissue are reliable locations for measurements of ptO 2 .
T56860 142362-142506 Sentence denotes In all, cardiac output (CO), stroke volume (SV), pulse pressure variation (PPV), and standard hemodynamic parameters were continuously recorded.
T22928 142507-142630 Sentence denotes Fluid responsiveness was defi ned as an increase in SV >15%, after a 500 ml colloid (HEA 130/0.4) infusion over 10 minutes.
T72206 142631-142911 Sentence denotes StO 2 measurements and VOT (sphygmomanometer infl ated until >50 mmHg above systolic pressure and kept infl ated until StO 2 decreased to 40%) were performed after anaesthesia induction (baseline), and before (PPV >13%, therefore defi ning hypovolemia) and after fl uid challenge.
T75308 142912-143039 Sentence denotes Results At baseline, no patient was preload dependent (mean PPV 7.9 ± 2%), and none required vasopressors during the procedure.
T74372 143040-143142 Sentence denotes Baseline mean StO 2 was 85 ± 6%, while CO and SV were 4.9 ± 0.9 l/minute and 68 ± 21 ml, respectively.
T47202 143143-143415 Sentence denotes During hypovolemia, compared with baseline, there was no diff erence in both StO 2 (85 ± 6 to 84 ± 9%, P = 0.76) and StO 2 desaturation rate (-9.6 ± 1.6 to -11 ± 2.7%/minute, P = 0.10), while the StO 2 recovery slope was lowered (5.1 ± 1.6 to 3.8 ± 1.5%/second, P = 0.04).
T15415 143416-143465 Sentence denotes Patients were all responders to fl uid challenge.
T12324 143466-143658 Sentence denotes After volume expansion, SV (84 ± 20 vs 62 ± 12 ml, P <0.01) and CO (6.5 ± 2 vs 4.8 ± 1.2 l/minute, P <0.01) were higher, with no signifi cant changes in both StO 2 and StO 2 desaturation rate.
T50232 143659-143779 Sentence denotes Fluid challenge induced a 46% increase in StO 2 recovery slope (P <0.01; Figure 1 ), which was comparable with baseline.
T50664 143780-144005 Sentence denotes Conclusions Whilst redistribution of blood fl ow may occur during circulatory failure (vasoconstriction of lesser vital organs), impairment of microcirculation and tissue hypoperfusion indicators are of particular importance.
T49603 144006-144146 Sentence denotes Both hypovolemia and intravascular volume expansion are associated with signifi cant modifi cations in the dynamic recovery slope of StO 2 .
T18939 144147-144227 Sentence denotes Future studies are needed to better clarify its potential clinical applications.
T84594 144228-144452 Sentence denotes Introduction Although the adverse eff ects of mechanical ventilation on circulation and intestinal organ perfusion are well known, the infl uence of assisted breathing versus controlled ventilation has not been investigated.
T82069 144453-144598 Sentence denotes We hypothesized that pressure support ventilation causes less decrease in gut perfusion and less neutrophil adhesion than controlled ventilation.
T34934 144599-144757 Sentence denotes Methods Male SD rats (n = 40) were anesthetized and tracheotomized and 10 animals each ventilated in pressure support (PSV) or pressure controlled (PCV) mode.
T64419 144758-144785 Sentence denotes PCV animals were paralyzed.
T9472 144786-144852 Sentence denotes After 5 hours of ventilation, intravital microscopy was performed.
T47023 144853-144945 Sentence denotes Endotoxin (15 mg/kg lipopolysaccharide) was given to 20 rats, 20 animals served as controls.
T37464 144946-145020 Sentence denotes Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T40378 145021-145097 Sentence denotes Results There were no diff erences in baseline hemodynamics or gas exchange.
T13251 145098-145207 Sentence denotes Animals were stable over the whole observation period with minimal changes in blood pressure and oxygenation.
T28808 145208-145335 Sentence denotes In PCV, the percentage of functional capillaries in the longitudinal mucosal layer was lower (57 ± 39%) than in PSV (87 ± 33%).
T99488 145336-145411 Sentence denotes In sepsis, there was a further decrease in PCV and a major decrease in PSV.
T78744 145412-145585 Sentence denotes Leukocyte adhesion in the intestinal submocosal venules (for example, V1 venules) was higher in PCV (228 ± 119) than in PSV (93 ± 65) in controls, but not in septic animals.
T52905 145586-145709 Sentence denotes Conclusions In septic rats with preserved macrohemodynamic stability, intestinal perfusion was impaired after LPS infusion.
T49896 145710-145828 Sentence denotes Pressure-controlled ventilation had a signifi cant infl uence on microcirculation and neutrophil adhesion in controls.
T47698 145829-145939 Sentence denotes In septic animals, pressure support ventilation did not attenuate these adverse eff ects as compared with PCV.
T9631 145940-146082 Sentence denotes Introduction Central venous oxygen saturation (ScvO 2 ) has been shown to be a useful therapeutic target in septic shock or high-risk surgery.
T79049 146083-146244 Sentence denotes The central venous-to-arterial carbon dioxide diff erence (Pcv-aCO 2 ) has been proposed as a complementary tool for goal-directed therapy (GDT) in septic shock.
T82262 146245-146371 Sentence denotes We tested the hypothesis that both ScvO 2 and Pcv-aCO 2 could be used as complementary tools for GDT during high-risk surgery.
T33544 146372-146570 Sentence denotes Methods Seventy adult patients, ASA I to III, undergoing major abdominal surgery, were randomly assigned to 6 ml/kg/hour (R-GDT group, n = 36) or 12 ml/kg/hour (C-GDT group, n = 34) of crystalloids.
T40201 146571-146698 Sentence denotes Additional boluses of HES (130/0.4) were given to maintain respiratory variation in peak aortic fl ow velocity (ΔPV) below 13%.
T11249 146699-146835 Sentence denotes In both groups, ScvO 2 , cardiac output (CO), oxygen delivery (DO 2 i), Pcv-aCO 2 and postoperative complications were blindly recorded.
T9790 146836-146987 Sentence denotes Results At baseline, there were no diff erences in hemodynamic variables, ScvO 2 (79 ± 7 vs 80 ± 6, P = 0.37) and Pcv-aCO 2 (6 ± 3 vs 6 ± 2, P = 0.95).
T28543 146988-147088 Sentence denotes The total volume of fl uid perfused was larger in the C-GDT group than in the R-GDT group (P <0.01).
T90160 147089-147207 Sentence denotes The two groups showed no diff erences in intraoperative blood loss, blood transfusion, mean CO and mean DO 2 i values.
T70600 147208-147355 Sentence denotes Overall, postoperative complications were increased in the R-GDT group (P <0.01), especially postoperative sepsis occurred more often (P = 0.0064).
T15530 147356-147444 Sentence denotes Minimal ScvO 2 (minScvO 2 ) was higher in the C-GDT group (72 ± 6 vs 69 ± 6%, P = 0.04).
T55027 147445-147644 Sentence denotes In patients with complications, minScvO 2 was signifi cantly reduced (72 ± 6 vs 67 ± 6%, P = 0.0017). minScvO 2 <70% was independently associated with sepsis (OR 4.2 (95% CI 1.1 to 14.4), P = 0.025).
T93640 147645-147736 Sentence denotes Intraoperative mean Pcv-aCO 2 was higher in the R-GDT group (7 ± 3 vs 5 ± 2 mmHg, P <0.01).
T43214 147737-147850 Sentence denotes In patients who develop sepsis, Pcv-aCO 2 was higher than in patients who did not (8 ± 2 vs 5 ± 2 mmHg, P <0.01).
T75621 147851-147955 Sentence denotes In patients with ScvO 2 >70% and who develop sepsis, Pcv-aCO 2 was also signifi cantly higher (P <0.01).
T62069 147956-148141 Sentence denotes The area under the ROC curve was 0.758 (95% CI 0.71 to 0.81) for discrimination of patients with ScvO 2 >70% who did and did not develop sepsis, with 5 mmHg as the best threshold value.
T7867 148142-148317 Sentence denotes Conclusions ScvO 2 refl ects important changes in oxygen delivery in relation to oxygen needs during the perioperative period and might help guiding GDT better than ΔPV alone.
T51078 148318-148526 Sentence denotes Pcv-aCO 2 appears a useful tool to identify persistent hypoperfusion when GDT is associated with ScvO 2 >70%. is a marker of venous fl ow adequacy to remove the total CO 2 produced by peripheral tissues [1] .
T73595 148527-148617 Sentence denotes Substitution of a central for a mixed venousarterial pCO 2 diff erence is acceptable [2] .
T42035 148618-148750 Sentence denotes The objective was to assess the relationship between ΔCO 2 and SOFA score variation in patients with severe sepsis and septic shock.
T50851 148751-148789 Sentence denotes Lactate and ScO 2 were also evaluated.
TextSentencer_T362 148790-148912 Sentence denotes Methods Prospective observational study in patients with severe sepsis and septic shock admitted to an adult tertiary ICU.
TextSentencer_T363 148913-149006 Sentence denotes The management of sepsis was carried out as proposed by Surviving Sepsis Campaign guidelines.
TextSentencer_T364 149007-149153 Sentence denotes The earliest simultaneous measurement of lactate, SvcO 2 , and ΔCO 2 were obtained when clinically indicated (T0) and after 8 to 12 hours (T8-12).
TextSentencer_T365 149154-149249 Sentence denotes The SOFA score was determined at T0 and after 24 hours (T24) and ΔSOFA (T24-T0) was calculated.
TextSentencer_T366 149250-149497 Sentence denotes Conclusions Patients with hyperlactatemia in the beginning of admission, which persists with increased levels of lactate, evolve to a worsening of SOFA score in 24 hours. ΔCO 2 and SvcO 2 and its trends are unrelated to the SOFA score in 24 hours.
T87792 149498-149606 Sentence denotes The measurement of cardiac output and its adequacy to tissue needs are essential for hemodynamic evaluation.
T68321 149607-149828 Sentence denotes In a recent review it was stated that the venous-to-arterial carbon dioxide diff erence (dPCO 2 ) could be considered a marker of adequacy of venous blood fl ow to remove the total CO 2 produced by the peripheral tissues.
T58273 149829-149955 Sentence denotes Several studies have already shown that dPCO 2 and the cardiac index (CI) are inversely correlated in critically ill patients.
T92603 149956-150084 Sentence denotes However, the dPCO 2 can be infl uenced not only by CI, but also by other factors governing CO 2 production and CO 2 elimination.
T65353 150085-150238 Sentence denotes The aim of this work was to study the behaviour of dPCO 2 , measured from central venous blood, and its evolution during the early stage of septic shock.
T40218 150239-150421 Sentence denotes Methods Forty-six patients with septic shock were prospectively included. dPCO 2 was calculated by the diff erence between the arterial PCO 2 and the PCO 2 from central venous blood.
T83684 150422-150468 Sentence denotes A value of dPCO 2 >6 mmHg was considered high.
T7267 150469-150522 Sentence denotes The CI was measured by transpulmonary thermodilution.
T37297 150523-150562 Sentence denotes ScvO 2 and serum lactate were obtained.
T27567 150563-150638 Sentence denotes Patients were separated into a normal dPCO 2 group and a high dPCO 2 group.
T98697 150639-150704 Sentence denotes The results were compared by Student t test or Mann-Whitney test.
T41875 150705-150741 Sentence denotes P <0.05 was chosen as signifi cance.
T69964 150742-150800 Sentence denotes Results At inclusion 24 patients (52%) had a high dPCO 2 .
T6968 150801-150960 Sentence denotes These patients had a lower CI (3.5 ± 1.1 vs 4.2 ± 0.99 l/min/m 2 , P = 0.04) and lower ScvO 2 (57 ± 17 vs 71 ± 8%, P <0.001) than patients with normal dPCO 2 .
T59815 150961-151078 Sentence denotes No diff erence was found in PaCO 2 or PaO 2 /FiO 2 levels between both groups, suggesting a similar CO 2 elimination.
T83279 151079-151274 Sentence denotes Thirteen patients had a decrease in dPCO 2 from above to below 6 mmHg (from 8 ± 2 to 5 ± 1 mmHg, P = 0.001) associated with an increase in CI (from 3.7 ± 1.3 to 4.2 ± 1.3 l/min/ m 2 , P = 0.003).
T9341 151275-151398 Sentence denotes Conversely, 11 patients had an increase in dPCO 2 from below to above 6 mmHg (from 3.8 ± 2.4 to 7.7 ± 2.6 mmHg, P = 0.002).
T64292 151399-151489 Sentence denotes In these patients, CI decreased (from 4.3 ± 1.3 to 3.5 ± 1 l/min/m 2 , P = 0.013) equally.
T60352 151490-151662 Sentence denotes A negative correlation was established between dPCO 2 and CI (r 2 = 0.40, P <0.001) and between changes in dPCO 2 and change in CI (r 2 = 0.16, P = 0.008) during the study.
T85489 151663-151708 Sentence denotes The lactate level was similar in both groups.
T25362 151709-151766 Sentence denotes The ScvO 2 was correlated with CI (r 2 = 0.44, P <0.001).
T60482 151767-152005 Sentence denotes Conclusions dPCO 2 patients with septic shock seem to be related principally to CI. dPCO 2 might be a marker of tissue perfusion adequacy to patient's metabolism and could be a resuscitation target for management of septic shock patients.
T40363 152006-152127 Sentence denotes Introduction High lactate (LCT) identifi es critically ill patients, predicts risk of mortality and guides resuscitation.
T93285 152128-152241 Sentence denotes Low central venous oxygen saturation (SvO 2 ) is associated with mortality and is used as a resuscitation target.
T30275 152242-152314 Sentence denotes A change in LCT, but not in SvO 2 , has been shown to relate to outcome.
T56750 152315-152468 Sentence denotes It is physiologically plausible that those with low SvO 2 and high LCT do worse versus those with only one of SvO 2 or LCT abnormal, or with both normal.
T91851 152469-152564 Sentence denotes Early changes in these combinations may also determine subsequent changes in organ performance.
T44985 152565-152703 Sentence denotes We hypothesised that changes in combinations in SvO 2 and LCT from day 1 to day 2 predicted changes in total SOFA between day 2 and day 4.
T34084 152704-152823 Sentence denotes Methods We used a retrospective cohort methodology using data obtained from the electronic clinical information system.
T75689 152824-152967 Sentence denotes All included patients underwent LCT and SvO 2 measurement (from internal jugular or subclavian vein) in the fi st 24 hours after ICU admission.
T25110 152968-153085 Sentence denotes Baseline (demographic, physiological), daily follow-up (physiological, SOFA) and 30-day mortality data were recorded.
T9635 153086-153169 Sentence denotes Worst admission values were used to combine SvO 2 /LCT into four groups (SL groups:
T4374 153170-153225 Sentence denotes 0 to 3) dichotomised by mean (SvO 2 ) and median (LCT):
T87842 153226-153257 Sentence denotes 0 -N/N; 1 -L/N; 2 -N/H; 3 -L/H.
T46328 153258-153497 Sentence denotes Variables individually associated (P <0.20) with a change in total SOFA between day 2 and day 4 were included in a multivariate linear regression model (with change in total SOFA as the dependent variable) using forward stepwise inclusion.
T26005 153498-153559 Sentence denotes Variables with adjusted P <0.05 remained in the fi nal model.
T44750 153560-153608 Sentence denotes Results A total of 1,544 patients were included.
T17193 153609-153679 Sentence denotes Complete data on all change variables were available for 675 patients.
T98450 153680-153744 Sentence denotes Mean (SD) SvO 2 was 63.6 (11.3) and median (IQR) LCT 3.85 (4.3).
T91394 153745-153840 Sentence denotes Mean (SD) APACHE II and age were 22.4 (6.2) and 64.9 (15.9), respectively, and 61.9% were male.
T22164 153841-153910 Sentence denotes The mean fall (SD) in total SOFA from day 2 to day 4 was 1.05 (2.78).
T37119 153911-153926 Sentence denotes APACHE II (adj.
T29038 153927-153958 Sentence denotes P <0.001), day 1 SL group (adj.
T645 153959-153984 Sentence denotes P = 0.019) and SOFA (adj.
T7812 153985-154034 Sentence denotes P <0.001), and C-reactive protein >209 mg/l (adj.
T91384 154035-154088 Sentence denotes P = 0.006) were independently associated with Δ-SOFA.
T67862 154089-154170 Sentence denotes Changes in SL group were not associated with improvements in organ function (adj.
T61393 154171-154181 Sentence denotes P = 0.12).
T43262 154182-154348 Sentence denotes Conclusions APACHE II, SL group and total SOFA (both on day 1) and C-reactive protein >209 mg/l were associated with worsening organ function between day 2 and day 4.
T74670 154349-154448 Sentence denotes Improvement in combinations of SvO 2 and LCT were not associated with changes in organ performance.
T17219 154449-154575 Sentence denotes concept, alternative sets of lactate production, nowadays, challenges our comprehension about oxygen delivery and consumption.
T14184 154576-154716 Sentence denotes Recent studies have shown the prognostic value of oxygen and lactate gradients measured from central venous to pulmonary artery circulation.
T89294 154717-154890 Sentence denotes Our data represent one sample of our 4-year experimental research, trying to build a conceptual framework related to oxygen and lactate dynamic in diff erent hypoxic states.
T52821 154891-154961 Sentence denotes Methods Sixteen large white pigs (35 kg) and seven shams were studied.
T19536 154962-155174 Sentence denotes After anesthesia and full monitorization (EKG, MAP, etCO 2 , continuous gas analysis, Doppler portal fl ow, small bowel tonometry, liver tpO 2 and urine output), abdominal sepsis was induced by fecal peritonitis.
T81489 155175-155552 Sentence denotes Conclusions Our preliminary data show high rates of oxygen extraction rates in coronary circulation and suggest apparent lactate consumption by heart and lactate production by the lung, during experimental sepsis. of the present study is to clarify whether metformin can increase cellular lactate production by inhibiting mitochondrial function in tissues other than the liver.
T8326 155553-155674 Sentence denotes Methods Platelet-rich-plasma (PRP) from healthy volunteers was incubated for 72 hours with diff erent doses of metformin.
T16639 155675-155726 Sentence denotes The plasma lactate concentration was then measured.
T98410 155727-155879 Sentence denotes The proportion of normally polarized vs abnormally depolarized platelet mitochondria (FL2/FL1) was assessed by fl ow cytometry after staining with JC-1.
T32770 155880-156032 Sentence denotes Platelet respiratory chain complex I activity and citrate synthase (CS) activity, a marker of mitochondrial content, were measured by spectrophotometry.
T50358 156033-156066 Sentence denotes Data are presented as means ± SD.
T34032 156067-156109 Sentence denotes Analysis was performed with one-way ANOVA.
T9242 156110-156148 Sentence denotes Main results are reported in Table 1 .
T33513 156149-156242 Sentence denotes Conclusions Metformin can cause hyperlactatemia by impairing platelet mitochondrial function.
T33113 156243-156339 Sentence denotes Introduction A patient presented with severe acidosis, point-of-care (POC) lactate of 42 mmol/l.
T5660 156340-156419 Sentence denotes This led to suspicion of mesenteric ischemia and potential need for laparotomy.
T14847 156420-156523 Sentence denotes However, plasma lactates were <4 mmol/l, and ethylene glycol (EG) ingestion was subsequently diagnosed.
T50733 156524-156720 Sentence denotes We therefore wished to determine why discrepant lactates occur and whether this lactate gap (that is, the diff erence between lactate measured using two common methods) could be clinically useful.
T53372 156722-156852 Sentence denotes Lactate is an important substrate for intermediary metabolism and allows movement of carbon and reducing power between cells [1] .
T38529 156853-156973 Sentence denotes Its use as a measure of end organ perfusion and as a marker of tissue hypoxia in the critically ill is well established.
T7137 156974-157081 Sentence denotes It is suggested that a rise in serum lactate is a sensitive indicator of poor prognosis in this group [2] .
T68539 157082-157163 Sentence denotes We wished to identify whether or not this was the case in our patient population.
T24680 157164-157306 Sentence denotes Methods A retrospective case note review of 504 consecutive admissions to Glasgow Royal Infi rmary ICU was undertaken over an 18-month period.
T92429 157307-157440 Sentence denotes Serum lactate on initial blood gas analysis following admission to intensive care was retrieved from the clinical information system.
T55349 157441-157542 Sentence denotes Demographic, APACHE II score and outcome data were retrieved from the Ward Watcher system in the ICU.
T28490 157543-157617 Sentence denotes Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T37422 157618-157666 Sentence denotes Results A total of 1,544 patients were included.
T27379 157667-157776 Sentence denotes Complete data to calculate day 1 and day 3 parameters were available in 1,070 and 656 patients, respectively.
T91489 157777-157812 Sentence denotes Overall 30-day mortality was 21.3%.
T70786 157813-157893 Sentence denotes Mean (SD) age and APACHE II score were 63.0 (16.4) and 21.6 (6.9), respectively.
T55016 157894-158072 Sentence denotes For survivors versus nonsurvivors there were signifi cant diff erences in baseline SIDa (P = 0.03), iSIDa, SIDe, lactate and base excess (all P <0.001), but not in SIG (P = 0.1).
T12807 158073-158223 Sentence denotes An increased SIDa (P = 0.015) and SIDe (P <0.001), and decreased iSIDa and lactate (all P <0.001) but not SIG (P = 0.09) were predictive of mortality.
T77634 158224-158427 Sentence denotes For day 1 to day 3, only Δ-SIG was weakly predictive of mortality (OR 1.03 per 1 unit increase, P = 0.04, 95% CI = 1.00 to 1.05, n = 656) but there was no diff erence between survival groups (P = 0.051).
T64609 158428-158652 Sentence denotes Conclusions This study confi rms recent data suggesting baseline diff erences (but not changes over 3 days) in the relationships between strong and weak ions and pCO 2 (refl ected in SIDa, lactate, and impacts on mortality).
T51812 158653-158766 Sentence denotes The diff erent eff ects observed for SIG and BE imply a signifi cant unmeasured acid load infl uencing mortality.
T42259 158767-158870 Sentence denotes Bias and confounding may aff ect these fi ndings and they should therefore be confi rmed prospectively.
T29084 158871-159034 Sentence denotes Introduction Intubation and mechanical ventilation impair secretion clearance and can lead to lung collapse, consolidation and ventilatorassociated pneumonia [1] .
T96778 159035-159136 Sentence denotes There is, however, no valid diagnosis of secretion retention in the intubated and ventilated patient.
T3886 159137-159272 Sentence denotes Vibration response imaging (VRI) is a commercially developed acoustic lung imaging system that displays breath sound distribution [2] .
T51102 159273-159387 Sentence denotes VRI should be able to identify relationships between specifi c breath sound distributions and secretion retention.
T29040 159388-159549 Sentence denotes This preliminary study investigated the changes in VRI measurements before and after chest physiotherapy in adult intubated and mechanically ventilated patients.
T38227 159550-159655 Sentence denotes Methods Intubated and ventilated adult patients who were receiving chest physiotherapy were investigated.
T72693 159656-159839 Sentence denotes Lung sound amplitude at peak inspiration was measured immediately before and after chest physiotherapy using two arrays of sensors attached to the patient's back in a supine position.
T78814 159840-160028 Sentence denotes Chest physiotherapy included combinations of closed airway suctioning, saline lavage, postural drainage, manual techniques and/or lung hyperinfl ation, dependent upon clinical indications.
T89874 160029-160098 Sentence denotes Means are compared with the Wilcoxon matched-pairs signed-ranks test.
T41253 160099-160195 Sentence denotes Results A total of 16 patients were included in the study (12 males, four females, age 65 ± 14).
T51721 160196-160297 Sentence denotes Patients were predominantly ventilated with continuous positive airway pressure and pressure support.
T50925 160298-160500 Sentence denotes Following physiotherapy, total lung sound amplitude at peak inspiration decreased twofold from 37 ± 58.10 6 to 18 ± 23.10 6 arbitrary units (AU), with signifi cant reduction in the left lung (P = 0.03).
T58323 160501-160655 Sentence denotes Furthermore, the diff erence in sound amplitude between right and left lungs signifi cantly decreased posttreatment compared with pretreatment (P = 0.03).
T48975 160656-160827 Sentence denotes Conclusions Computerized lung sound monitoring may be useful to assess secretion retention and the eff ectiveness of secretion removal in mechanically ventilated patients.
T20003 160828-160999 Sentence denotes Further investigation is, however, necessary in order to distinguish between secretion-related eff ects and changes due to other factors such as airfl ow rate and pattern.
T99043 161000-161086 Sentence denotes Introduction Posterior auscultation of mechanically ventilated patient is challenging.
T38385 161087-161174 Sentence denotes Environmental ICU noises make the detection of subtle auscultatory features diffi cult.
T49841 161175-161257 Sentence denotes Digitalized pulmonary acoustic monitoring has recently been introduced in the ICU.
T63129 161258-161338 Sentence denotes We explored the possibility to listen to sound waves recorded by the VRI system.
T67542 161339-161493 Sentence denotes Methods Lung sounds were recorded for 20 seconds using two arrays of 17 piezoelectric contact sensors attached to the patient's back in a supine position.
T21320 161494-161559 Sentence denotes Sound fi les were archived in a WAV format for offl ine analysis.
T95694 161560-161787 Sentence denotes Three physicians and one trained respiratory therapist, blinded to the patient's clinical status, provided their fi ndings while listening to sound waves recorded by 12 sensors distributed from apex to base, six from each lung.
T49335 161788-161925 Sentence denotes Breath sounds were categorized as normal versus abnormal and adventitious lung sounds were characterized as wheezes, rhonchi or crackles.
T37746 161926-162052 Sentence denotes Findings were compared with anterior stethoscope auscultation performed at the time of the recording by one of the physicians.
T59217 162053-162160 Sentence denotes Results Eighteen critically ill mechanically ventilated patients (age 65 ± 17) were enrolled in this study.
T55432 162161-162233 Sentence denotes Chest radiography (CXR) fi ndings included consolidation in 13 patients.
T71157 162234-162328 Sentence denotes There was an agreement among at least three clinicians in the normal/abnormal classifi cation.
T47130 162329-162481 Sentence denotes Furthermore, in 10 out of these 15 patients (67%), this assessment based on sound wave analysis was in agreement with anterior stethoscope auscultation.
T89282 162482-162728 Sentence denotes Finally, the physician who performed both sound wave analysis and stethoscope auscultation reported crackles/rhonchi in fi ve out of 13 patients with consolidation (38%) during sound wave analysis but only in one patient during auscultation (8%).
T69329 162729-162888 Sentence denotes Conclusions The level of interobserver variability for sound wave characterization was comparable with levels usually reported during stethoscope auscultation.
T55120 162889-163062 Sentence denotes However, in patients with consolidation, a higher number of crackles/rhonchi was reported during posterior sound wave analysis than during anterior stethoscope auscultation.
T28343 163063-163201 Sentence denotes This discrepancy may be either due to the anterior/posterior orientation or to the higher sensitivity of the offl ine sound wave analysis.
T3600 163202-163332 Sentence denotes Introduction Knowledge of micromechanical properties of lung parenchyma is essential for understanding macroscopic lung mechanics.
T97656 163333-163437 Sentence denotes The fi rst results of in vivo and in situ measurements using an endomicroscopic device [1] are reported.
T77060 163438-163526 Sentence denotes The degree of local lung deformation in dependence of locally applied pressure is shown.
T43312 163527-163675 Sentence denotes Methods An endoscopic system including two concentric trocars was constructed to apply a defi ned local pressure within the fi eld of view (P fov ).
T10320 163676-163792 Sentence denotes The endoscopic system was placed between the ribs of mechanically ventilated rats with the tip placed on the pleura.
T57000 163793-163886 Sentence denotes P fov was applied to a circular area on to the lungs' surface and led to a local deformation.
T51117 163887-163999 Sentence denotes By adjusting the fl ow rate of the fl ushing fl uid from the outer trocar to the inner trocar, P fov was varied.
T17129 164000-164161 Sentence denotes The resulting local deformation of lung parenchyma was optically measured by estimating the diameter of ceramic particles, fi xed on the pleura for that purpose.
T40908 164162-164272 Sentence denotes Deformation was measured at diff erent levels of airway pressure (P aw ) with P fov ramped from 0 to -40 mbar.
T56130 164273-164412 Sentence denotes The healthy lung ( Figure 1A ) parenchyma showed less deformation caused by fl uidic pressure compared with the lavaged lung ( Figure 1B) .
T79173 164413-164520 Sentence denotes In contrast to the lavaged lung, the deformation of the healthy lung was less when higher P aw was present.
T37329 164521-164624 Sentence denotes Conclusions Micromechanical properties of lung parenchyma can be analyzed in vivo at an alveolar level.
T41739 164625-164711 Sentence denotes The healthy lung parenchyma appears to be stiff er (less deformation) at higher P aw .
T36932 164712-164943 Sentence denotes The stronger deformation and less dependence on airway pressure in the lavaged lung support the hypothesis that small lung compliance in lavaged lungs might not be reasoned by stiff lung parenchyma, but rather by regional collapse.
T85948 164944-165197 Sentence denotes References At every step we studied the changes of FRC, C rs , PaO 2 /FIO 2 ratio and performed a transthoracic echocardiography (Agilent 5500; Hewlett and Packard) to evaluate the integral of velocity time of left ventricular outfl ow tract (LVOT VTI).
T65141 165198-165233 Sentence denotes All data are reported as mean ± SD.
T12865 165234-165284 Sentence denotes ANOVA was used to compare changes during the time.
T67102 165285-165340 Sentence denotes Results Table 1 presents the main results of the study.
T95004 165341-165497 Sentence denotes Best PEEP was set at 10 cmH 2 O, at which level the decrease of FRC and improvement of C rs indicates the start of de-recruitment and end of overdistention.
T68461 165498-165625 Sentence denotes Introduction Electrical impedance tomography (EIT) is a promising new tool for bedside monitoring of regional lung ventilation.
T64771 165626-165760 Sentence denotes Several studies have focused on the ventilation distribution and relationship with regional lung volume on a lower, caudal lung level.
T2315 165761-165830 Sentence denotes However, no information is available at a higher, cranial lung level.
T74525 165831-165982 Sentence denotes Methods EIT (EIT Evaluation Kit 2; Dräger, Lübeck, Germany) was measured at cranial and caudal lung levels in 10 patients after cardiothoracic surgery.
T52412 165983-166116 Sentence denotes Patients were fully sedated and mechanically ventilated and a PEEP trial was performed at four PEEP levels (15, 10, 5 and 0 cmH 2 O).
T62394 166117-166247 Sentence denotes The center of gravity index decreased after lowering the PEEP level at both the caudal and cranial lung levels ( Figure 1 right) .
T11157 166248-166441 Sentence denotes Whereas the tidal volume impedance variation divided by tidal volume increased at the cranial lung level and decreased at the caudal lung level during the step-wise reductions in PEEP (Figure 1
T63020 166443-166613 Sentence denotes Conclusions During decremental PEEP steps, the ventilation distribution not only shifts from a dorsal to ventral direction, but also from the caudal to cranial direction.
T70538 166614-166769 Sentence denotes Introduction Electrical impedance tomography (EIT) is a promising bedside tool for monitoring regional lung ventilation during mechanical ventilation [1] .
T55446 166770-166970 Sentence denotes The purpose of this study was to assess regional lung ventilation by EIT in a pig model of acid-induced acute lung injury (ALI) during pressurecontrolled (PCV) and volume-controlled ventilation (VCV).
T99716 166971-167213 Sentence denotes Methods Ten anesthetized and tracheotomized female pigs (25 to 30 kg) were randomized into two groups: mechanical ventilation by PCV (pressure adjusted to achieve and maintain 8 ml/kg tidal volume, n = 5) or VCV (8 ml/kg, n = 5) in FiO 2 50%.
T3570 167214-167316 Sentence denotes ALI was induced in both groups by intratracheal instillation of 4 ml/kg hydrochloric acid (HCl) 0.1 N.
T51602 167317-167546 Sentence denotes Impedance changes (Draeger, Germany) were recorded by a 16-electrode belt placed at the level of the sixth intercostal space, and four horizontal, equally-sized regions of interest (ROIs) were defi ned for offl ine data analysis.
T34515 167547-167619 Sentence denotes Measurements were performed before (T-BL) and after lung injury (T-ALI).
T44539 167620-167808 Sentence denotes Lung tidal volume (Vt), pulmonary static compliance (C stat ), pulmonary mean artery pressure (mPAP), peak pressure (P p ), respiratory rate (RR) and PaO 2 /FiO 2 ratio were also recorded.
T32708 167809-167999 Sentence denotes Statistical analysis was based on two-way ANOVA followed by the Tukey test for analysis of data within and between groups, and a t test was used analysis of impedance changes induced by ALI.
T86023 168000-168159 Sentence denotes Introduction Electrical impedance tomography (EIT) is a non-invasive bedside imaging tool with the potential to assess regional lung ventilation reliably [1] .
T64472 168160-168291 Sentence denotes The purpose of this study was to monitor changes in lung impedance in a pig model of severe shock followed by fl uid resuscitation.
T41142 168292-168453 Sentence denotes Methods Twelve anesthetized, mechanically ventilated (8 ml/kg, PEEP 5 cmH 2 O), supine pigs were submitted to acute hemorrhagic shock with infusion of endotoxin.
T95891 168454-168652 Sentence denotes Animals were allocated to positive control (PC, n = 6) or treatment group with lactated Ringer's to achieve and maintain pulse pressure variation 13% and mean arterial pressure 65 mmHg (PPV, n = 6).
T7316 168653-168794 Sentence denotes Ventilatory and hemodynamic parameters were recorded at baseline, 1 hour after hemorrhagic shock (Tshock), and hourly for 3 hours (T1 to T3).
T71356 168795-168909 Sentence denotes A 16-electrode belt was placed at the level of the sixth intercostal space for EIT measurements (Dräger, Germany).
T66757 168910-169016 Sentence denotes Offl ine analysis was based on four horizontal regions of interest (ROIs) over the ventrodorsal lung area.
T48832 169017-169102 Sentence denotes Statistical analysis was based on two-way ANOVA followed by the Tukey test (P <0.05).
T14976 169103-169371 Sentence denotes At Tshock there was hemodynamic compromise, statistical decrease in lung compliance (C stat ) and signifi cant increases in pulmonary vascular resistance index, mean pulmonary artery pressure and peak pressure (P peak ), with no statistical diff erence between groups.
T70688 169372-169459 Sentence denotes Endpoints and hemodynamic stability were achieved in the PPV group in 117 ± 28 minutes.
T75498 169460-169550 Sentence denotes C stat continued to deteriorate and P peak continued to rise in both groups from T1 to T3.
T7824 169551-169747 Sentence denotes When compared with PC, the PPV group had signifi cant impedance increases in ROIs 1 and 2 at T2 and T3 and, at T3 the increase in ROI 1 was also statistically greater than Tshock within the group.
T95910 169748-169900 Sentence denotes Statistical decrease in the percentage tidal distribution in ROI 3 and increase in ROI 2 of the PPV group, in relation to the PC group, were also noted.
T82595 169901-170224 Sentence denotes Conclusions Despite re-establishment of hemodynamic adequacy in PPV group and although ventilatory parameters were similar in both groups over time, resuscitation as performed in the study induced signifi cant changes in tidal impedance toward nondependent lung regions, implying greater lung impairment in treated animals.
T40040 170225-170427 Sentence denotes Introduction At the bedside, but even in most research work, the analysis of respiratory system mechanics is limited to quasi-static conditions excluding any insight into what happens during the breath.
T58459 170428-170487 Sentence denotes The new gliding-SLICE method helps looking into the breath.
T67375 170488-170717 Sentence denotes It is a further development of the SLICE method for calculating compliance and resistance of subsequent intratidal volume ranges (slices) of the pressurevolume (PV) loop by multiple linear regression analysis in a continuous way.
T36346 170718-170821 Sentence denotes This allows for detecting intratidal compliance and resistance nonlinearity during ongoing ventilation.
T87640 170822-170996 Sentence denotes Our objective was to determine whether the nonlinear intratidal compliance profi le hints at what level to set PEEP and tidal volume (VT) to make lung ventilation protective.
T17878 170997-171080 Sentence denotes Methods In 12 piglets, atelectasis was induced by application of negative pressure.
T15752 171081-171218 Sentence denotes The PV relationship and the ECG signal were recorded during mechanical ventilation at diff erent levels of end-expiratory pressure (PEEP:
T73121 171219-171268 Sentence denotes 0, 5, 10 and 15 cmH 2 O) and a VT of 12 ml/kg BW.
T85274 171269-171413 Sentence denotes Using the gliding-SLICE method [1] , intratidal compliance profi les were calculated and compared with the conventional quasi-static compliance.
T92570 171414-171596 Sentence denotes Results In contrast to quasi-static compliance, the gliding-SLICE method revealed pronounced intratidal nonlinearity of the compliance profi le under ongoing ventilation (Figure 1 ).
T56968 171597-171785 Sentence denotes At low levels of PEEP, intratidal compliance increased in the low volume range, remained at a high level while further volume was delivered, and fi nally decreased with volume >6 ml/kg BW.
T50249 171786-171876 Sentence denotes With higher levels of PEEP, intratidal compliance decreased from the onset of inspiration.
T50310 171877-172012 Sentence denotes Conclusions The gliding-SLICE method gives detailed insights into the intratidal course of compliance during uninterrupted ventilation.
T85076 172013-172190 Sentence denotes From Introduction Heartbeats transfer mechanical energy to the lungs causing fl ow and pressure disturbances that appear as cardiogenic oscillations (COS) at the airway opening.
T29200 172191-172263 Sentence denotes Here we adopt a new approach for analyzing respiratory system mechanics.
T87737 172264-172427 Sentence denotes We consider the beating heart as a natural intrathoracic mechanical oscillator transferring mechanical energy to the lungs that travels across the lung parenchyma.
T94064 172428-172529 Sentence denotes COS therefore convey information on the mechanical conditions of the lung parenchyma that they cross.
T96893 172530-172743 Sentence denotes Methods In 25 piglets with either healthy or atelectatic lungs, the pressurevolume relationship and the ECG signal were recorded during mechanical ventilation at diff erent levels of end-expiratory pressure (PEEP:
T3759 172744-172769 Sentence denotes 0, 5, 10 and 15 cmH 2 O).
T24670 172770-172942 Sentence denotes The heartbeat-related disturbance of the PV loop was quantifi ed as the maximal compliance following an R-wave in the ECG signal, as determined by the gliding-SLICE method.
T30468 172943-172974 Sentence denotes Atelectasis was assessed by CT.
T92413 172975-173083 Sentence denotes The intratidal pattern of heartbeat-induced C COS changed with PEEP and atelectasis in a characteristic way.
T65623 173084-173351 Sentence denotes With PEEP and tidal volume levels assumed to be lung protective C COS was high with little intratidal changes, compared with atelectasis and overdistension that were signaled by low C COS that either increased (atelectasis) or decreased (overdistension) intratidally.
T33758 173352-173501 Sentence denotes The systolic pressure variations did not parallel the C COS pattern, hinting at a negligible impact of hemodynamics on the inspiratory C COS pattern.
T71639 173502-173699 Sentence denotes Conclusions Heartbeats induce fl uctuations in the PV loop and, as a consequence, peaks in compliance, which show characteristic patterns depending on the presence of atelectasis or overdistension.
T72895 173700-173946 Sentence denotes The gliding-SLICE method has the potential to detect those intratidal nonlinearities without requiring additional technical equipment making use of the ECG signal and the pressure and fl ow signals already required for controlling the ventilator.
T68772 173947-174068 Sentence denotes Introduction Setting the optimal level of positive end-expiratory pressure (PEEP) in the ICU is still a matter of debate.
T80081 174069-174216 Sentence denotes Talmor and colleagues used the transpulmonary pressure calculated from the oesophageal balloon to set PEEP in a recent randomized controlled study.
T82533 174217-174351 Sentence denotes This strategy aims at preventing alveolar collapse by counterbalancing the gravitational force of the lung by an equal or higher PEEP.
T9224 174352-174490 Sentence denotes We evaluated the relation between ventilation distribution measured by EIT and transpulmonary pressure during a PEEP trial in porcine ALI.
T62403 174491-174625 Sentence denotes Methods Eight pigs (30 kg) were studied during a PEEP trial before and after the induction of acute lung injury (ALI) with oleic acid.
T34407 174626-174739 Sentence denotes Global lung parameters, regional compliance, and oesophageal pressure were recorded at the end of each PEEP step.
T24583 174740-174897 Sentence denotes Regional compliance was calculated by dividing the tidal impedance variation (EIT Evaluation Kit 2; Dräger, Lübeck, Germany) by the applied driving pressure.
T91765 174898-175101 Sentence denotes Results Transpulmonary pressures were negative at 0 cmH 2 O PEEP and became positive during the stepwise increase of PEEP at 5 cmH 2 O before, and 10 cmH 2 O PEEP after the induction of ALI ( Figure 1 ).
T70885 175102-175229 Sentence denotes Optimum regional compliance was diff erent between the ventral (nondependent) and dorsal (dependent) regions of interest (ROI).
T65454 175230-175388 Sentence denotes In the healthy lung, optimum PEEP was 10 in the dorsal ROI and 5 in the ventral ROI, whereas after ALI this was 15 in the dorsal ROI and 5 in the ventral ROI.
T88682 175389-175666 Sentence denotes Conclusions If EIT is measured at a caudal lung level, optimal EIT PEEP in the dependent lung exceeds the PEEP required for positive transpulmonary pressures as used in the Talmor study, whereas in the nondependent lung optimal EIT PEEP is equal before ALI and lower after ALI.
T56143 175667-175782 Sentence denotes We speculate that this is probably infl uenced by the location of the EIT slice in the cranial to caudal direction.
T68544 175783-176123 Sentence denotes A prospective pilot study of the eff ect of neutrophil elastase on the pulmonary vascular permeability in patients with pneumonia T Tagami Introduction Some cases of pneumonia may lead to hypoxemia with acute respiratory failure, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS), which may require intensive management.
T30750 176124-176338 Sentence denotes Neutrophil elastase is thought to be one of the causes of ALI/ARDS, because it raises the pulmonary capillary permeability, lyses of pulmonary connective tissue proteins, and produces leukocyte chemotactic factors.
T40301 176339-176573 Sentence denotes However, a causal relationship between the plasma neutrophil elastase level and changes in the pulmonary capillary permeability has not been established in patients with pneumonia, one of the most serious diseases underlying ALI/ARDS.
T75705 176574-176771 Sentence denotes Therefore, the objective of this study was to determine whether an increase in plasma neutrophil elastase is related to elevation of the pulmonary capillary permeability in patients with pneumonia.
T68788 176772-176970 Sentence denotes Methods Patients with pneumonia who were hospitalized from November 2008 to April 2009 and had PaO 2 ≤60 in room air with no need for mechanical ventilation were prospectively enrolled in the study.
T90883 176971-177097 Sentence denotes Plasma neutrophil elastase levels were collected via blood samples at baseline; 1, 3, and 7 days after the start of the study.
T75818 177098-177355 Sentence denotes Of those enrolled, patients with PaO 2 /FiO 2 ≤150 also had their extravascular lung water index (EVLWi) and pulmonary vascular permeability index (PVPI) monitored using the PiCCO system (Pulsion, Munich, Germany) when required by their attending physician.
T92113 177356-177482 Sentence denotes Statistical analysis was performed using the Spearman correlation coeffi cient (R s ) with P ≤0.05 assumed to be signifi cant.
T21152 177483-177536 Sentence denotes Results Fourteen patients were enrolled in the study.
T36694 177537-177611 Sentence denotes In six of these patients, the EVLWi and PVPI were measured simultaneously.
T65522 177612-177732 Sentence denotes At baseline, the elastase level and the PVPI showed a strong and signifi cant correlation (R s = 1.000, n = 6, P <0.05).
T32111 177733-177913 Sentence denotes All of the plot data of the six patients showed strong correlations of the elastase level with the EVLWi (R s = 0.750, n = 25, P <0.01) and the PVPI (R s = 0.811, n = 25, P <0.01).
T74271 177914-178034 Sentence denotes The plasma neutrophil elastase level and the PVPI measured by PiCCO were strongly correlated in patients with pneumonia.
T94051 178035-178286 Sentence denotes This suggests that a rise in the blood level of elastase may elevate the PVPI, resulting in an Introduction Acute lung injury (ALI), and its more severe subset acute respiratory distress syndrome (ARDS), are a major cause of mortality in the ICU [1] .
T43016 178287-178451 Sentence denotes Mechanical ventilation, a supportive therapy necessary to sustain life in many cases, may contribute to and worsen ALI, termed ventilatorinduced lung injury (VILI).
T62271 178452-178512 Sentence denotes Fibroproliferation is an early response to lung injury [2] .
T30278 178513-178627 Sentence denotes Indeed, dysregulated repair resulting in pulmonary fi brosis may be at the heart of ventilator dependence in ARDS.
T74515 178628-178791 Sentence denotes Characterising the role of excessive lung stretch in contributing to aberrant repair mechanisms would assist in developing strategies to hasten recovery from ARDS.
T54369 178792-178959 Sentence denotes Methods Male Sprague-Dawley rats were anaesthetized, orotracheally intubated and subjected to injurious ventilation until a defi ned worsening of compliance was noted.
T87235 178960-179003 Sentence denotes The rats were then recovered and extubated.
T92415 179004-179119 Sentence denotes The level of ongoing injury/repair was characterised at time periods of 6, 24 and 48 hours and at 4, 7 and 14 days.
T35265 179120-179279 Sentence denotes Systemic oxygenation, lung compliance, wet/dry ratio, BAL total protein, cytokines and cell count and histological analysis was carried out at each time point.
T27533 179280-179439 Sentence denotes The results demonstrated a time-course-dependent improvement in compliance and oxygenation, together with clearance of neutro philic infi ltration at 96 hours.
T6346 179440-179533 Sentence denotes TNFα, and IL-1β, IL-6 and IL-10 were signifi cantly elevated in BAL fl uid early post injury.
T58738 179534-179764 Sentence denotes Although total lung collagen remained similar at all time points, evidence of an early fi broproliferative response was present in the form of transforming growth factor-β activation and pro-collagen I and III peptide mRNA levels.
T76005 179765-179859 Sentence denotes Matrix metalloproteinase 3 and 9 zymography demonstrated increased levels of these matrikines.
T80968 179860-179977 Sentence denotes Histologic assessment of injury revealed increased alveolar tissue fraction up to and including 96 hours post injury.
T96229 179978-180097 Sentence denotes Myofi broblasts were present in α-smooth muscle actin stained sections in signifi cantly increased numbers post injury.
T31423 180098-180419 Sentence denotes Conclusions This rat model of repair of VILI demonstrates some of the mechanisms by which excessive lung stretch can contribute to fi broproliferation in ARDS and will serve to improve our knowledge of aberrant lung tissue remodelling as well as provide a useful paradigm for testing strategies to hasten recovery in ALI.
T4800 180421-180554 Sentence denotes The eff ects of hemorrhagic shock on respiratory system mechanics have rarely been investigated and published data are controversial.
T47516 180555-180647 Sentence denotes Pulmonary compliance depends in part on intrapulmonary blood and interstitial fl uid volume.
T21847 180648-180753 Sentence denotes When compliance is severely reduced, small modifi cation of these components may have important eff ects.
T42735 180754-180905 Sentence denotes The present analysis explored the eff ect of hemorrhagic shock on respiratory system mechanics and oxygenation parameters in a model of pigs with ARDS.
T90102 180906-181040 Sentence denotes Methods We evaluated the dynamic respiratory system compliance (C rs = VT / (inspiratory airways pressure -PEEP)) of 14 domestic pigs.
T20185 181041-181160 Sentence denotes Animals were mechanically ventilated: tidal volume (VT) set at 10 ml/kg; respiratory rate at 15 bpm; PEEP at 0 cmH 2 O.
T42595 181161-181239 Sentence denotes Animals were separated into a control group (n = 9) and an ARDS group (n = 5).
T33469 181240-181287 Sentence denotes ARDS was induced by lung lavage with NaCl 0.9%.
T8511 181288-181348 Sentence denotes During hemorrhage 40% of the total blood volume was removed.
T63531 181349-181408 Sentence denotes The blood was then infused during the re-transfusion phase.
T68845 181409-181513 Sentence denotes In the control group, C rs (ml/cmH 2 O) did not change during hemorrhage or re-transfusion ( Figure 1 ).
T11965 181514-181613 Sentence denotes In the ARDS group, C rs decreased with lung lavage (31.2 ± 5.7 (baseline) to 16.4 ± 3.0; *P <0.01).
T49598 181614-181763 Sentence denotes After hemorrhage C rs increased (21.5 ± 2.9; **P <0.001 compared with lavage) and then decreased again after re-transfusion (18.7 ± 2.7; ***P <0.05).
T74700 181764-181979 Sentence denotes In the same group PaO 2 /FiO 2 (mmHg) decreased after ARDS (469 ± 50 (baseline) to 105 ± 38; P <0.001), increased during hemorrhage (218 ± 105; P <0.05) and did not change after re-transfusion (207 ± 125; P = 0.82).
T26414 181980-182172 Sentence denotes The shunt fraction (%) decreased during hemorrhage in the ARDS group (26.2 ± 14.9 (lavage) to 6.4 ± 6.6; P <0.05) but did not change signifi cantly after re-transfusion (13.9 ± 17.0; P = 0.3).
T37054 182173-182308 Sentence denotes Conclusions Acute reduction of blood volume is associated with an increase of respiratory system compliance and oxygenation parameters.
T75030 182309-182440 Sentence denotes Reduction of intrapulmonary blood and interstitial fl uid volume or thoracic cage compliance could be responsible for this eff ect.
T96434 182441-182719 Sentence denotes Introduction Trials comparing higher versus lower levels of positive end-expiratory pressure (PEEP) in adults with acute lung injury or acute respiratory distress syndrome (ARDS) were underpowered to detect small but important eff ects on mortality, overall or in any subgroups.
T54492 182720-183018 Sentence denotes Methods We searched MEDLINE, Embase, and the Cochrane Central Register for trials randomly assigning adults with acute lung injury or ARDS to higher versus lower levels of PEEP (minimal diff erence of 3 cmH 2 O over fi rst 3 days), while using low tidal volume ventilation, and comparing mortality.
T65210 183019-183120 Sentence denotes Data from 2,299 individual patients in three trials were analyzed using uniform outcome defi nitions.
T92767 183121-183276 Sentence denotes We tested prespecifi ed eff ect modifi ers using multivariable hierarchical regression, adjusting for important prognostic factors and clustering eff ects.
T49409 183277-183484 Sentence denotes Results Overall, there were 374 hospital deaths (32.9%) in the higher PEEP group and 409 (35.2%) in the lower PEEP group (adjusted relative risk, 0.94; 95% confi dence interval (CI), 0.86 to 1.04; P = 0.25).
T74931 183485-183697 Sentence denotes Treatment eff ects varied with the presence or absence of ARDS, defi ned by a ratio of partial pressure of oxygen to fractional inspired oxygen concentration equal to or less than 200 mmHg (interaction P = 0.02).
T58511 183698-183875 Sentence denotes The relative risks of hospital mortality for patients with and without ARDS were 0.90 (95% CI, 0.81 to 1.00, P = 0.049) and 1.37 (95% CI, 0.98 to 1.92, P = 0.065), respectively.
T55611 183876-184143 Sentence denotes Patients with ARDS were more likely to achieve unassisted breathing earlier (hazard ratio, 1.16 (95% CI, 1.03 to 1.30, P = 0.01); whereas the hazard ratio for time to unassisted breathing was 0.79 (95% CI, 0.62 to 0.99, P = 0.04) in patients without ARDS at baseline.
T31695 184144-184251 Sentence denotes Rates of pneumothorax and the use of neuromuscular blockers, vasopressors and corticosteroids were similar.
T77075 184252-184397 Sentence denotes Conclusions Higher levels of PEEP are likely to improve survival for patients with ARDS, but not for patients with less severe acute lung injury.
T44426 184398-184587 Sentence denotes Introduction Experimental and clinical studies have shown benefi cial eff ects of recruitment maneuvers (RMs) (sustained infl ation (SI) or SIGH) on ventilatory and gas exchange parameters.
T9434 184588-184694 Sentence denotes In this study we investigated the eff ect of diff erent RMs on bacterial translocation from lung to blood.
T82279 184695-184856 Sentence denotes Methods Thirty-two rats were anesthetized, after tracheotomy was performed ventilation was started with 10 cmH 2 O P aw , 0 cmH 2 O PEEP, 60 breaths/minute, I/E:
T35522 184857-184907 Sentence denotes 1/2 on pressure-controlled ventilation (PCV) mode.
T88426 184908-185001 Sentence denotes After cannulation of the carotid artery was performed, a baseline blood gas sample was taken.
T83582 185002-185191 Sentence denotes Subsequently 0.5 ml of 10 5 cfu/ml Pseudomonas aeruginosa was inoculated through the tracheotomy tube and PEEP was increased to 3 cmH 2 O and ventilated for 30 minutes before randomization.
T31710 185192-185675 Sentence denotes Then rats were randomized into four groups: G1; SI was performed as 40 cmH 2 O PEEP and 0 P aw for 20 seconds, four times in an hour (15-minute intervals), G2; SI was performed as 20 cmH 2 O PEEP and 0 P aw for 40 seconds, four times in an hour (15-minute intervals), G3; SIGH was performed four times in 1 hour (15-minute intervals) as 40 cmH 2 O P aw , 3 mH 2 O PEEP for 60 seconds, G4; control group that was ventilated with P aw 10 cmH 2 O, PEEP 3cmH 2 O during the study period.
T68283 185676-185764 Sentence denotes Multiplication of pressure and pressure performing time for each study group were equal.
T5784 185765-185949 Sentence denotes Blood cultures were taken at baseline, 15 minutes after randomization, which is after each RM for the fi rst hour, and last blood culture was taken after 60 minutes from the fourth RM.
T72054 185950-186130 Sentence denotes Then rats were sacrifi ced with intra-arterial sodium thiopental, and the lungs were extirpated; the left lung was taken for measurement of the wet weight/dry weight ratio (WW/DW).
T34536 186131-186220 Sentence denotes Results There were no diff erences in baseline pH, PaO 2 , PaCO 2 , MAP, HR among groups.
T18880 186221-186346 Sentence denotes But PaO 2 were decreased in groups G1, G2, and G3, but only in G3 was statistically signifi cant to compared baseline values.
T24942 186347-186459 Sentence denotes The WW/DW ratio was found higher in G3 when compared with G1, and G2, but this diff erence was not signifi cant.
T24946 186460-186537 Sentence denotes The amount of positive blood culture was higher in G3 at early study periods.
T5910 186538-186667 Sentence denotes Conclusions SIGH as a recruitment maneuver causes a high probability of bacterial translocation from the lung to the bloodstream.
T29114 186668-186787 Sentence denotes Introduction Alveolar recruitment/de-recruitment (R/D) seems to play an important role in the development of VILI [1] .
T89473 186788-186945 Sentence denotes Many clinicians base their determination of PEEP settings during mechanical ventilation of ARDS/ ALI patients on an estimate of alveolar recruitability [2] .
T71503 186946-187050 Sentence denotes This project aims to establish an online tool that provides estimates of R/D in patients at the bedside.
T47773 187051-187276 Sentence denotes Methods In volume-controlled ventilated piglets as ARDS models, the airway pressure P aw (SI-Special Instruments, Nördlingen, Germany) and the fl ow rate Q (F + G GmbH, Hechingen Germany) were continuously recorded at 200 Hz.
T7593 187277-187437 Sentence denotes The pressure curve shows high nonlinearity being a suspect of recruitment eff ects during inspiration and a relaxation process during the end inspiratory pause.
T23374 187438-187559 Sentence denotes Based on the obtained data, the parameters of the linear viscoelastic model [3] are calculated by a LSE fi tting process.
T57191 187560-187717 Sentence denotes As the parameter C 1 represents a static constant compliance of the lung, this model is not capable of reproducing the nonlinear eff ects during inspiration.
T94902 187718-187890 Sentence denotes To improve on this, the constant compliance C 1 is replaced by a nonlinear pressure-dependent compliance describing recruitment and dilatation as proposed by Hickling [1] .
T23136 187891-188081 Sentence denotes Results Since the nonlinear model has far more variable parameters to be optimized in the fi tting process than the linear model, an approach via fi tting the linear model fi rst is helpful.
T42916 188082-188263 Sentence denotes Therefore, the estimated parameters of the linear model fi t can be used as starting values for fi tting the nonlinear model where the focus can be put on the recruitment phenomena.
T53348 188264-188452 Sentence denotes With the new nonlinear model, using the estimated values of R 1 , R 2 , C 2 from the linear model ( Figure 1 left), it is now possible to reproduce the nonlinear characteristics ( Figure 1
T83585 188454-188632 Sentence denotes Conclusions Using this new model it is possible to fi t nonlinear behavior due to alveolar recruitment separately from viscoelastic eff ects with minimized error. to 10 cmH 2 O).
T8708 188633-188688 Sentence denotes Images were obtained at end expiration and inspiration.
T25664 188689-188776 Sentence denotes Global and regional quantitative CT analyses from each step of PEEP were compared [1] .
T89029 188777-188978 Sentence denotes Results Analyses of 12 patients showed that MRS reduced signifi cantly the global amount of nonaerated tissue (54 ± 8% to 7 ± 6%, P <0.01), tidal recruitment (4 ± 4% to 1 ± 1%, P = 0.029) ( Figure 1 ).
T58453 188979-189171 Sentence denotes Most dependent regional tidal recruitment signifi cantly increased from PEEP 10 to 20 cmH 2 O (2 ± 3% to 11 ± 7%, P <0.01), but signifi cantly decreased after MRS (11 ± 7% to 2 ± 2%, P <0.01).
T49117 189172-189232 Sentence denotes High PEEP (25 cmH 2 O) was necessary to sustain recruitment.
T89207 189233-189339 Sentence denotes Increasing PEEP without full recruitment may cause lung injury exacerbation in the severe ARDS population.
T22919 189341-189519 Sentence denotes In patients with acute respiratory distress syndrome (ARDS) tidal ventilation is always inhomogeneous, with atelectasis in dependent lung and overdistention in nondependent lung.
T21879 189520-189750 Sentence denotes The aim of our study was to develop a fl ow pattern that simultaneously produces locally diff erent alveolar pressures, in order to recruit collapsed alveoli and at the same time to prevent hyperinfl ation of already open alveoli.
T526 189751-189897 Sentence denotes Methods We modifi ed Horsfi eld's model of the canine lung [1] to predict alveolar pressure diff erences between the collapsed and opened alveoli.
T69959 189898-190025 Sentence denotes The morphometric model has an asymmetrical branching airway system with 47 orders, whereby order 47 corresponds to the trachea.
T76195 190026-190141 Sentence denotes Each branch is terminated with a viscoelastic tissue unit and there are in total 150,077 acini for the whole model.
T30940 190142-190292 Sentence denotes Using this model, atelectasis of alveoli was simulated by reducing the diameter of small airways (order 1, 2 and 3) up to 90% of their original sizes.
T22876 190293-190396 Sentence denotes The tissue damping factor G was 10 4 times higher in the collapsed alveoli than that in normal alveoli.
T55581 190397-190478 Sentence denotes The shunt gas compression compliance C g for the alveolus was 10 6 times smaller.
T21813 190479-190551 Sentence denotes Diff erent percentages of atelectatic area from 0 to 90% were simulated.
T79233 190552-190656 Sentence denotes Flow distribution and airway input impedance were calculated at diff erent frequencies from 0.1 to 5 Hz.
T28504 190657-190779 Sentence denotes Alveolar pressure diff erences were obtained by analyzing the products of fl ow distribution and alveolar input impedance.
T16317 190780-190881 Sentence denotes The alveolar pressure P alv reduced as the frequency increased (for both collapsed and open alveoli).
T65280 190882-190957 Sentence denotes Compared with the situation at 0.2 Hz, P alv reduced to 9.1 ± 1.0% at 4 Hz.
T28695 190958-191063 Sentence denotes On the other hand, P alv increased as the percentage of atelectatic area increased (for all frequencies).
T51488 191064-191152 Sentence denotes P alv increased to 267 ± 6% when 70% of alveoli collapsed compared with 10% of collapse.
T20066 191153-191251 Sentence denotes The pressure diff erences between collapsed and open alveoli increased as the frequency increased.
T12601 191252-191360 Sentence denotes At 0.2 Hz the diff erences were <3%, while at 4 Hz the diff erences were >20% (relative to the lower value).
T79891 191361-191456 Sentence denotes Introduction Low tidal volumes (Vt) are thought to protect the lung by avoiding overdistension.
T6539 191457-191548 Sentence denotes We recently have shown that Vt may also infl uence repeated opening and closing (O/C) [1] .
T92097 191549-191735 Sentence denotes The goal of this study was to determine whether decreasing Vt from 6 to 4 ml/kg was eff ective to reduce O/C, and whether it was possible to maintain alveolar ventilation at such low Vt.
T88476 191736-191778 Sentence denotes Methods Cross-over study at two Vt levels:
T315 191779-191800 Sentence denotes 6 versus 4 ml/kg IBW.
T92241 191801-191911 Sentence denotes We included ALI/ARDS patients, ventilated <48 hours, and who would have a chest computed tomography (CT) scan.
T27004 191912-192084 Sentence denotes For the 4 ml/kg arm: we replaced the heat and moisture exchange fi lter by a heated humidifi er, and the respiratory rate was increased to keep minute ventilation constant.
T15643 192085-192150 Sentence denotes The protocol had two parts: one bedside and other in the CT room.
T8979 192151-192191 Sentence denotes Both Vts were applied in a random order.
T89553 192192-192256 Sentence denotes For the bedside protocol each Vt arm was applied for 30 minutes.
T79603 192257-192335 Sentence denotes Data on lung mechanics and gas exchange were taken at baseline and 30 minutes.
T6832 192336-192536 Sentence denotes For the CT scan protocol each Vt arm was applied for 5 minutes and then a dynamic CT (4 images/second for 8 seconds) was taken at each Vt at a fi xed transverse region at the lower third of the lungs.
T7633 192537-192741 Sentence denotes Afterwards, CT images were analyzed by software (MALUNA) and repeated O/C was determined as nonaerated tissue variation between inspiration and expiration, expressed as a percentage of lung tissue weight.
T45303 192742-192881 Sentence denotes We analyzed nine patients (six male), who had a median age of 39 (21 to 72) years, APACHE II score 14 (5 to 23) and SOFA score 9 (6 to 15).
T85791 192882-192976 Sentence denotes All patients had a pulmonary origin of their ARDS and were on their fi rst day of ventilation.
T92348 192977-193117 Sentence denotes At baseline patients had a PaO 2 /FiO 2 ratio of 141 (71 to 280), compliance of 32 (17 to 43) ml/cmH 2 O, and PEEP of 12 (10 to 16) cmH 2 O.
T44242 193118-193379 Sentence denotes In the Vt arms 4 and 6 ml/kg, Vts were 260 (210 to 300) and 350 (310 to 400) ml, respectively (P <0.01), respiratory rates were 37 (31 to 42) and 25 (21 to 28) breaths per minute (P <0.01), and PaO 2 levels were 84 (54 to 148) and 83 (61 to 162) mmHg (P = 0.3).
T18737 193380-193414 Sentence denotes PEEP and FiO 2 were kept constant.
T21926 193415-193543 Sentence denotes PaCO 2 did not signifi cantly increase with Vt 4 but repeated O/C (delta nonaerated tissue) consistently decreased ( Figure 1 ).
T16866 193544-193685 Sentence denotes Introduction Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are associated with signifi cant morbidity and mortality.
T12858 193686-193750 Sentence denotes Mechanical ventilation is the cornerstone of supportive therapy.
T5741 193751-193840 Sentence denotes However, the optimal strategy of ventilation and adjunctive therapies are still evolving.
T20042 193841-194112 Sentence denotes There is evidence to support the use of volume-limited and pressure-limited lung-protective ventilation but practice variability in the clinical management is still a concern mainly in sicker patients. and hospital outcome have not found a consistent outcome association.
T68425 194113-194354 Sentence denotes We hypothesized that severity of hypoxemia on admission after optimal ventilation may predict hospital outcome if the ARDS patients are categorised based on the primary etiology: pulmonary ARDS (ARDS p ) and extra pulmonary ARDS (ARDS exp ).
T84702 194355-194561 Sentence denotes Our aim was therefore to ascertain the relationship between hospital outcome and the severity of hypoxemia in patients with early ARDS (days 1 to 3 following admission) after categorising based on etiology.
T41068 194562-194763 Sentence denotes Methods We used a prospective cohort study design and enrolled 151 consecutive patients with a primary diagnosis of ARDS on the day of admission, admitted over a 2-year period to our adult general ICU.
T38505 194764-194851 Sentence denotes Patients enrolled in other clinical interventional trials were excluded from the study.
T23869 194852-194944 Sentence denotes Protocol-based management of mechanical ventilation was used to achieve optimal ventilation.
T15600 194945-195067 Sentence denotes Two authors independently designated patients as ARDS p or ARDS exp and a third reviewed any confl icts (only four cases).
T21914 195068-195178 Sentence denotes Patients were then subcategorised by severity of hypoxaemia based on PaO 2 /FiO 2 ratio (P/F ratio) intervals.
T34165 195179-195257 Sentence denotes All other clinical interventions were at the discretion of treating clinician.
T87572 195258-195349 Sentence denotes The hospital mortality in all patients included in the study (n = 151) with ARDS was 44.1%.
T85970 195350-195523 Sentence denotes The patients classifi ed as ARDS p had a higher hospital mortality (50.6%) compared with ARDS exp (36.4%), but the diff erence was not statistically signifi cant (P = 0.12).
T42436 195524-195727 Sentence denotes Nonsurvivors with ARDS p had a signifi cantly lower P/F ratio on day 1 of ARDS diagnosis compared with survivors (12.05 ± 4.46 vs 15.39 ± 4.97 kPa; P = 0.002), a relationship not observed with ARDS exp .
T55652 195728-196002 Sentence denotes This association between mortality and hypoxaemia in early ARDS p persisted at even more serve levels of hypoxaemia (<15 kPa, <12.5 kPa, and <10 kPa; P = 0.01, P = 0.003 and P = 0.002, respectively), while in ARDS exp the eff ect of hypoxaemia on mortality was not observed.
T64669 196003-196230 Sentence denotes Conclusions Our fi ndings indicate that the hypoxaemia burden as assessed by P/F ratio intervals despite optimal ventilatory support on the day of ICU admission predicts increased risk of death in ARDS p ; but not in ARDS exp .
T28895 196231-196385 Sentence denotes Interventional trials need to account for the infl uence of etiology and hypoxaemia burden on outcome prior to concluding this as a negative intervention.
T89932 196387-196523 Sentence denotes The pathological organ dysfunction that occurs in patients with SIRS or sepsis is believed to be related to vascular endothelial damage.
T38018 196524-196652 Sentence denotes We investigated the role of vascular endothelial damage in the occurrence of acute lung injury in severe TBI patients with SIRS.
T75696 196653-196712 Sentence denotes Methods The subjects were 20 severe TBI patients with SIRS.
T63254 196713-196843 Sentence denotes The P/F ratio was calculated from arterial blood gas analysis data obtained for seven consecutive days from the time of admission.
T55206 196844-197038 Sentence denotes Peripheral blood samples were collected four times to measure the serum levels of IL-6 and IL-8, and the levels of ICAM-1 and granulocyte elastase (GE) as markers of vascular endothelial damage.
T84334 197039-197110 Sentence denotes The P/F ratio decreased with time and was below 300 from day 4 onwards.
T63516 197111-197172 Sentence denotes However, the survivors maintained a P/F ratio of 300 or more.
T55932 197173-197296 Sentence denotes In the patients with a fatal outcome, the ratio continued to decline and the subjects developed acute lung injury on day 3.
T20022 197297-197445 Sentence denotes From day 5 onward, they showed a signifi cant decrease of the ratio, with values of 200 or less and symptoms of adult respiratory distress syndrome.
T91518 197446-197556 Sentence denotes The levels of IL-6, IL-8, ICAM-1, and GE increased after admission, but then decreased again in the survivors.
T21449 197557-197691 Sentence denotes In the patients who died, these levels continued to rise and there was a signifi cant increase of IL-6, IL-8, and ICAM-1 after 1 week.
T9241 197692-197919 Sentence denotes The correlation between the blood level of IL-6 and the level of IL-8, ICAM-1, or GE was strong, while that between the IL-8 level and the ICAM-1 or GE levels was also strong and that between the ICAM-1 and GE level was weaker.
T96127 197920-198049 Sentence denotes In contrast, the correlations between the P/F ratio and the blood levels of IL-6, IL-8, ICAM-1, or GE were moderate and negative.
T84944 198050-198140 Sentence denotes Therefore, inverse correlations were noted between the P/F ratio and all these parameters.
T41166 198141-198376 Sentence denotes Conclusions By determining the changes of humoral mediators, we demonstrated that vascular endothelial damage was involved in the occurrence of the pathological state of acute lung injury, which occurs in severe TBI patients with SIRS.
T26314 198377-198585 Sentence denotes Introduction With adaptive support ventilation (ASV), a microprocessorcontrolled mode of mechanical ventilation, the ventilator adapts tidal volume (VT) size based on the Otis least work of breathing formula.
T11990 198586-198696 Sentence denotes In recent studies in patients with ALI/ARDS, ASV applied VT of 7.3 (6.7 to 8.8) ml/kg ideal body weight (IBW).
T50084 198697-198767 Sentence denotes It is unclear whether an open-lung approach was used in these studies.
T98047 198768-198890 Sentence denotes Lung recruitment improves lung compliance, and as a consequence may allow the ventilator to apply too large a VT with ASV.
T21342 198891-199124 Sentence denotes Methods Ten consecutive patients with ALI/ARDS, ventilated in accordance with our local protocol dictating frequent recruitment maneuvers, were observed while the ventilator was switched from pressure control ventilation (PC) to ASV.
T3379 199125-199213 Sentence denotes Thereafter, all patients were subjected to an additional standard recruitment procedure.
T4675 199214-199316 Sentence denotes The primary endpoint was VT before and after switch of the ventilator, and after standard recruitment.
T71393 199317-199382 Sentence denotes Results Four patients suff ered from ALI, six patients from ARDS.
T22731 199383-199439 Sentence denotes Seven patients had an extrapulmonary cause for ALI/ARDS.
T47182 199440-199539 Sentence denotes VT increased from 6.5 ± 0.8 ml/kg IBW to 9.0 ± 1.6 ml/kg IBW (P <0.01) after switch from PC to ASV.
T10346 199540-199649 Sentence denotes Additional recruitment after switch of the ventilator did not aff ect VT size (9.3 ± 1.4 ml/kg IBW, P >0.05).
T98574 199650-199747 Sentence denotes In seven patients ASV applied VT >8 ml/kg IBW, in one patient VT even increased to >12 ml/kg IBW.
T93424 199748-199843 Sentence denotes Conclusions Patients with ALI/ARDS may be ventilated with too large a VT when subjected to ASV.
T86251 199844-199986 Sentence denotes Our results contrast fi ndings of previous studies on ASV in patients with ALI/ARDS, probably because we frequently use recruitment maneuvers.
T28729 199987-200008 Sentence denotes Conference criteria).
T33988 200009-200184 Sentence denotes We measured plasma RAGE levels twice on the fi rst 2 days from intubation, then every 3 days for the fi rst month and then once a week, until ICU discharge or death (n = 188).
T19550 200185-200303 Sentence denotes We also measured RAGE levels in BALf obtained by means of a standardized technique when clinically indicated (n = 22).
T38237 200304-200418 Sentence denotes At each sampling time we recorded data on ventilator settings, gas exchange, organ function and blood cell counts.
T27183 200419-200561 Sentence denotes Results Day 1 plasma RAGE levels (normal values <170 pg/ml) were high (median 1,588 pg/ml, IQR 780 to 2,398 pg/ml) and then lowered over time.
T51100 200562-200809 Sentence denotes When all samples were considered, plasma RAGE levels were signifi cantly higher in patients with blood platelet count <100 x 10 3 /μl, with plasma creatinine level ≥2 mg/dl and with SOFA score ≥5 (P = 0.029, P = 0.001 and P = 0.045, respectively).
T51084 200810-200883 Sentence denotes Plasma RAGE increased also with the number of organ failures (P = 0.004).
T85962 200884-201037 Sentence denotes Moreover, circulating RAGE was signifi cantly higher in patients with PaO 2 /FiO 2 <150 and with PEEP ≥10 cmH 2 O (P = 0.045 and P <0.001, respectively).
T23311 201038-201105 Sentence denotes RAGE was present in BALf (median 174 pg/ml, IQR 46 to 1,476 pg/ml).
T30981 201106-201179 Sentence denotes Interestingly, plasma and BALf RAGE levels were not correlated (P = 0.2).
T78629 201180-201364 Sentence denotes BALf RAGE was signifi cantly higher in patients with PaO 2 /FiO 2 <150 mmHg and with administered tidal volume:ideal body weight ratio >6 ml/kg (P = 0.021 and P = 0.009, respectively).
T39092 201365-201482 Sentence denotes Patients with culture-positive BALf had higher BALf RAGE levels in comparison with culture-negative BALf (P = 0.014).
T27447 201483-201616 Sentence denotes In ALI/ARDS patients, circulating RAGE is high on day 1, decreases over time and may be related to systemic and lung injury severity.
T73070 201617-201710 Sentence denotes BALf RAGE obtained from these patients may be associated with lung dysfunction and infection.
T48748 201711-201942 Sentence denotes Introduction In animal models of ventilator-induced lung injury (VILI), mild hypothermia was found to be protective by reducing pulmonary infl ammation and possibly by reducing mechanical strain by applying lower respiratory rates.
T96638 201943-202013 Sentence denotes However, models are hampered by severe alkalosis or an ex vivo design.
T97665 202014-202163 Sentence denotes In a physiological model of VILI, we investigated whether hypothermia protects from VILI by reducing respiratory rates, or by reducing infl ammation.
T76266 202164-202266 Sentence denotes Methods In rats, VILI was induced using a peak inspiratory pressure (PIP) of 23 cmH 2 O and zero PEEP.
T2925 202267-202339 Sentence denotes Controls were ventilated with a PIP of 12 cmH 2 O and PEEP of 5 cmH 2 O.
T14801 202340-202425 Sentence denotes Hypothermia (32ºC) was induced by external cooling, controls were maintained at 37ºC.
T88149 202426-202582 Sentence denotes Normo-pH (7.3 to 7.4) or strict normocapnia (4.5 to 5.0 kPa) was achieved by adjusting the respiratory rate according to blood gases drawn every 30 minutes.
T54274 202583-202674 Sentence denotes After 4 hours of Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T47843 202675-202726 Sentence denotes ventilation, bronchoalveolar lavage (BAL) was done.
T19335 202727-202786 Sentence denotes Statistics include Kruskal-Wallis and Mann-Whitney U tests.
T57710 202787-202841 Sentence denotes Results A physiological model of VILI was established.
T97884 202842-202984 Sentence denotes In the normo-pH group, hypothermia decreased pulmonary IL-6 and neutrophil infl ux and tended to decrease pulmonary protein leak ( Figure 1 ).
T88969 202985-203129 Sentence denotes In the normocapnia group, hypothermia allowed for lower respiratory rates compared with normo-pH (11 ± 1 vs 17 ± 2 breaths/minute) ( Figure 2 ).
T52912 203130-203193 Sentence denotes However, this did not further reduce parameters of lung injury.
T91537 203194-203362 Sentence denotes Conclusions Hypothermia was protective in a physiological model of VILI, by reduction of infl ammation, but not by reducing the repetitive strain of respiratory cycles.
T33810 203363-203449 Sentence denotes Introduction Therapeutic hypothermia is applied to reduce hypoxiainduced organ injury.
T35615 203450-203572 Sentence denotes In the past decades, the use of hypothermia has increased in critically ill patients who are mechanically ventilated (MV).
T60457 203573-203673 Sentence denotes Data on the eff ect of hypothermia on gas exchange and lung mechanics in these patients are limited.
T5854 203674-203825 Sentence denotes In this retrospective study, we describe the eff ect of induced hypothermia and rewarming on respiratory parameters in patients after a cardiac arrest.
T52271 203826-203973 Sentence denotes Methods Patients with a Glasgow Coma Scale <8 after resuscitation for a cardiac arrest in whom hypothermia was applied (32 to 34°C), were enrolled.
T42749 203974-204088 Sentence denotes Patients with PaO 2 /FiO 2 ratio <200 or MV with positive endexpiratory pressure (PEEP) >15 cmH 2 O were excluded.
T48317 204089-204254 Sentence denotes Ventilator settings and arterial blood gasses were retrieved from the electronic patient database during hypothermia and at every °C grade increase during rewarming.
T99685 204255-204290 Sentence denotes Statistics include z paired t test.
T57339 204291-204389 Sentence denotes Results From a cohort of 98 patients, 35 patients were excluded, leaving 62 patients for analysis.
T20173 204390-204522 Sentence denotes During hypothermia, arterial pCO 2 decreased, while end tidal (et) CO 2 was low at unchanged minute volume ventilation ( Figure 1 ).
T54451 204523-204680 Sentence denotes Hypothermia increased the P/F ratio from 255 ± 55 to 283 ± 12 at unchanged PEEP (P <0.05), while fl uid balances were positive in all patients (2.5 ± 1.6 l).
T14891 204681-204750 Sentence denotes After rewarming, arterial pCO 2 was unchanged while etCO 2 increased.
T42726 204751-204922 Sentence denotes The P/F ratio after rewarming was unchanged compared with the start of hypothermia, while lower PEEP levels were applied (7.0 ± 0.4 cmH 2 O vs 6.1 ± 0.3 cmH 2 O, P <0.05).
T70279 204923-205019 Sentence denotes Conclusions Induced hypothermia improved ventilation and oxygenation in critically ill patients.
T75904 205020-205147 Sentence denotes Hypothermia may be considered in patients with acute lung injury, in whom low minute ventilation results in severe hypercapnia.
T55103 205148-205214 Sentence denotes Extracorporeal life support service in a regional referral center:
T33965 205215-205385 Sentence denotes The median stay of ACLS maneuvers before ECLS start was 62.5 minutes In cases of cardiogenic shock undergoing ECLS, two out of four patients were discharged from our ICU.
T26952 205386-205500 Sentence denotes Conclusions A complete competence acquisition for ECLS management makes this system a safe and feasible technique.
T50349 205501-205611 Sentence denotes The possibility to guarantee a safe treatment must involve diff erent specialists and properly trained nurses.
T75968 205612-205666 Sentence denotes We found the importance of a well-timed start of ECLS.
T1794 205667-205789 Sentence denotes Introduction Severe acute respiratory distress syndrome (ARDS) patient transportation is an extremely high-risk procedure.
T84999 205790-205912 Sentence denotes We report our experience in transferring these patients to our centre while on extracorporeal membrane oxygenation (ECMO).
T47150 205913-206071 Sentence denotes Methods After telephone referral and bed availability confi rmation, patients matching entry criteria for ECMO are evaluated for transportation to our centre.
T46627 206072-206252 Sentence denotes A skilled crew consisting of two expert plus one training physician, one expert plus one training ICU nurse and one ECMO specialist reaches the referral hospital for re-evaluation.
T68531 206253-206331 Sentence denotes If eligible, cannulation, ECLS circuit set up and ECLS start are accomplished.
T1970 206332-206450 Sentence denotes Ground transport is performed with a specially equipped ambulance, endowing enlarged oxygen, fuel and energy supplies.
T20139 206451-206589 Sentence denotes The ambulance is loaded with all of the items required for cannulation and ECMO circuit set up, additional oxygen and a nitric oxide tank.
T76010 206590-206781 Sentence denotes Entry criteria are: potentially reversible respiratory failure, Murray Score ≥3 or respiratory acidosis with pH <7.2, no intracranial bleeding and absolute contraindication to heparinization.
T75052 206783-206973 Sentence denotes Between 2004 and 2009 our crew evaluated for transfer on ECMO 15 ARDS patients (10 males), age 38 ± 15 years, BMI 28 ± 7, APACHE II score 26 ± 9, SOFA score 9 ± 4, Oxygenation Index 39 ± 17.
T34984 206974-207012 Sentence denotes The average distance was 133 ± 124 km.
T49548 207013-207084 Sentence denotes Two patients improved after NO trial and were transferred without ECMO.
T80084 207085-207137 Sentence denotes All of the other patients underwent venovenous ECMO:
T76007 207138-207248 Sentence denotes 11 with cannulation of femoral veins, one femoral-jugular veins and one with a DL cannula in the jugular vein.
T62370 207249-207319 Sentence denotes ECMO settings were (mean ± SD) BF 2.9 ± 0.8, GF 3.6 ± 1.6, GF FiO 2 1.
T9286 207320-207803 Sentence denotes Data have been recorded 30 minutes before and 1 hour after ECLS began: vv-ECMO granted a better clearance of pCO 2 (75 ± 20.5 vs 49.7 ± 7.9 mmHg, P <0.01), thus improving the pH (7.279 ± 0.10 vs 7.41 ± 0.06, P <0.01) and mean pulmonary arterial pressure (41 ± 11 vs 31 ± 5 mmHg, P <0.05) and allowing a reduction in respiratory rate (28 ± 11 vs 9 ± 4, P <0.01), minute ventilation (10.2 ± 4.6 vs 3.3 ± 1.7 l/min, P <0.01) and mean airway pressure (26 ± 6 vs 22 ± 5 cmH 2 O, P <0.01).
T63159 207804-207892 Sentence denotes Arterial pO 2 , mean blood pressure and heart rate did not show signifi cant variations.
T91699 207893-207994 Sentence denotes After ECMO began, vasoconstrictor therapy (being administered to fi ve patients) was quickly tapered.
T82668 207995-208060 Sentence denotes Neither clinical nor technical major complications were reported.
T6235 208061-208163 Sentence denotes Conclusions ECMO employment at referral centers enabled longdistance, high-risk ground transportation.
T80361 208165-208338 Sentence denotes Controversy exists over the possible benefi cial eff ects of hypertonic saline (HS) in pulmonary infl ammatory response, particularly in neutrophil immunomodulation [1, 2] .
T23424 208339-208472 Sentence denotes This study was designed to investigate possible benefi ts of HS in the treatment of pigs submitted to experimental acute lung injury.
T89438 208473-208713 Sentence denotes Methods Twelve anesthetized, tracheotomized pigs (25 to 30 kg) were mechanically ventilated by pressure, adjusted to 8 ml/kg tidal volume, with FiO 2 50%, and submitted to intratracheal instillation of 4 ml/kg hydrochloric acid (HCl) 0.1 N.
T95312 208714-208894 Sentence denotes They were then randomized to ALI group (n = 7) or ALI + HS group (n = 5), where animals of the latter group received 4 ml/kg intravenous hypertonic saline, 15 minutes after injury.
T2563 208895-209146 Sentence denotes Hemodynamic parameters, pulmonary compliance (C stat ), peak pressure (P peak ), plateau pressure (P plat ) and tidal volume (V t ) were analyzed at baseline (TBL), 15 minutes after HCl instillation (TALI) and hourly thereafter for 4 hours (T0 to T3).
T86470 209147-209279 Sentence denotes Bronchoalveolar lavage was performed at the end of the observation period for fl ow cytometry analysis of neutrophil burst activity.
T30695 209280-209372 Sentence denotes Postmortem histopathology of the right diaphragmatic lung was also performed in all animals.
T80643 209373-209542 Sentence denotes Results After TALI, animals of both groups presented signifi cant increases in P peak and P plat , and a decrease in C stat , at all time points, when compared with TBL.
T31227 209543-209586 Sentence denotes V t was preserved in both groups over time.
T58978 209587-209811 Sentence denotes There were signifi cant diff erences between groups ALI and ALI + HS, respectively, in: central venous pressure (T0, T1 and T2), pulmonary artery occlusion pressure (T1 and T2) and pulmonary vascular resistance index (TALI).
T85189 209812-210026 Sentence denotes In the ALI group, signifi cant diff erences related to TBL were found in mean arterial pressure (T1), mean pulmonary artery pressure (TALI, T0, T1, T2 and T3) and pulmonary vascular resistance index (TALI, T0, T3).
T1324 210027-210277 Sentence denotes In the ALI + HS group, there were signifi cant diff erences related to TBL in mean arterial pressure (T0, T1, T2), mean pulmonary artery pressure (TALI, T0, T1, T2, T3), cardiac index (T0, T1, T2) and pulmonary vascular resistance index (T1, T2, T3).
T47133 210278-210374 Sentence denotes No diff erences were found between groups regarding histopathology and fl ow cytometry analyses.
T35673 210375-210500 Sentence denotes Conclusions HS produced no signifi cant benefi t in the studied parameters regarding the lungs, in the proposed model of ALI.
T82411 210501-210699 Sentence denotes Introduction Conventional mechanical ventilation (MV) may cause additional lung injury in ALI/ARDS due to overdistention of aerated lung regions (high Vt) and cyclic lung reopening (low PEEP level).
T72217 210700-210786 Sentence denotes Hyperproduction of infl ammatory mediators is one of the side eff ects in these cases.
T64829 210787-210864 Sentence denotes This factor could delay or prevent resolution of respiratory failure [1, 2] .
T86939 210865-210955 Sentence denotes However, it is not clear whether conventional mechanical ventilation damages intact lungs.
T47656 210956-211108 Sentence denotes The aim of this study was to evaluate the eff ects of conventional and protective mechanical ventilation on intact lungs in patients with severe trauma.
T75425 211109-211238 Sentence denotes Methods A prospective, randomized controlled trial in trauma patients with mechanical ventilation for extrapulmonary indications.
T50047 211239-211295 Sentence denotes The protocol was approved by the local ethics committee.
T79893 211296-211483 Sentence denotes Seventy-eight patients were randomized to conventional (Vt 10 to 12 ml/kg IBW, PEEP 5 cmH 2 O -n = 39) or protective (Vt 5 to 6 ml/kg IBW, PEEP 10 cmH 2 O -n = 39) mechanical ventilation.
T40178 211484-211583 Sentence denotes TNFα, IL-1β and IL-6 levels in plasma and BAL fl uids were measured on 1, 2, 3, 5 and 7 days of MV.
T3683 211584-211640 Sentence denotes Frequency of ALI (AECC criteria) and VAP were evaluated.
T78700 211641-211726 Sentence denotes The endpoints of this study were the length of MV, LOS in ICU and outcome on 28 days.
T43744 211727-211909 Sentence denotes Results In fi rst 3 days ALI was revealed in 26 patients (66.6%) in the conventional and 10 patients (26.5%) in the protective MV groups (P = 0.001; OR 4.375, 95% CI 2.227 to 8.189).
T88404 211910-212037 Sentence denotes ARDS occurred in four patients (10,2%) of the conventional MV group (LIS >2) and no one in the protective MV group (P <0.0001).
T75944 212038-212258 Sentence denotes Levels of TNFα, IL-1β and IL-6 in BAL fl uids were signifi cantly higher in the conventional MV group from 1 to 7 days with maximal increase on day 3 (542 ± 44/91 ± 11; 315 ± 35/86 ± 10; 1,092 ± 160/111 ± 18, P <0.0001).
T25344 212259-212338 Sentence denotes No diff erences were found in levels of TNFα, IL-1β and IL-6 in plasma samples.
T86431 212339-212489 Sentence denotes VAP occurred in 31 patients (83.7%) of the conventional and nine patients (23%) of the protective MV groups (P = 0.0001; OR 17.2, 95% CI 5.5 to 54.3).
T72331 212490-212661 Sentence denotes The length of MV was 17.4 ± 6 vs 12.8 ± 3 (P = 0.0001; OR 4.2, 95% CI 1.5 to 11.5), LOS in the ICU was 21.9 ± 5.6 vs 15.75 ± 2.9 (P = 0.0002; OR 2.0, 95% CI 0.18 to 23.6).
T84736 212662-212731 Sentence denotes The 28-day mortality was not signifi cantly diff erent in the groups.
T59106 212732-212901 Sentence denotes Conclusions Conventional MV for more than 72 hours in patients with severe trauma and intact lungs can cause lung injury, and increase duration of MV and LOS in the ICU.
T35445 212902-213103 Sentence denotes Introduction Administration of 80 mg/kg methylprednisolone has been shown to prevent controlled mechanical ventilation (CMV) diaphragm dysfunction in rats, partly by inhibiting the calpain system [1] .
T79367 213104-213256 Sentence denotes The current experiments determined whether lower doses of corticosteroids will also provide protection against ventilator-induced diaphragm dysfunction.
T36740 213257-213428 Sentence denotes Methods Rats were assigned to a control group or to 24 hours of CMV receiving a single injection of saline or 5 mg/kg (low MP) or 30 mg/kg (high MP) of methylprednisolone.
T37014 213429-213579 Sentence denotes Results Diaphragm force production was decreased after CMV but signifi cantly more in the low MP group while similar to controls in the high MP group.
T88277 213580-213649 Sentence denotes Atrophy of the type IIa fi bers was only present in the low MP group.
T30110 213650-213793 Sentence denotes Atrophy of the type IIx/b fi bers was more severe in the low MP group than in the CMV group while no atrophy was observed in the high MP group.
T16178 213794-213966 Sentence denotes Diaphragm calpain activity was increased after CMV (+93%, P <0.05 vs C) and in the low MP group (+83%, P <0.05 vs C), while it was similar to controls in the high MP group.
T43024 213967-214202 Sentence denotes Expression of calpastatin was Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1 decreased in the CMV and the low MP group (-18%, P <0.05 vs C) but its level was preserved to control levels in the high MP group.
T10750 214203-214372 Sentence denotes Analysis of the caspase-3 mediated cleavage of α II -spectrin revealed that CMV induced a signifi cant rise in caspase-3 activity when compared with C (+194%, P <0.001).
T21119 214373-214560 Sentence denotes Caspase-3 activity was similarly increased in the MP-5 and the MP-30 groups (+96% and +78% respectively, P <0.05 vs C) but this increase was signifi cantly less compared with that of CMV.
T96772 214561-214746 Sentence denotes Signifi cant negative correlations were found between calpain activity and diaphragm force (-0.50 <r <-0.41, P <0.05) as well as with CSA of the type IIx/b fi bers (r = -0.57, P <0.02).
T17136 214747-214931 Sentence denotes Signifi cant positive correlations were observed between calpastatin and diaphragm force (0.43 <r <0.54, P <0.05) and calpastatin and CSA of the type IIx/b fi bers (r = 0.57, P <0.02).
T10130 214932-215136 Sentence denotes Conclusions The ability of corticosteroids to protect against CMV-induced diaphragmatic contractile dysfunction and atrophy are dose dependent with only high doses of corticosteroids providing protection.
T60036 215137-215227 Sentence denotes Introduction Controlled mechanical ventilation (CMV) results in diaphragmatic dysfunction.
T25943 215228-215409 Sentence denotes Oxidative stress is an important contributor to ventilator-induced diaphragm dysfunction, since 18 hours of CMV lead to increased protein oxidation and increased lipid peroxidation.
T22886 215410-215582 Sentence denotes We hypothesized that administration of an antioxidant, N-acetylcysteine (NAC), would restore the redox balance in the diaphragm and prevent the deleterious eff ects of CMV.
T38773 215583-215791 Sentence denotes Methods Anesthetized rats were submitted for 24 hours to either spontaneous breathing while receiving 150 mg/kg NAC (SBNAC) or saline (SBSAL) or to CMV while receiving 150 mg/kg NAC (MVNAC) or saline (MVSAL).
T11270 215792-215885 Sentence denotes After 24 hours, diaphragm forces were signifi cantly lower in MVSAL compared with all groups.
T32861 215886-216033 Sentence denotes Administration of NAC completely abolished this decrease such that forces produced in the MVNAC group were comparable with those of both SB groups.
T30382 216034-216132 Sentence denotes Protein oxidation was signifi cantly increased in MVSAL (+53%, P <0.01) and was restored in MVNAC.
T16523 216133-216238 Sentence denotes Diaphragm caspase-3 activity was signifi cantly increased in MVSAL compared with SBSAL (+279%, P <0.001).
T5913 216239-216381 Sentence denotes Caspase-3 activity was also increased in the MVNAC group (+158.5%, P <0.01) but to a signifi cantly lesser extent compared with that of MVSAL.
T50751 216382-216519 Sentence denotes Calpain activity was signifi cantly increased after CMV (+137%, P <0.001 vs SBSAL), while it was similar to SB groups in the MVNAC group.
T50311 216520-216639 Sentence denotes Signifi cant negative correlation was found between calpain activity and diaphragm tetanic force (r = -0.48, P = 0.02).
T98967 216640-216771 Sentence denotes Conclusions These data show that the administration of NAC was able to preserve the diaphragm from the deleterious eff ects of CMV.
T25760 216772-216905 Sentence denotes NAC inhibits the increase in oxidative stress and proteolysis and reduces the decrease in force generating capacity of the diaphragm.
T84521 216906-217119 Sentence denotes In vitro muscle contraction force measurements on isolated and entire rat diaphragms Introduction Inactivity of the diaphragmatic muscles during mechanical ventilation leads to atrophy and contractile dysfunction.
T68913 217120-217217 Sentence denotes Up to now, in vitro force measurements were performed only on single diaphragmatic muscle strips.
T82960 217218-217351 Sentence denotes Our intention was to fi nd out how mechanical and electrical stimulation infl uences the condition of the diaphragm as a whole organ.
T28371 217352-217459 Sentence denotes To determine the status of the diaphragm, muscle contraction forces were measured on entire rat diaphragms.
T24867 217460-217582 Sentence denotes Methods We used an earlier described bioreactor [1] as the cultivation and measurement device for the whole rat diaphragm.
T56094 217583-217712 Sentence denotes The bioreactor consists of a pressure chamber and a supply chamber that are separated by a very fl exible and soft membrane [2] .
T77204 217713-217761 Sentence denotes On this membrane the sample diaphragm is placed.
T97176 217762-217897 Sentence denotes By application of certain gas volumes (0 to 1.5 ml) in the pressure chamber, diaphragms are defl ected to various levels of pretension.
T67616 217898-218054 Sentence denotes Diaphragms were electrically stimulated at each defl ection level 10 times (750 ms duty cycle, 100 ms stimulation time, 5 ms pulse width, 200 Hz frequency).
T37327 218055-218189 Sentence denotes Pressure changes caused by muscle contraction were recorded inside the pressure chamber and muscle contraction forces were calculated.
T68976 218190-218464 Sentence denotes After initial force measurements, diaphragms were exposed for 6 hours to one of four diff erent treatments: nonstimulated storage (control), cyclic mechanical defl ection, electrical stimulation every 20 minutes, combination of cyclic defl ection and electrical stimulation.
T992 218465-218519 Sentence denotes After 6 hours another force measurement was performed.
T33981 218520-218597 Sentence denotes Supernatants were collected after 6 hours and investigated for IL-6 activity.
T90834 218598-218750 Sentence denotes Results Depending on the level of defl ection of the diaphragms, muscle contraction force increased from 0.1 N (volume 0.6 ml) to 0.7 N (volume 1.5 ml).
T81263 218751-218832 Sentence denotes A larger pretension of the diaphragm resulted in larger muscle contraction force.
T77073 218833-218899 Sentence denotes After treatment, muscle contraction force decreased in all groups.
T14265 218900-219125 Sentence denotes Muscle contraction force was smallest in the passive control group (0.05 N), larger and similar in the electrically stimulated (0.1 N) and combination (0.09 N) groups and largest in the mechanically defl ected group (0.15 N).
T69317 219126-219177 Sentence denotes IL-6 activity increased after 6 hours of treatment.
T907 219178-219298 Sentence denotes Conclusions We conclude that it is possible to perform force measurements on whole rat diaphragms in our in vitro model.
T3901 219299-219462 Sentence denotes Additionally, the diaphragms can kept alive for >6 hours to apply diff erent stimulation Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T5724 219463-219761 Sentence denotes Introduction Neurally adjusted ventilatory assist (NAVA) is a new mode of assisted mechanical ventilation that uses the signal obtained from electromyography activity of the diaphragm (EAdi) to control the mechanical ventilator that delivers assist in proportion to the patient's respiratory drive.
T39599 219762-219955 Sentence denotes This study evaluated the monitoring Edi on conventional mode response, during the switch to pressure support assist and during the change to NAVA: a mode of predicting weaning from ventilation.
T65418 219956-220156 Sentence denotes Methods Sixteen adult patients ventilated with SERVO-I (Maquet) on pressure control or Bivent were randomized; we placed the specialized naso/orogastric tube (Edi catheter) and watched the Edi signal.
T46889 220157-220230 Sentence denotes PSV was set to obtain a Vt/kg of 6 to 8 ml/kg with an active inspiration.
T31954 220231-220299 Sentence denotes Were studied the peak airway pressure (P aw ) and breathing pattern.
T94893 220300-220455 Sentence denotes Were registered the Edi minimum and Edi maximum for determining PEEP and peak pressure, respectively, Vt, respiratory rate, FiO 2 and blood gases serially.
T54160 220456-220645 Sentence denotes We observed synchrony between Edi signal and ventilator breaths in pressure control or Bivent, and when the patients have started spontaneous breaths (T signal) we move to pressure support.
T61688 220646-220861 Sentence denotes Low Edi minimum (0 to 1) was associated with overdistending the diaphragm and required decreasing the PEEP, contrary to high Edi minimum that was associated with higher tonic activity and dictated to raise the PEEP.
T7233 220862-220926 Sentence denotes During NAVA, the pressure delivered was proportional to the Edi.
T37496 220927-221041 Sentence denotes The NAVA level was continuously readjusted in proportion to the predicted inspiratory eff ort from the Edi signal.
T80762 221042-221264 Sentence denotes At the highest assist level, we found lower Vt/kg (6.1 ± 3 ml/kg vs 8.1 ± 1.8, P <0.001), and higher breathing frequency (19 ± 6.9 vs 11 ± 7, P <0.001) and peak EAdi (11.8 ± 8.5 vs 8.1 ± 7.7, P <0.002) in NAVA than in PSV.
T97667 221265-221437 Sentence denotes The asynchrony during mechanical ventilation increases the cost of care, length of days on mechanical ventilation, and other morbidities associated with increased ICU stay.
T43200 221438-221600 Sentence denotes The Edi monitoring helps to understand other modes of ventilation and has been a great tool to decide the timing of a switch to NAVA and predict an early weaning.
T43888 221601-221858 Sentence denotes Systematically increasing the NAVA level reduces the respiratory drive, unloads respiratory muscles, and off ers a method to determine an assist level that results in sustained unloading, low Vt, and stable respiratory function when implemented for 3 hours.
T1883 221859-221968 Sentence denotes NAVA gives us the opportunity to augment these patients' own drive to breathe enough to recover more quickly.
T83352 221969-222049 Sentence denotes Introduction Sepsis and muscle inactivity may lead to neuromuscular dysfunction.
T96890 222050-222214 Sentence denotes Neurally adjusted ventilatory assist (NAVA) converts diaphragm electrical activity (EAdi) into airway pressure (Paw) and preserves respiratory muscle activity [1] .
T76525 222215-222369 Sentence denotes We hypothesised that respiratory neuromuscular function would be better preserved with NAVA compared with volume cycled ventilation (VCV) in early sepsis.
T95645 222370-222628 Sentence denotes Methods Twenty-eight pigs (40.0 (37.6; 41.8) kg; median (quartiles)) were randomized (n = 7 per group) to fecal peritonitis or nonseptic controls ventilated for 24 hours with either NAVA or VCV (nonparalyzed, Vt 6 to 8 ml/kg, rate adjusted to suppress EAdi).
T46798 222629-222735 Sentence denotes Fluids and norepinephrine (NE) were used based on protocols to keep mean arterial pressure (MAP) >50 mmHg.
T25726 222736-222905 Sentence denotes Before sepsis and after 24 hours, transcutaneous supramaximal stimulations of the cervical phrenic nerve (tPNS) and expiratory occlusion manoeuvres (eOM) were performed.
T3312 222906-223168 Sentence denotes Latency and amplitude of diaphragm compound muscle activity potentials (CMAP) were measured during tPNS; maximal defl ections of Paw (ΔPaw), esophageal (ΔPes), and transdiaphragm (ΔPdi) pressures were measured during repetitive tPNS (40 Hz, 100 stimuli) and eOM.
T84111 223169-223279 Sentence denotes Results Hemodynamic parameters were not diff erent among groups before sepsis and remained stable in controls.
T35285 223280-223453 Sentence denotes MAP did not change in septic NAVA but decreased in septic VCV animals from 91 (74; 95) mmHg before sepsis to 58 (57; 68) mmHg at 24 hours (P <0.001, MANOVA t-g interaction).
T61960 223454-223552 Sentence denotes The heart rate increased (P <0.001) and stroke volume decreased (P = 0.034) in both septic groups.
T87228 223553-223606 Sentence denotes Fluid balance was not diff erent among septic groups.
T69167 223607-223664 Sentence denotes Three septic NAVA and six septic VCV animals received NE.
T3833 223665-223835 Sentence denotes CMAP latency and amplitude, as well as ΔPaw, ΔPes, and ΔPdi were not diff erent among all groups during repetitive tPNS and eOM before sepsis and after 24 hours (P = NS).
T63944 223836-223974 Sentence denotes Conclusions Respiratory neuromuscular function is not aff ected by the mode of ventilation during the fi rst 24 hours of abdominal sepsis.
T2961 223975-224076 Sentence denotes Early eff ects of sepsis on neuromuscular function are not refl ected in respiratory muscle strength.
T89026 224077-224142 Sentence denotes NAVA may reduce the need for hemodynamic support in early sepsis.
T98512 224143-224360 Sentence denotes Introduction This study aimed to evaluate the eff ect of high versus low tidal volumes (VT) during volume control (VC) ventilation and neurally adjusted ventilatory assist (NAVA) in spinal cord injured (SCI) patients.
T93254 224361-224481 Sentence denotes We hypothesized that VC with higher VT would signifi cantly unload and deactivate the diaphragm, whereas NAVA would not.
T27118 224482-224533 Sentence denotes Methods Seven intubated C3 to C7 SCI patients (age:
T33257 224534-224562 Sentence denotes 28 ± 12 years) were studied.
T78100 224563-224725 Sentence denotes Using VC (Servo300), VT was increased progressively (not exceeding 40 cmH 2 O or 2 l VT) (high volume) and then lowered until 6 ml/kg or intolerance (low volume).
T6618 224726-224796 Sentence denotes NAVA was then progressively adjusted targeting similar peak pressures.
T15432 224797-224904 Sentence denotes Finally subjects received 15 minutes each of: high VC, low VC, high NAVA, and low NAVA in randomized order.
T40174 224905-225022 Sentence denotes Results Despite comparable increases in peak airway pressure (Pmo), VT increased with VC but was unaltered with NAVA.
T83408 225023-225154 Sentence denotes Inspiratory and total breath durations were lower and respiratory rate higher with NAVA compared with VC during both assist levels.
T19094 225155-225274 Sentence denotes VC resulted in signifi cant diaphragm unloading and deactivation whereas both were maintained during high and low NAVA.
T65395 225275-225383 Sentence denotes Complete diaphragm deactivation in more than 80% of breaths was observed during VC in fi ve of the patients.
T10200 225384-225518 Sentence denotes Introduction A novel methodology is proposed to adapt decisionmaking strategies into our fuzzy-based expert system, AUTOPILOT-BT [1] .
T25640 225519-225826 Sentence denotes The special features of this approach are: knowledge from clinical experts can be extracted in a setup simulating daily ICU routine; an automated process serves to obtain the required information and to create new fuzzy sets; and the fuzzy controller from AUTOPILOT-BT employs the newly derived fuzzy rules.
T53611 225827-225985 Sentence denotes Thus, the knowledge base can easily be modifi ed and the resulting mechanical ventilation therapies may be adapted to individual preferences of the clinician.
T93441 225986-226112 Sentence denotes Methods The methodology consists of: (i) Acquisition of decision-making strategies from single or groups of anesthesiologists.
T90312 226113-226351 Sentence denotes This can either be done with a questionnaire or with a PC-based program simulating the doctors every day situation in diagnosis. (ii) Defi nition of fuzzy membership functions based on the acquired knowledge (fuzzifi cation of the input).
T36648 226352-226485 Sentence denotes (iii) Construction of fuzzy inference rules and defuzzifi cation or calculation of change in ventilator settings (controller action).
T39647 226486-226594 Sentence denotes This approach allows implementing clinician-dependent decision-making that refl ects individual preferences.
T18940 226595-226792 Sentence denotes Thus guidelines from EBM can be used but as well ICU specifi cs can be realized, for example diff erent levels of acceptable hypercapnia in patients with acute respiratory distress syndrome (ARDS).
T22996 226793-227014 Sentence denotes Results Exemplarily Figure 1 shows, for healthy and ARDS lungs, the diff erence between two fuzzy sets for our paCO 2 controller given from two clinicians (C10 and C51) with diff erent expertise in mechanical ventilation.
T66693 227015-227214 Sentence denotes With the newly designed fuzzy sets, our AUTOPILOT-BT reacts according to the clinicians' preferences, but still minimizes the time in which the patient is not ventilated within the specifi ed limits.
T78537 227215-227385 Sentence denotes Conclusions The system automatically implements the know-how of medical experts in ventilation management if the clinicians are willing to interact with the query system.
T29340 227386-227489 Sentence denotes The resulting strategy is mainly infl uenced by the expertise, experience and demands of the clinician.
T24744 227490-227622 Sentence denotes Thus the AUTOPILOT-BT, has the potential to select established guidelines or to adapt the system to modifi ed ventilation therapies.
T18674 227623-227802 Sentence denotes Introduction Respiratory muscle weakness is an important risk factor for prolonged mechanical ventilation, and may be part of critical illness related polyneuropathy and myopathy.
T98954 227803-227966 Sentence denotes Animal data also strongly point to atrophy and weakness of the diaphragm due to mechanical ventilation itself, called ventilator-induced diaphragmatic dysfunction.
T73808 227967-228125 Sentence denotes Recently, measuring transdiaphragmatic pressure following magnetic stimulation (TwPdi BAMPS) was introduced in the ICU to evaluate diaphragm function [1, 2] .
T78927 228126-228237 Sentence denotes We aimed to evaluate reproducibility of twitch TwPdi BAMPS in critically ill, mechanically ventilated patients.
T17828 228238-228334 Sentence denotes We also aimed to describe the relationship between TwPdi and duration of mechanical ventilation.
T64876 228335-228417 Sentence denotes Methods Prospective observational study in a medical ICU of a university hospital.
T72361 228418-228498 Sentence denotes TwPdi BAMPS was measured in critically ill and mechanically ventilated patients.
T38698 228499-228780 Sentence denotes Briefl y, the phrenic nerves were stimulated bilaterally from the anterior approach, at the posterior border of the sternocleidomastoid muscle, at the level of the cricoids using two fi gureof-eight 45 mm magnetic coils (Magstim, Dyfed, Wales) and a bistim (Magstim, Dyfed, Wales).
T30572 228781-228871 Sentence denotes A custom-built occlusion valve was used to create isometric conditions during stimulation.
T33876 228872-229032 Sentence denotes Oesophageal and abdominal pressure changes were measured using balloon catheters (UK Medical, Sheffi eld, UK) inserted through the nose after local anaesthesia.
T27886 229033-229158 Sentence denotes Results Nineteen measurements were made in a total of 10 patients at various intervals after starting mechanical ventilation.
T40821 229159-229263 Sentence denotes In seven patients, measurements were made on at least two occasions with a minimal interval of 24 hours.
T55540 229264-229384 Sentence denotes The between-occasion coeffi cient of variation of TwPdi was 9.7%, which is comparable with data from healthy volunteers.
T55303 229385-229504 Sentence denotes Increasing duration of mechanical ventilation was associated with a logarithmic decline in TwPdi (R = 0.69, P = 0.038).
T50328 229505-229794 Sentence denotes This association was also found when cumulative time on pressure control ventilation (R = 0.71, P = 0.03) and pressure support ventilation (P = 0.05, R = 0.66) were considered separately, as well as for cumulative dose of propofol (R = 0.66, P = 0.05) and piritramide (R = 0.79, P = 0.01).
T31166 229795-229916 Sentence denotes Conclusions Increased duration of mechanical ventilation is associated with a logarithmic decline in diaphragmatic force.
T26769 229917-230013 Sentence denotes These fi ndings are compatible with the concept of ventilator-induced diaphragmatic dysfunction.
T30144 230014-230134 Sentence denotes The observed decline may also be due to the cumulative dose of sedatives/analgesics or other co-factors, such as sepsis.
T19448 230135-230296 Sentence denotes Introduction The aim of the investigation was to study the parameters of haemodynamics, gas exchange and volhaemic status in patients with severe thermal injury.
T11108 230297-230411 Sentence denotes The trial has covered 30 injured patients aged from 21 to 60 years with 25 to 78% skin burns and PO 2 /FiO 2 <300.
T2120 230412-230453 Sentence denotes Patients were randomized into two groups.
T99528 230454-230523 Sentence denotes The fi rst group was n = 13, PO 2 /FiO 2 <300, 24 to 72 h after burn.
T92620 230524-230595 Sentence denotes The second group was n = 17, PO 2 /FiO 2 <300, 4 to 11 days after burn.
T59120 230596-230960 Sentence denotes Injured persons were subjected to evaluation of cardiac index (CI), intrathoracic blood volume index (ITBI), extravascular lung water index (ELWI0 and pulmonary vascular permeability index (PVPI) by single transpulmonary thermodilution (PiCCOplus; Pulsion Medical Systems, Germany), calculation of oxygen delivery (DO 2 ), and colloidal osmotic pressure of plasma.
T34103 230961-231042 Sentence denotes Grade of pulmonary damage was evaluated by Murrey, severity of dispragia by SOFA.
T65695 231043-231121 Sentence denotes Correlation analysis was performed using Pearson and Spearman criteria (r; P).
T93348 231122-231164 Sentence denotes Diff erences were signifi cant at P <0.05.
T69187 231165-231366 Sentence denotes Results Hypoxaemia (PO 2 /FiO 2 = 259 ± 19) in the injured of the fi rst group was developing at the background of reduction of CI = 3.2 ± 0.5; ITBI = 751 ± 114; DO 2 = 596 ± 124 (r = -0.92; P = 0.02).
T44218 231367-231401 Sentence denotes ELWI level was normal (7.3 ± 0.8).
T26850 231402-231676 Sentence denotes In the second group, reduction of PO 2 /FiO 2 has been developing at the background of burn sepsis (average SOFA point = 7.0 ± 1.9, Murrey = 1.6 ± 0.4) and was caused by increasing of ELWI up to 9.0 ± 1.4 (r = -0.66; P = 0.002) and correlated with PVPI (r = 0.57; P = 0.01).
T96390 231677-231807 Sentence denotes There was no statistically signifi cant correlation ELWI with ITBI and colloidal osmotic pressure of plasma (r = 0.13, r = -0.42).
T35222 231808-231958 Sentence denotes Conclusions Gas exchange disorders in patients of the fi rst group were caused by lack of perfusion and misbalance between oxygen delivery and demand.
T42558 231959-232120 Sentence denotes Reduction of oxygenation index in patients from the second group was accompanied by ELWI at the background of alteration of intravascular penetration and sepsis.
T38488 232121-232337 Sentence denotes Introduction Prior non-invasive ventilation (NIV) is associated with an increased mortality in patients with haematological malignancies and acute respiratory failure treated by invasive mechanical ventilation (IMV).
T21693 232338-232488 Sentence denotes Methods We have assessed whether NIV failure is an independent prognostic factor for hospital discharge in a general cancer population treated by IMV.
T80901 232489-232664 Sentence denotes One hundred and six patients with solid tumours and 58 patients with haematological malignancies were eligible for this retrospective study; 41 were treated by NIV before IMV.
T95839 232665-232837 Sentence denotes The main indications for mechanical ventilation were sepsis/ shock (35%), acute respiratory failure (33%), cardiopulmonary resuscitation (16%) and neurologic disease (10%).
T45830 232838-232947 Sentence denotes Respectively, 35%, 28% and 24% of the patients were extubated, discharged from the ICU and from the hospital.
T8065 232948-233038 Sentence denotes For patients treated with NIV prior to IMV, the rates were 22%, 17% and 10%, respectively.
T66158 233039-233217 Sentence denotes In multivariate analysis, three variables were independently associated with a decreased probability of being discharged from the hospital: NIV use before IMV (OR = 0.30, 95% CI:
T91258 233218-233273 Sentence denotes 0.09 to 0.95; P = 0.04); leucopenia (OR = 0.21, 95% CI:
T85959 233274-233348 Sentence denotes 0.06 to 0.77; P = 0.02) and serum bilirubin >1.1 mg/dl (OR = 0.38, 95% CI:
T37135 233349-233373 Sentence denotes 0.16 to 0.94; P = 0.04).
T49004 233374-233484 Sentence denotes Conclusions NIV failure before IMV is an independent poor prognostic factor in cancer patients treated by IMV.
T45128 233485-233698 Sentence denotes The data for 102 patients who were treated for swelling of the larynx at the Department of Otorhinolaryngology of Ludwig-Maximilians-University of Munich from 2004 to 2008 were evaluated in a retrospective survey.
T2609 233699-233968 Sentence denotes Results Causes of laryngeal AE were in 26 patients an allergic reaction, in 33 cases were due to radiotherapy after cancer, 32 patients took an angiotensin-converting enzyme inhibitor (ACEI), one patient had a hereditary angioedema (HAE) and in 10 patients are unknown.
T73811 233969-234220 Sentence denotes All patients independent from the underlying cause were treated with high-dose intravenous steroids, 69 patients with antihistamines, 33 with epinephrine (inhalation or i.m.), two patients with ACEI-induced AE were successfully treated with icatibant.
T83589 234221-234332 Sentence denotes Ten patients needed an intubation, 11 a tracheotomy, one patient an emergency coniotomy to preserve the airway.
T89608 234333-234383 Sentence denotes All 11 tracheotomy patients suff ered from cancer.
T61145 234384-234479 Sentence denotes Nine out of 10 intubated patients took an ACEI and were extubated on the ICU after 2 to 7 days.
T91600 234480-234719 Sentence denotes Conclusions According to our experience 80% of the patients with laryngeal swelling and upper airway obstruction react well to the standard therapy with steroids, epinephrine and antihistamines, indicating that the AE is histamine induced.
T44852 234720-234829 Sentence denotes In contrast these drugs have almost no eff ect on bradykinin-induced angioedema; that is, AE induced by ACEI.
T97512 234830-235011 Sentence denotes There is preliminary evidence that the bradykinin B 2 receptor antagonist icatibant that is approved for treatment of HAE type I and II may also be eff ective in ACEI-induced edema.
T20150 235012-235048 Sentence denotes Forty-six laryngoscopes were tested.
T78687 235049-235095 Sentence denotes All had traditional vacuum incandescent bulbs.
T81106 235096-235175 Sentence denotes Twelve (26%) fell below 1,000 Lux and six (13%) fell below the 500 Lux minimum.
T54782 235176-235295 Sentence denotes The failures were corrected by battery replacement in 25% and by bulb replacement in the remaining 75% (see Figure 1 ).
T88176 235296-235448 Sentence denotes Conclusions Simply checking laryngoscopes for the presence of illumination on a regular basis is insuffi cient to ensure best or even adequate function.
T38665 235449-235527 Sentence denotes Poor function is as frequently related to bulb dysfunction as battery fatigue.
T54662 235528-235683 Sentence denotes Institutions should consider quality control and maintenance programs or consider more advanced laryngoscopic lighting (for example, LED or halogen bulbs).
T1552 235684-235706 Sentence denotes References (Table 1) .
T22002 235707-235935 Sentence denotes We did not fi nd signifi cant diff erences of respiratory and hemodynamic data between groups; MR did not induce cardiovascular instability: the mean cardiac output was 5.2 ± 2.2 vs 4.9 ± 1.5 l/min (MRa vs no-MRa, respectively).
T12046 235936-236053 Sentence denotes Conclusions RM with CPAP performed before PDT could be performed safely to prevent alveolar derecruitment due to PDT.
T8198 236054-236225 Sentence denotes In neurosurgical patients requiring ventilation on the ICU, a tracheostomy is frequently formed to facilitate airway protection and weaning from the mechanical ventilator.
T32987 236226-236296 Sentence denotes However, the issue of when to form a tracheostomy remains contentious.
T78508 236297-236400 Sentence denotes In order to better inform our decision-making processes we audited practice within our own institution.
T69796 236401-236579 Sentence denotes Methods A retrospective study was conducted in which the ICU charts of all neurosurgical patients admitted to a tertiary referral ICU during the calendar year 2007 were reviewed.
T48262 236580-236693 Sentence denotes Patients who did not require mechanical ventilatory support or who died within 7 days of admission were excluded.
T50947 236694-236880 Sentence denotes Demographic data, diagnosis, duration of mechanical ventilation, ICU day of stay on which tracheostomy was formed, and ICU length of stay were recorded and the data analysed accordingly.
T61301 236881-236950 Sentence denotes Results A total of 106 patients were included, 65 male and 41 female.
T4013 236951-236977 Sentence denotes The mean age was 49 years.
T62652 236978-237138 Sentence denotes Sixty-three patients were able to be separated from the mechanical ventilator within 7 days of commencement of ventilation via a cuff ed oral endotracheal tube.
T3028 237139-237263 Sentence denotes Of the remaining 43 patients, 34 (79%) went on to undergo tracheostomy formation as determined by the attending intensivist.
T61992 237264-237332 Sentence denotes In this group the median time of tracheostomy formation was 13 days.
T76772 237333-237433 Sentence denotes The median time from tracheostomy formation to separation from the mechanical ventilator was 3 days.
T25544 237434-237698 Sentence denotes Of those patients Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1 who could not be extubated within 7 days of ventilatory support, nine (14%) were successfully separated from the mechanical ventilator without the need for a tracheostomy.
T98563 237699-237782 Sentence denotes There were no signifi cant diff erences in age or diagnosis between the two groups.
T63111 237783-237982 Sentence denotes Conclusions Our data suggest that the failure of a neurosurgical patient to separate from the mechanical ventilator within 7 days is predictive of the eventual requirement for tracheostomy formation.
T50702 237983-238105 Sentence denotes In light of this we intend to expand our sample size over a 5-year period and subject the data to multivariate regression.
T6005 238106-238198 Sentence denotes References Introduction Percutaneous tracheostomy is a common procedure in many trauma ICUs.
T29965 238199-238379 Sentence denotes A concern about the safety of performing percutaneous tracheostomy in patients with no cervical spine clearance or cervical spine injury has limited its adoption for some surgeons.
T73071 238381-238495 Sentence denotes The total number of tracheotomies during the study period was 220, of which 125 (56%) were PT and 95(44%) were OT.
T31666 238496-238554 Sentence denotes Both groups were similar in age, sex and ISS distribution.
T93958 238555-238661 Sentence denotes Of the OT group, 60 (63%) were done in patients with no cervical spine clearance or cervical spine injury.
T44898 238662-238725 Sentence denotes There were no immediate complications reported in the OT group.
T46950 238726-238849 Sentence denotes The PT group had 63 cases (50.4%) done with no preoperative cervical spine clearance or positive for cervical spine injury.
T55648 238850-238939 Sentence denotes The PT group underwent the procedure without bronchoscopy assistance in 95% of the cases.
T24555 238940-239077 Sentence denotes Two cases (1.5%) in the PT group were reported with postoperative bleeding from the tracheostomy site that did not required intervention.
T67779 239078-239189 Sentence denotes Both cases were PT done without bronchoscopy assistance and did not have preoperative cervical spine clearance.
T51421 239190-239237 Sentence denotes No other immediate complications were reported.
T35611 239238-239421 Sentence denotes Conclusions The results of this study suggest that PT is safe in trauma patients without preoperative cervical spine clearance or with cervical injuries as compared with the OT group.
T77681 239422-239491 Sentence denotes Most of the PT cases were done without bronchoscopy assistance (95%).
T41717 239492-239595 Sentence denotes This fi nding suggests the need for further study to clarify the role of bronchoscopy assistance in PT.
T27555 239596-239700 Sentence denotes Introduction Mechanically ventilated (MV) patients are prone to develop ventilator-associated pneumonia.
T87577 239701-239838 Sentence denotes One of the major risk factors is microaspirations of supraglottic secretions past the endotracheal tube cuff (usually in polyvinyl (PV)).
T47612 239839-239911 Sentence denotes A novel polyurethane (PUE) cuff was designed to minimize these leakages.
T94094 239912-239989 Sentence denotes We therefore compared the sealing capacities of the two tubes in MV patients.
T94864 239990-240049 Sentence denotes Methods Twenty-nine consecutive MV patients (mean age ± SD:
T84757 240050-240216 Sentence denotes 68 ± 13, 21 males), were randomly allocated to receive either a PV (HI-LO Evac, Mallinckrodt) or a PUE (SEALGUARD Evac, Mallinckrodt) cuff ed endotracheal tube (size:
T4032 240217-240259 Sentence denotes 9 for men; 8 or 8.5 for women, as a rule).
T25474 240260-240414 Sentence denotes We excluded patients with emergency intubation, unstable haemodynamics, severe respiratory failure or patients with history of tracheal/laryngeal disease.
T57693 240415-240618 Sentence denotes In each patient, cuff pressure was maintained at 30 cmH 2 O, and ventilator parameters were set to plateau pressure ≤30 cmH 2 O; patients were fasting and placed in a strict semirecumbent position (45°).
T8443 240619-240875 Sentence denotes Radioactivity of tracheal aspirates was assessed sequentially (hourly samplings from T0 to T6 hours, then T8 hours and T12 hours) after injection of 74 MBq 99m Tc-DTPA diluted in 5 ml of 0.9% NaCl just above the cuff via the aspiration channel of the tube.
T22441 240876-241009 Sentence denotes Additionally, kinetics of respiratory tract contamination was followed by simultaneous pulmonary images using a scintillation camera.
T56031 241010-241059 Sentence denotes Data were blindly analysed by nuclear physicians.
T52990 241060-241165 Sentence denotes The study was approved by the hospital ethics committee and informed consent was obtained from relatives.
T77988 241166-241224 Sentence denotes Results Sixteen PUE and 13 PV cuff ed tubes were compared.
T39096 241225-241332 Sentence denotes The study was performed 3.2 ± 2.8 days after intubation and 8.3 ± 9.6 days after ICU admission (mean ± SD).
T88438 241333-241471 Sentence denotes Ventilator parameters were the following: volume control or pressure support but one on T tube, FiO 2 was 0.43 ± 0.14, PEEP 6 ± 2 cmH 2 O.
T28440 241472-241596 Sentence denotes Leakages were observed in 11/29 patients (38%), with similar rate of aspiration in PUE (5/16) and PV (6/13) groups (P = NS).
T38974 241597-241692 Sentence denotes Leakages were more frequently observed in female (7/8) than in male patients (4/21) (P <0.001).
T98309 241693-241793 Sentence denotes There was a trend to decreased frequency of aspiration in patients with larger tubes (size 9 vs 8.5:
T25437 241794-241805 Sentence denotes P = 0.062).
T24609 241806-241929 Sentence denotes Conclusions Both PUE and PV cuff ed endotracheal tubes are poorly eff ective in preventing microaspirations in MV patients.
T92991 241930-242040 Sentence denotes Tube size and/or gender may be more important than cuff composition in the prevention of aspiration during MV.
T38160 242041-242134 Sentence denotes Introduction For decades it was assumed that cuff ed endotracheal tubes prevented aspiration.
T50961 242135-242281 Sentence denotes However, currently used cuff ed tubes do not prevent the development of post-intubation pulmonary complications caused by microaspiration [1, 2] .
T18476 242282-242361 Sentence denotes A new taper-shaped cuff ed tube (TaperGuard (TG)) has recently been introduced.
T40382 242362-242473 Sentence denotes The aim of this study was to compare this tube with a traditional tube (Hi-Lo (HL)) in an aspiration pig model.
T38364 242474-242530 Sentence denotes Methods Fourteen pigs between 65 and 75 kg were studied.
T2363 242531-242633 Sentence denotes The pigs were randomly intubated with either TaperGuard (tapered cuff ) or Hi-Lo (barrel cuff ) tubes.
T94918 242634-242690 Sentence denotes The tube size was either 7.0 or 8.5 depending on weight.
T32172 242691-242749 Sentence denotes Cuff pressures were maintained between 24 and 27 cm water.
T33756 242750-242834 Sentence denotes After intubation, 0.3 ml/kg acidic blue dye (ph 2.5) was placed on top of the cuff .
T73404 242835-242875 Sentence denotes The animals were ventilated for 3 hours.
T82753 242876-242959 Sentence denotes The animals were then sacrifi ced and the tracheobronchial tree and lungs examined.
T64207 242960-243079 Sentence denotes Aspiration was characterized as follows: dye leak, ulceration/erosion, hemorrhagic pneumonia, bronchitis/bronchiolitis.
T9919 243080-243153 Sentence denotes Of the 14 pigs, one had to be excluded due to accidental cuff defl ation.
T23099 243154-243208 Sentence denotes Tube sizes were evenly distributed amongst the groups.
T33125 243209-243261 Sentence denotes Cuff pressures were equal: TG 23.7, HL 25.2 -P <0.2.
T10361 243262-243407 Sentence denotes As seen in Table 1 , the incidence of microaspiration was signifi cantly less for TG in the Blue Dye and bronchitis groups. following extubation.
T51893 243408-243494 Sentence denotes However, the true incidence of laryngeal edema in postoperative patients is not clear.
T39666 243495-243621 Sentence denotes We assessed the relationship between upper airway obstruction and the values of cuff -leak pressure in postoperative patients.
T60192 243622-243725 Sentence denotes Methods One hundred and fi fty-eight postoperative patients (123 elective, 35 emergency) were included.
T48338 243726-243873 Sentence denotes After ventilator weaning was accomplished, we measured the airway pressure at which a sound of cuff leakage was audible by a cuff pressure monitor.
T45434 243874-243960 Sentence denotes In 28 cases, the cuff leak pressure was measured during both awake and sedated states.
T21072 243961-244095 Sentence denotes The cuff leak pressure value was 12.8 ± 10.1 (median 10) mmHg for elective cases and 12.6 ± 10.0 (median 10) for emergency cases (NS).
T84654 244096-244211 Sentence denotes Six patients (3.8%) were not extubated because of high leak pressure and the value was 40.5 ± 16.0 (24 to 60) mmHg.
T80859 244212-244338 Sentence denotes One hundred and fortythree patients were extubated and nine of those (6.3%) were diagnosed as laryngeal edema by laryngoscopy.
T13092 244339-244517 Sentence denotes Seven of those (5.0%) needed reintubation, one was for the reason of massive sputa, three were for granuloma formation, and three (2.1%) were diagnosed as severe laryngeal edema.
T63972 244518-244686 Sentence denotes Patients who developed severe laryngeal edema had a higher leak pressure (27.2 ± 22.7 mmHg) than those who did not, and all of such patients had pressure above 20 mmHg.
T88555 244687-244833 Sentence denotes The sensitivity and the specifi city of the test using a threshold value of 20 mmHg for severe laryngeal edema were 97.2% and 40.0%, respectively.
T11477 244834-245050 Sentence denotes The occurrence of severe laryngeal edema was not associated with age, gender, perioperative weight gain, duration of translaryngeal intubation, inner diameter of the endotracheal tube, or serum albumin concentration.
T17866 245051-245228 Sentence denotes However, the cuff leak pressure value >20 mmHg was associated with gender (female, P = 0.02) and inner diameter of the endotracheal tube (P = 0.0017) by multivariate regression.
T50448 245229-245340 Sentence denotes In 28 patients, the cuff leak pressure was 17.8 ± 10.6 during the awake state and 9.9 ± 4.6mmHg under sedative.
T11838 245341-245533 Sentence denotes Because tonus of larynx is considered to be related to cuff leak pressure, it is useful to measure the cuff leak pressure in a sedated state if the patient had a high value in the awake state.
T72620 245534-245639 Sentence denotes Conclusions Cuff leak pressure values <20 mmHg at any time are useful to rule out severe laryngeal edema.
T27101 245640-245740 Sentence denotes It may be useful to measure the pressure in a sedated state if the value in the awake state is high.
T11341 245742-245849 Sentence denotes The rapid shallow breathing index (RSBI) has been shown to be a parameter that predicts successful weaning.
TextSentencer_T367 245850-245912 Sentence denotes A RSBI of less than 105 is a predictor for successful weaning.
TextSentencer_T368 245913-246000 Sentence denotes We investigated whether the RSBI could be a useful parameter in our patient population.
TextSentencer_T369 246001-246123 Sentence denotes Methods From June 2008 until March 2009 all patients who had been mechanically ventilated on our six-bed ICU were studied.
TextSentencer_T370 246124-246312 Sentence denotes Only the patients who were invasively mechanically ventilated, for longer than 6 hours, who had no missing information and did not die whilst on the ventilator were included in this study.
TextSentencer_T371 246313-246484 Sentence denotes RSBIs were measured by these patients at two diff erent time points of weaning, fi rstly at the point of reduction in pressure support and then at the point of extubation.
TextSentencer_T372 246485-246628 Sentence denotes The RSBI was measured using the ventilator (Maquet servo-i) by reducing the pressure support level to zero and adjusting the PEEP to 5 cmH 2 O.
TextSentencer_T373 246629-246685 Sentence denotes A signifi cance level <0.05 was considered signifi cant.
TextSentencer_T374 246686-246764 Sentence denotes The nonparametric Kruskall-Wallis test was used to analyse the collected data.
TextSentencer_T375 246765-246845 Sentence denotes Results One hundred and nineteen patients were ventilated over this time period:
TextSentencer_T376 246846-246912 Sentence denotes 74 patients did not meet the inclusion criteria; 45 were included.
TextSentencer_T377 246913-247115 Sentence denotes At the time point of further reduction in pressure support, the RSBI showed signifi cant diff erences (P = 0.038) between the group who was ready for weaning and the group who was not ready for weaning.
TextSentencer_T378 247116-247286 Sentence denotes In the group with successful reduction of PS (n = 28) the RSBI was 83.54 ± 32.12, and in the group without successful reduction of PS (n = 2) the RSBI was 158.50 ± 38.89.
TextSentencer_T379 247287-247387 Sentence denotes At the point of extubation the RSBI was signifi cant in predicting successful extubation (P <0.001).
TextSentencer_T380 247388-247555 Sentence denotes In the group who was successfully extubated (n = 24) the RSBI was 75.25 ± 21.62, and in the group who was unsuccessfully extubated (n = 5) the RSBI was 155.20 ± 25.23.
TextSentencer_T381 247556-247661 Sentence denotes Conclusions At the moment of extubation, the RSBI showed signifi cant low values in the successful group.
TextSentencer_T382 247662-247739 Sentence denotes This was also for the time point further reduction in pressure support level.
T53946 247740-247829 Sentence denotes Increasing pressure support during vibrocompression is useful during respiratory therapy?
T82168 247830-248175 Sentence denotes W Naue, A Guntzel, A Silva, R Condessa, R Oliveira, S Vieira Methods After being placed in the supine position in bed, with head angle elevation at 30°, patients were randomized to: group 1 (G1): vibrocompression for 10 minutes in the chest, or group 2 (G2): vibrocompression plus increase of 10 cmH 2 O in IP in PSV for 10 minutes in the chest.
T96188 248176-248231 Sentence denotes Clinical variables and APACHE II score were registered.
T89948 248232-248458 Sentence denotes Parameters analyzed at the beginning (1) and at the end (2) of the protocol were: variation of peak pressure (ΔPP = Pp2 -Pp1), variation of tidal volume (ΔVT = VT2 -VT1), variation of dynamic compliance (ΔCdyn = Cdyn2 -Cdyn1).
T72894 248459-248558 Sentence denotes The amount of variation of mucus secretion aspirated (ΔSa = Sa2 -Sa1) at the end was also measured.
T96628 248559-248595 Sentence denotes The results are showed in mean ± SD.
T30815 248596-248705 Sentence denotes Results Both groups (G1: n = 30 and G2: n = 39) were similar in clinical characteristics and APACHE II score.
T91715 248706-248980 Sentence denotes The variation of variables in G1 and G2, were respectively: ΔPp (cmH 2 O) = 0.58 ± 1.41 and -0.10 ± 0.98, P = 0.02; ΔVT (ml) = 28.90 ± 119.40 and 64.26 ± 93.82, P = 0.96; ΔCdyn (cmH 2 O) = 3.03 ± 9.56 and 4.26 ± 8.24, P = 0.89; ΔSa (g) 0.29 ± 1.73 and 0.93 ± 2.28, P = 0.36.
T39388 248981-249092 Sentence denotes Conclusions We found no diff erences between groups, except in peak pressure (Pp2 >Pp1) that was greater in G1.
T8217 249093-249158 Sentence denotes This result could be probably due to decreased airway resistance.
T21267 249159-249294 Sentence denotes References Introduction Failure in weaning from mechanical ventilation (MV) is frequent (25 to 30%) and associated with high mortality.
T58374 249295-249348 Sentence denotes Indexes predicting success can be helpful clinically.
T70502 249349-249440 Sentence denotes However their predictive capacity can be low, principally in patients with cardiac disease.
T91757 249441-249561 Sentence denotes The goal of this study is to evaluate weaning predictor indexes in patients with cardiac disease during weaning from MV.
T80182 249562-249786 Sentence denotes Methods We included patients with and without cardiac disease under MV for at least 48 hours, submitted to spontaneous breathing trial (SBT) for 30 minutes, extubated according to clinical decision and followed for 48 hours.
T53182 249787-249896 Sentence denotes They were evaluated concerning age, sex, clinical characteristics, length of hospital and ICU stay and of MV.
T71581 249897-250147 Sentence denotes At the fi rst and 30th minutes from SBT there were analyzed: arterial blood gases, hemodynamic and respiratory parameters as respiratory rate (f ), tidal volume (VT), rapid shallow breathing index (f/VT), maximal inspiratory and expiratory pressures.
T26623 250148-250283 Sentence denotes Comparisons were done between this group of patients and success x failure, defi ning failure as a return to MV in the fi rst 48 hours.
T45141 250284-250381 Sentence denotes Results Four hundred and thirteen patients were studied, 81 with cardiac disease and 332 without.
T48193 250382-250413 Sentence denotes Overall mortality rate was 14%.
T18673 250414-250445 Sentence denotes Return to MV occurred in 19.7%.
T8384 250446-250643 Sentence denotes The most important diff erences comparing patients with cardiac disease with the control group were: lower mortality rate (21% x 13.5%, P <0.006), shorter length of ICU stay (9 ± 3 x 16 ± 13 days).
T44860 250644-250749 Sentence denotes Comparing patients who failed in the weaning process with and without heart disease (20% x 20%, P <0.55).
T86372 250750-250964 Sentence denotes Comparing f/VT in 30th minute of patients who have had success with those who failed the weaning process (60 ± 38 x 74 ± 47, P <0.012), a lower increase in f/VT (Δf/VT) (4 ± 27 x 11 ± 33, P <0.075) during the test.
T8059 250965-251095 Sentence denotes Conclusions In this group of patients a great number failed in the weaning process, showing, as expected, a higher mortality rate.
T23107 251096-251212 Sentence denotes Parameters most related to failure in the literature were higher age, longer length of ICU stay, mortality and f/VT.
T37717 251213-251523 Sentence denotes In this study, just the last parameter was sensitive principally in the 30th minute, and higher increase in f/VT (Δf/VT) during the test, demonstrating that patients with cardiac disease not fail more than others during the weaning process, as well as the effi ciency of the test to predict success in weaning.
T91508 251524-251707 Sentence denotes Introduction Due to the improvement of nearly all fi elds of acute care in the past decades, the burden of long-term dependency from mechanical ventilation (MV) increases incessantly.
T38544 251708-251849 Sentence denotes The aim of this study was to implement and test a standardised weaning protocol in patients suff ering from long-term mechanical ventilation.
T82768 251850-251992 Sentence denotes Methods After approval by the local ethics committee and informed consent, 644 patients were enrolled in a prospective cohort study in 1 year.
T49926 251993-252067 Sentence denotes The mean time on the ventilator before inclusion was 39.4 (6 to 357) days.
T83469 252068-252189 Sentence denotes The reasons for long-term MV were: cerebral 33.1%; cardiovascular 31.5%; pulmonary 28.7% and 5.6% neuromuscular diseases.
T98424 252190-252384 Sentence denotes The weaning protocol started with 6 x 5 minutes spontaneous breathing (intermission of mechanical ventilation) on day 1 and was increased stepwise up to 24 hours spontaneous breathing on day 22.
T96792 252385-252548 Sentence denotes If there was no improvement in weaning steps over 5 days or there were more than three steps backwards the patient was switched to the individual weaning approach.
T17739 252549-252665 Sentence denotes The weaning protocol was carried out by the previously trained ICU staff as well as by specialized physiotherapists.
T61441 252666-252774 Sentence denotes Results A total of 77.3% (n = 498) of the patients could be weaned off the ventilator by the fi rst eff ort.
T30556 252775-252883 Sentence denotes Out of these, 85.9% of the patients were weaned by the protocol whereas 14.1% needed an individual approach.
T64477 252884-253003 Sentence denotes The mean time of weaning was 17 (5 to 67) days using the protocol and 29 (1 to 88) days due to the individual approach.
T77579 253004-253134 Sentence denotes In 12.6% both weaning procedures failed and these patients were discharged from the hospital into a home-care ventilation program.
T15113 253135-253220 Sentence denotes In total, 10.1% of the patients died on mechanical ventilation during their ICU stay.
T6124 253221-253379 Sentence denotes Patients who had needed a second weaning eff ort (n = 111) were weaned in 36.4% by the protocol, transferred to home-care ventilation (28.8%) or died (35.1%).
T64558 253380-253564 Sentence denotes Conclusions Using the standardised weaning protocol, more than three-quarters of the prolonged mechanically ventilated patients could be weaned off the ventilator in a mean of 17 days.
T35030 253565-253668 Sentence denotes Only 14.1% needed an individual strategy that takes 29 days until complete release from the ventilator.
T58676 253669-253977 Sentence denotes Therefore we suggest this kind of weaning protocol as a useful Introduction This study compared the reliability and the effi cacy of three diff erent non-invasive CPAP systems, Ventumask® low fl ow (LF), Ventumask® high fl ow (HF) and Boussignac® CPAP valve (B), both in a lung model and in healthy subjects.
T68705 253978-254139 Sentence denotes Methods Lung model: pneumatic simulator fi rst set at respiratory rate 16/ minute with 400 ml tidal volume (L1), then RR 40/minute with 800 ml tidal volume (L2).
T68119 254140-254152 Sentence denotes Human study:
T43823 254153-254293 Sentence denotes 10 healthy subjects were asked to make an expiratory pause (T1), fi ve breaths at tidal volume (T2), and a short sequence of tachypnea (T3).
T65485 254294-254389 Sentence denotes The diff erences between set and eff ective PEEP and FiO 2 were used as indexes of reliability.
T28152 254390-254515 Sentence denotes The minimum airway pressure below the PEEP level and the airway pressure swing around PEEP were used as indexes of effi cacy.
T10606 254516-254638 Sentence denotes In the lung simulator protocol, the pressure-time product was measured and then correlated to the other effi cacy indexes.
T35562 254639-254719 Sentence denotes Results Lung model: HF showed a tendency towards a more stable PEEP (P = 0.067).
T66091 254720-254844 Sentence denotes In B a signifi cant fall in the FiO 2 value from L1 (96.9 (95.5; 97.6)%) to L2 (54.2 (50.4; 56.9)%) was observed (P <0.001).
T39004 254845-254988 Sentence denotes The airway pressure swing around PEEP was greater in LF and B compared with HF in L1 (P <0.001), while during L2 it was lower in B (P = 0.007).
T14804 254989-255164 Sentence denotes The pressure-time product was better described by the airway pressure swing around PEEP (r 2 = 0.95) rather than the minimum airway pressure below the PEEP level (r 2 = 0.85).
T89757 255165-255265 Sentence denotes Human study: a lower diff erence between set and eff ective FiO 2 was registered with HF (P <0.001).
T59860 255266-255382 Sentence denotes Ventumask® systems showed an overall higher minimum airway pressure below the PEEP level compared with B (P <0.001).
T70969 255383-255587 Sentence denotes During T3, HF (+10.1 (+7.4; +13.2) cmH 2 O) showed a smaller airway pressure swing around PEEP relative to LF (+11.9 (+10.1; +16.6) cmH 2 O, P <0.001) but not to B (+12.2 (+6.6; +15.1) cmH 2 O, P = 0.40).
T82284 255588-255679 Sentence denotes During the whole respiratory sequence, an increase in end-expiratory pressure was observed.
T68094 255680-255746 Sentence denotes This increase was greater in B valve than in HF and LF (P <0.001).
T921 255747-255827 Sentence denotes Conclusions According to observations, HF seemed to be the most reliable device.
T88253 255828-255907 Sentence denotes In conditions of high fl ow demand, B reached FiO 2 values lower than expected.
T69877 255908-256070 Sentence denotes The dynamic hyper-pressurization, higher with B, is probably due to the relationship between expiratory fl ow and the resistance off ered by the expiratory valve.
T82190 256071-256166 Sentence denotes B, even if handy and lightweight, is less reliable in terms of fl ow supply and PEEP stability.
T70781 256167-256361 Sentence denotes Introduction Non-invasive mechanical ventilation (NIV) has been used in hypoxic postoperative cardiac patients but more studies are necessary to clarify its respiratory and hemodynamic eff ects.
T43304 256362-256509 Sentence denotes Therefore, our objective was to study its eff ects in the oxygenation index (PaO 2 /FiO 2 ) and in hemodynamic variables in this group of patients.
T87302 256510-256729 Sentence denotes Methods This is a randomized trial in which all postoperative cardiac patients having a pulmonary artery catheter and showing a PaO 2 /FiO 2 between 150 and 300 (with FIO 2 0.31), 1 hour after extubation, were included.
T31546 256730-256936 Sentence denotes The intervention group used NIV with a bilevel positive airway pressure (an inspiratory pressure to generate a tidal volume of 6 ml/kg and an expiratory pressure of 7 cmH 2 O) with FIO 2 0.4 during 3 hours.
T42912 256937-257017 Sentence denotes The control group used oxygen by Venturi mask in order to keep good oxygenation.
T33491 257018-257211 Sentence denotes In both groups, measurements were done in a basal situation (FiO 2 0.31), in the fi rst hour after beginning the treatment (FiO 2 0.4) and 1 hour after the end of the intervention (FiO 2 0.31).
T12334 257212-257468 Sentence denotes Variables studied included: pH, PaO 2 , PaCO 2 and PaO 2 /FiO 2 ratio, heart rate (HR), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), mean pulmonary arterial pressure (MPAP) and cardiac output (CO).
T2500 257469-257530 Sentence denotes Results Forty-two patients were included in the study period.
T5610 257531-257564 Sentence denotes The mean age was 65.7 ± 10 years.
T90846 257565-257616 Sentence denotes The basal variables were similar in the two groups.
T56224 257617-257834 Sentence denotes There was an increase in the PaO 2 /FiO 2 ratio in the NIV group in the fi rst hour (P <0.05, 95% CI 74.8 to 6.6) and 1 hour after stopping the treatment (P <0.05, 95% CI 90.7 to 10.8) compared with the control group.
T88029 257835-257954 Sentence denotes There were no signifi cant changes in hemodynamic parameters, pH and PaCO 2 during NIV compared with the control group.
T71854 257955-258036 Sentence denotes Conclusions There were no changes in hemodynamic variables during the NIV period.
T94143 258037-258139 Sentence denotes However, these results suggest that NIV improved oxygenation even 1 hour after stopping the treatment.
T1667 258140-258231 Sentence denotes (NIPPV) has been used with success in hypercapnic and hypoxaemic acute respiratory failure.
T48841 258232-258305 Sentence denotes However, the outcome of NIPPV with burn patients is less well documented.
T18407 258306-258408 Sentence denotes The purpose of this study is to report our experience with NIPPV in a series of burn-injured patients.
T77486 258409-258554 Sentence denotes Methods The records of all burn patients from July 2008 to September 2009, in whom NIPPV was used in the intensive burn care unit, were reviewed.
T96727 258555-258763 Sentence denotes The criteria for selecting patients for NIPPV included a combination of the following factors: patients with acute respiratory failure, haemodynamically stable, conscious and cooperative with their treatment.
T42363 258764-258816 Sentence denotes There had to be no need for endotracheal intubation.
T49162 258817-258869 Sentence denotes Results Thirty-one patients were treated with NIPPV.
T86633 258870-258891 Sentence denotes Nineteen were female.
T54317 258892-258965 Sentence denotes Mean age was 44.22 years, mean total body surface area (TBSA) was 38.37%.
T70468 258966-259076 Sentence denotes NIPPV was used to treat hypoxia in 21 patients, hypercapnia in four patients and both of them in six patients.
T17936 259077-259129 Sentence denotes The mean PaO 2 /FiO 2 ratio before NIPPV was 188.53.
T32712 259130-259273 Sentence denotes NIPPV was used to treat ARDS in 12 patients, pneumonia in eight patients, atelectasis in six patients and cardiogenic oedema in fi ve patients.
T24129 259274-259325 Sentence denotes The mean PaO 2 /FiO 2 ratio after NIPPV was 256.43.
T18712 259326-259399 Sentence denotes Intubation was successfully avoided in 12 out of the 31 (38.7%) patients.
T33674 259400-259476 Sentence denotes All of these patients progressed to self-ventilation status following NIPPV.
T29423 259477-259593 Sentence denotes Conclusions The use of NIPPV with burn-injured patients is, as yet, unclear because little work has been documented.
T56781 259594-259712 Sentence denotes In our experience, the use of NIPPV can lead to avoid the need for endotracheal intubation and mechanical ventilation.
T91560 259714-259905 Sentence denotes The purpose of this prospective study is to describe the hemodynamic and cardiac variation during a trial of non-invasive ventilation (NIV) in the process of weaning from ventilatory support.
T37307 259906-260066 Sentence denotes A continuous hemodynamic monitoring was performed with a pulse contour method, the MostCare (Vytech Health, Laboratoires Pharmaceutiques Vygon, Ecouen, France).
T99791 260067-260200 Sentence denotes This device could be used to identify the early warnings of cardiovascular dysfunction, which may contribute to unsuccessful weaning.
T88520 260201-260527 Sentence denotes Methods Fourteen patients, admitted to our ICU between January and July 2009, were included in the study: six intubated on respiratory failure due to cardiogenic pulmonary edema (CPE; 52 ± 18 years, four male (M), two female (F)), eight intubated on chronic obstructive pulmonary disease (COPD; 71 ± 16 years, four M, four F).
T52074 260528-260671 Sentence denotes The NIV trial was performed with a face mask: pressure support (PS) = 5 to 10 cmH 2 O, positive endexpiratory pressure (PEEP) = 5 to 7 cmH 2 O.
T54024 260672-260766 Sentence denotes Cardiovascular variables and gas exchange data were measured at three defi ned points in time:
T17846 260767-260966 Sentence denotes 1 hour before the extubation (T1), continuously during the NIV trial (a mean value was calculated and expressed as T2), and at the end of the NIV trial with the patient in spontaneous breathing (T3).
T10286 260967-261207 Sentence denotes The variation of cardiac index (CI) was: T1 2.53 ± 0.43 ml/minute/m 2 CPE vs 3.2 ± 0.64 ml/minute/m 2 COPD; T2 2.93 ± 0.93 ml/minute/m 2 CPE vs 2.9 ± 1.33 ml/minute/m 2 COPD; T3 1.96 ± 0.61ml/minute/m 2 CPE vs 3.3 ± 1.37 ml/minute/m 2 COPD.
T23237 261208-261335 Sentence denotes The variation of CI depended on the variation of stroke volume (SV), while the heart rate (HR) did not change during the trial.
T38365 261336-261590 Sentence denotes We calculated the oxygen delivery (DO 2 ) by the correlation of CI and gas exchange: T1 767 ± 218 ml/minute CPE vs 839 ± 134.3 ml/minute COPD, T2 917 ± 417 ml/minute CPE vs 701 ± 349 ml/minute COPD, T3 760 ± 404 ml/minute CPE vs 753 ± 340 ml/minute COPD.
T17752 261591-261686 Sentence denotes The variation of CI and DO 2 , observed within and among the two groups was never signifi cant.
T78614 261687-261776 Sentence denotes Conclusions Both groups of patients were successful in achieving spontaneous ventilation.
T60686 261777-262054 Sentence denotes In our opinion, continuous hemodynamic monitoring may provide helpful beat-to-beat information and it might be used, combined with the gas exchange and oxygen saturation monitoring, during the weaning process as a predictor of cardiovascular instability or respiratory failure.
T95597 262055-262258 Sentence denotes Moreover, continuous hemodynamic monitoring enables one to be aware of the variation of systemic oxygen delivery, and these data could be used to value critically ill patients during the weaning process.
T5844 262259-262360 Sentence denotes Introduction Obesity rates are increasing in the general population and it is also prevalent in ICUs.
T34738 262361-262659 Sentence denotes Patients are sometimes admitted to ICUs for hypercapnic respiratory failure or cor pulmonale but in general they are admitted for pneumonia, excessive daytime sleepiness, heart failure, COPD or asthma attacks or pulmonary embolism; and hypercapnic respiratory failure is noticed during this period.
T82165 262660-262772 Sentence denotes On the other hand, optimal non-invasive mechanical ventilation strategy is not known during their ICU treatment.
T99060 262773-262940 Sentence denotes The aim of this study is to assess the diff erences between NIV strategies and outcomes between obese and nonobese patients with acute hypercapnic respiratory failure.
T90792 262941-263059 Sentence denotes Methods In this retrospective cohort study, 73 patients were studied and all of them were ventilated with a face mask.
T77967 263060-263328 Sentence denotes Patients divided into two groups as obese (BMI >35 kg/m 2 ) and nonobese (BMI <35 kg/m 2 ), and whether necessary pressure, volume, mode, ventilator and time to reduce PaCO 2 below 50 mmHg were signifi cantly diff erent in obese and nonobese patients was investigated.
T91241 263329-263456 Sentence denotes Results Mean age of the patients was 66 ± 14 years and mean admission APACHE II score was 18 ± 4; 41 (56%) of them were female.
T41197 263457-263658 Sentence denotes ICU admission reasons for the obese patients were signifi cantly more frequently pulmonary edema and less frequently pulmonary infections (P = 0.003 and 0.043, respectively) than the nonobese patients.
T85538 263659-263929 Sentence denotes While there were no signifi cant diff erences across the groups between the ventilators, modes, and inspiratory pressure levels, obese patients required higher end-expiratory pressure levels and more time to reduce the PaCO 2 level below 50 mmHg than the nonobese group.
T72798 263930-264023 Sentence denotes Length of NIV and ICU stay, intubation and the mortality rate were similar across the groups.
T95137 264024-264232 Sentence denotes Conclusions These results suggest that improvement of hypercapnia in obese patients may require higher PEEP levels and longer times than the non-obese ones during acute hypercapnic respiratory failure attack.
T96275 264233-264472 Sentence denotes A simple predictive scoring system for prolonged mechanical ventilation in severe sepsis and septic shock N Saito, Y Sakamoto, K Mashiko Chiba Hokusou Hospital, Nippon Medical School, Chiba, Japan Critical Care 2010, 14(Suppl 1):P243 (doi:
T52076 264473-264607 Sentence denotes 10.1186/cc8475) Introduction Prolonged mechanical ventilation (MV) is associated with high morbidity and mortality in septic patients.
T43529 264608-264678 Sentence denotes However, limited data are available on the prediction of prolonged MV.
T86747 264679-264818 Sentence denotes We conducted an observational cohort study aimed at developing a prolonged MV predictive scoring system for severe sepsis and septic shock.
T77303 264819-264996 Sentence denotes Methods We retrospectively analyzed 120 consecutive patients with severe sepsis or septic shock who were ventilated for more than 72 hours between January 2005 and October 2009.
T36449 264997-265106 Sentence denotes Clinical features and physiologic parameters were examined for more than 15 days for use as predictors of MV.
T75935 265107-265225 Sentence denotes Patients were divided into two groups: group 1, those requiring MV for <15 days; group 2, those requiring MV >15 days.
T67567 265226-265345 Sentence denotes The mean (± SD) age and SOFA scores were 65.3 ± 16.7 years and 10.0 ± 3.9, respectively, and 35% required prolonged MV.
T74207 265346-265764 Sentence denotes Univariate analysis indicated that the length of ICU and hospital stays, hospital mortality, the rate of transfusion, incidence of ARDS, ventilator-associated pneumonia (VAP), other nosocomial infection (NI) and drug-resistant bacteria, the ratio of steroid therapy and muscle relaxant use, and the mean PaO 2 /FiO 2 ratio during the fi rst 3 days after admission were signifi cantly diff erent between the two groups.
T47709 265765-265847 Sentence denotes The independent predictors for prolonged MV were ARDS (OR 5.24 (P = 0.001; 95% CI:
T68810 265848-265894 Sentence denotes 1.9 to 14.1)), VAP (OR 7.75 (P <0.001; 95% CI:
T57905 265895-265954 Sentence denotes 2.7 to 22.0)), and transfusion (OR 2.84 (P = 0.036; 95% CI:
T84857 265955-266054 Sentence denotes 1.0 to 7.5)) Using these results, we were able to develop a prolonged MV predictive scoring system.
T14354 266055-266201 Sentence denotes This simplifi ed clinical risk assessment tool was developed from Introduction Severity scoring is a powerful tool for quality control in the ICU.
T95 266202-266257 Sentence denotes We introduced a new severity scoring system to our ICU.
T78696 266258-266357 Sentence denotes The aim of this report is to describe the database and present the results of the fi rst 12 months.
T80556 266358-266418 Sentence denotes Methods We analysed needs for database and severity scoring.
T29500 266419-266558 Sentence denotes We chose on-admission scoring with EUROSCORE for cardiac surgical patients, and Mortality Prediction Model II time zero for other patients.
T87726 266559-266627 Sentence denotes Data were collected via highly simplifi ed forms onto a spreadsheet.
T92828 266628-266814 Sentence denotes Demographic entry was by ward clerk, on-admission severity scoring was by resident medical staff , and risk of death calculation and data cleaning was by senior attending medical staff .
T23644 266815-266873 Sentence denotes Individual patient risk of death was presented as a logit.
T32179 266874-266979 Sentence denotes Combined risk of death for the whole cohort was calculated from the arithmetic mean of individual logits.
T64285 266980-267093 Sentence denotes We estimated the time to completion of each step in data acquisition to calculate a total time spent per patient.
T15939 267094-267234 Sentence denotes Results There were 1,355 admissions, mean (SD) age 69.2 (15.9) years, 57.1% male; median (range) length of stay 23.1 (1.7 to 1,882.5) hours.
T34607 267235-267328 Sentence denotes Fiftyfour per cent of patients were ventilated for a median (range) 7.5 (0.8 to 1,877) hours.
T92151 267329-267454 Sentence denotes Predicted mortality for cardiothoracic and noncardiothoracic patients combined was 8.64% and the observed mortality was 2.8%.
T93250 267455-267584 Sentence denotes EUROSCORE-predicted mortality for the 535 cardiothoracic patients was 5.72% and the observed mortality was 0.75% (four patients).
T56343 267585-267706 Sentence denotes MPMpredicted mortality for the 820 noncardiothoracic patients was 11.23% and the observed mortality was 4% (34 patients).
T93168 267707-267901 Sentence denotes Estimated time to complete the severity scoring form was 30 seconds, to enter a new patient on the database was 90 seconds and to calculate risk of death and check data integrity was 90 seconds.
T39559 267902-267936 Sentence denotes Total was 3.5 minutes per patient.
T80287 267937-268021 Sentence denotes Conclusions Data collection/analysis is essential for quality management in the ICU.
T60529 268022-268056 Sentence denotes Proprietary systems are expensive.
T29523 268057-268138 Sentence denotes Traditional scoring systems (APACHE II) are poorly calibrated to some case mixes.
T2039 268139-268233 Sentence denotes To overcome these problems, we devised a simple, inexpensive and highly valuable ICU database.
T27370 268234-268386 Sentence denotes The key features were well calibrated, on-admission severity scoring, highly simplifi ed forms, a basic spreadsheet and collaborative staff involvement.
T42810 268387-268443 Sentence denotes Senior medical staff performed the fi nal data checking.
T95393 268444-268538 Sentence denotes The project provided abundant high-quality data with a total input of 3.5 minutes per patient.
T26363 268539-268672 Sentence denotes We are trialling the database in a large ICU in China and we would welcome input from other ICUs that would like to copy our methods.
T63056 268673-268781 Sentence denotes Validation of a computerised system to calculate the sequential organ failure assessment score C Bourdeaux 1
T88927 268783-268951 Sentence denotes The sequential organ failure assessment (SOFA) score was introduced with the aim of quantifying the severity of illness, based on organ dysfunction, serially over time.
T68873 268952-269113 Sentence denotes A previous study has suggested that the reliability and accuracy of SOFA scoring by intensive care physicians is good but there may be room for improvement [1] .
T30143 269114-269168 Sentence denotes Manual calculation of the score can be time consuming.
T42751 269169-269302 Sentence denotes We developed a computer program that derives a SOFA score from the electronic patient record, the Innovian system (Draeger, Germany).
T73438 269303-269378 Sentence denotes To date, no automated method for SOFA score calculation has been validated.
T96967 269379-269483 Sentence denotes We validated the automated SOFA score collection method in order to assess its accuracy and reliability.
T12273 269484-269619 Sentence denotes We also measured the time for manual collection of SOFA scores in order to assess the resource saving potential of the computer system.
T7923 269620-269793 Sentence denotes Methods Fifty patient records were selected from the database as a stratifi ed random sample in order to represent the patient population of our teaching hospital adult ICU.
T23001 269794-269907 Sentence denotes Two ICU physicians calculated a total SOFA score and an individual organ score on each of the 50 patient records.
T23025 269908-270049 Sentence denotes A gold standard SOFA score was then generated after discussion between the two physicians with the aid of a third adjudicating ICU physician.
T86316 270050-270144 Sentence denotes SOFA scores generated by the computer were compared with the gold standard to assess accuracy.
T98229 270145-270190 Sentence denotes Reasons for inaccurate scoring were recorded.
T29267 270191-270332 Sentence denotes Results SOFA scores varied from 1 to 15 in this sample, the mean SOFA score for the Gold standard was 8.1 and the standard deviation was 2.9.
T77083 270333-270392 Sentence denotes The agreement between the diff erent ratings was very good.
T27647 270393-270602 Sentence denotes The computer score had a better agreement with the gold standard score (Pearson correlation coeffi cient 0.92), compared with the individual physician scores (Pearson correlation coeffi cient 0.890 and 0.895).
T43336 270603-270731 Sentence denotes The computer calculated the SOFA score correctly in 41 cases and the physicians calculated the SOFA score correctly in 32 cases.
T56837 270732-270853 Sentence denotes The average time to calculate a SOFA score was 4.91 minutes and was not signifi cantly diff erent between the physicians.
T96841 270854-271015 Sentence denotes The results show that this computer system is highly accurate at calculating SOFA scores from the electronic patient record and is more accurate than physicians.
T41311 271016-271047 Sentence denotes The time saved is considerable.
T32397 271048-271271 Sentence denotes Reference [1] found patients older than 60 years and with SOFA score higher than 9 for at least 5 days unlikely to survive, suggesting that it could provide a basis for deciding whether to withhold or withdraw life support.
T55460 271272-271335 Sentence denotes We tried to control their hypothesis in our patient population.
T94000 271336-271463 Sentence denotes Methods We reviewed the data of the patients older than 60 years and with a LOS higher than 5 days admitted to our ICU in 2007.
T70608 271464-271556 Sentence denotes We calculated the daily SOFA score of the patients with an initial SOFA score higher than 9.
T5901 271557-271729 Sentence denotes IGSII, LOS and mortality were compared between patients with a SOFA score higher than 9 for at least 5 days (SOFA(+) group) and the other selected patients (SOFA(-) group).
T32303 271730-271777 Sentence denotes In 2007, 430 patients were admitted to our ICU.
T8665 271778-271866 Sentence denotes One hundred and forty were older than 60 years and remained more than 5 days in the ICU.
T15897 271867-271945 Sentence denotes Eleven of these patients had a SOFA score higher than 9 during 5 days or more.
T89037 271946-272068 Sentence denotes In the SOFA(+) group, LOS (22.6 ± 13.1 vs 10.8 ± 6.9 days) and mortality (55% vs 33%) are signifi cantly higher (P <0.05).
T41999 272069-272207 Sentence denotes The mortality of 55% is in good agreement with the predicted IGSII mortality but far less than the 100% predicted by Cabré and colleagues.
T92842 272208-272359 Sentence denotes Conclusions A SOFA score higher than 9 for at least 5 days in patients older than 60 years seems useless to defi ne futility in our patient population.
T41159 272360-272435 Sentence denotes It is applicable to only less than 3% of the 430 patients admitted in 2007.
T4497 272436-272565 Sentence denotes The mortality rate of the SOFA(+) group increased but remained far from values permitting to withdraw or withhold intensive care.
T29101 272566-272708 Sentence denotes A weakness of the use of sequential SOFA score to predict outcome is that some therapeutic options can infl uence the value of the SOFA score.
T79364 272709-272804 Sentence denotes Introduction Prolonged ICU stay is associated with high morbidity, mortality and costs [1, 2] .
T22673 272805-272923 Sentence denotes Prediction of this prolonged stay will provide information for physician and family and help with resource allocation.
T10963 272924-272974 Sentence denotes Even though, available severity scoring system ie.
T21488 272975-273090 Sentence denotes APACHE II, APACHE III, MPM, SAPS II, MODS scores are widely accepted for evaluating outcomes in the ICU population.
T71532 273091-273203 Sentence denotes But these models might be inaccurate when apply to subpopulation and might not predict prolonged length of stay.
T81371 273204-273375 Sentence denotes Conclusions All three scores are useful prognostic factors for mortality and for ICU therapy in the ED, with usually lower patients' severity of infection than in the ICU.
T25283 273376-273484 Sentence denotes The ICU-validated APACHE II and SOFA scores were of similar prognostic value as the ED-specifi c MEDS score.
T65557 273485-273659 Sentence denotes Recently, Raum and colleagues [1] generated and validated a new trauma score (Emergency Trauma Score, EMTRAS) based on age, prehospital GCS, prothrombin time and base excess.
T75874 273660-273734 Sentence denotes Each parameter is subdivided into four classes, scored from 0 to 3 points.
T59814 273735-273810 Sentence denotes Scores of each class are summed to obtain the EMTRAS, ranging from 0 to 12.
T38150 273811-273965 Sentence denotes Here we present preliminary results of a study with the aim to validate this new scoring system and to compare it with other commonly used illness scores.
T8908 273966-274119 Sentence denotes Methods One hundred and fi fty trauma patients admitted to the regional referral trauma center (Careggi Teaching Hospital, Florence, Italy) were studied.
T3303 274120-274350 Sentence denotes Predictive value of the EMTRAS score was compared with the Injury Severity Score (ISS), Revised Trauma Score (RTS), Trauma Injury Introduction Severe sepsis is an important cause of morbidity and mortality following major surgery.
T99985 274351-274545 Sentence denotes Factors that are associated with an increased risk of sepsis following surgery include emergency surgery, patient co-morbidities, allogeneic blood transfusion and degree of surgical insult [1] .
T68659 274546-274637 Sentence denotes Physiological track-and-trigger systems are widely used to identify deteriorating patients.
T54411 274638-274789 Sentence denotes The Modifi ed Early Warning System (MEWS) is one such system, but has not been studied in regard to predicting the development of sepsis after surgery.
T89985 274790-275003 Sentence denotes Although high MEWS scores are associated with increased hospital mortality, the sensitivity of MEWS and other physiological track and trigger scores for predicting death or admission to intensive care is low [2] .
T52633 275004-275144 Sentence denotes Methods We carried out a prospective cohort study on 101 patients undergoing elective major surgery in a large university teaching hospital.
T40944 275145-275248 Sentence denotes The patients were followed up for 10 days, and the incidence of sepsis and septic shock was documented.
T85031 275249-275298 Sentence denotes MEWS scores were recorded daily for each patient.
T46694 275299-275384 Sentence denotes Admissions to critical care were documented, along with critical care length of stay.
T54873 275385-275475 Sentence denotes Results Twenty-seven (27%) patients developed sepsis and nine (9%) developed septic shock.
T62245 275476-275670 Sentence denotes Factors associated with the development of sepsis were intraoperative blood transfusion (P = 0.013), duration of operation (P = 0.004) and a postoperative MEWS score greater than 3 (P = 0.0003).
T33434 275671-275863 Sentence denotes Using multivariate logistic regression analysis, a MEWS score greater than 3 after surgery was the only factor that remained signifi cantly associated with sepsis (odds ratio 4.89, P = 0.003).
T29041 275864-276055 Sentence denotes Although a high MEWS score was associated with sepsis after surgery, only fi ve (19%) patients who developed sepsis had an abnormal MEWS score prior to (mean 4.6 days) sepsis being diagnosed.
T23796 276056-276217 Sentence denotes In the post-CCO group 10 of the 27 patients were admitted to the ICU and 17 of these were treated in hematology ward, and nine of these received NIV (Figure 1 ).
T39016 276218-276351 Sentence denotes We defi ned six criteria for activation of the CCO team: radiological signs of pneumonia, organ increased by 116% (n = 65; type 1 MI:
T69824 276352-276367 Sentence denotes 54%; type 2 MI:
T87075 276368-276382 Sentence denotes 46%; P <0.05).
T80972 276383-276502 Sentence denotes Type 1 MI increased by 75%, which was refl ected by a 57% decrease of patients formerly classifi ed as instable angina.
T48511 276503-276664 Sentence denotes Of note, increases of MI diagnosis were mainly refl ected by a 200% increase of type 2 MI (for example, acute heart failure, tachycardia or hypertensive crisis).
T55663 276665-276781 Sentence denotes Numbers of patients with noncardiac chest pain were not signifi cantly changed with the use of the new cutoff point.
T34464 276782-276882 Sentence denotes AUC of admission cTnT levels were 0.76 and 0.96 for the cTnT fourth generation and cTnThs (P <0.05).
T79453 276883-277041 Sentence denotes At admission, sensitivity and specifi city of cTnThs were 93% and 94% for the detection of acute MI, while they were 32% and 96% using cTnT fourth generation.
T12277 277042-277201 Sentence denotes Conclusions Using lower cutoff points for the defi nition of MI as suggested by current recommendations, the rate of chest pain patients with acute MI doubled.
T51763 277202-277444 Sentence denotes Because the increased rate of patients categorized as acute MI is mainly refl ected MI type 2, the ED triage decision at lower cutoff levels of cTnT levels should include patient history, physical examination, 12-lead ECG and cardiac imaging.
T97852 277445-277633 Sentence denotes Introduction The aim of this study was to determine the correlation between B+ line score and blood gas analysis (BGA) parameters in patients with acute cardiogenic pulmonary edema (ACPE).
T90551 277634-277733 Sentence denotes The presence of B+ line artifacts on lung US is correlated with increased extravascular lung water.
T99688 277734-277870 Sentence denotes In patients with acute decompensated heart failure the resolution of B+ lines can be used to monitor resolution of pulmonary congestion.
T48911 277871-277974 Sentence denotes A simple nine-point comet score has been proposed to quantify B+ lines and monitor ACPE treatment [1] .
T27972 277975-278097 Sentence denotes Methods Twenty-one patients with ACPE were submitted to lung US and BGA on presentation at 2 and 24 hours after admission.
T83872 278098-278184 Sentence denotes Lung US was done in nine thoracic areas and scored one point if B+ lines were present.
T42721 278185-278283 Sentence denotes A score of 10 was given for the presence of multiple coalesced comets in all fi elds (white lung).
T84511 278284-278353 Sentence denotes BGA values were used to calculate PO 2 /FiO 2 (P/F) and A-a gradient.
T63405 278354-278419 Sentence denotes Results A total of 64 scans were performed with simultaneous BGA.
T20255 278420-278528 Sentence denotes Ninety-eight percent of patients presenting with white lung were severely hypoxic (PO 2 <50 mmHg; P/F <200).
T67845 278529-278656 Sentence denotes Figure 1 illustrates a strong linear correlation between reduction in comet score and improvement in P/F (r = -0.73; P <0.001).
T78904 278657-278760 Sentence denotes A decrease in comet score of 2 points corresponded to a minimum increase of 20 points in P/F (P <0.05).
T11756 278761-278962 Sentence denotes The correlation between comet score and A-a gradient was less striking signifi cant (r = -0.51; P = 0.05), perhaps because patients with underlying lung disease were not excluded from this pilot study.
T87080 278963-279078 Sentence denotes Conclusions There is a strong negative correlation between lung comet score and gas exchange in patients with ACPE.
T73026 279079-279206 Sentence denotes In these patients, serial thoracic US may reduce the need for repeated invasive BGA monitoring and further help tailor therapy.
T37713 279207-279216 Sentence denotes Reference
T49922 279218-279322 Sentence denotes The conventional treatment for most distal radial fractures is closed reduction and cast immobilization.
T85019 279323-279511 Sentence denotes Conventionally the hematoma block is used to reduce the fractures but it is done blindly and radiographic techniques have been essential and eff ective in monitoring these reductions [1] .
T87366 279512-279695 Sentence denotes Radiation-free ultrasonography, however, can provide both real-time and dynamic multiple-plane images with a small and simpleto-use transducer that can be operated with only one hand.
T34951 279696-279798 Sentence denotes We therefore wanted to see whether the real-time and dynamic multiple-plane Figure 1 (abstract P267) .
T87663 279799-280115 Sentence denotes Correlation between reduction in comet score and improvement in P/F. observation capabilities of ultrasonography would allow an ED physician to perform under direct vision a hematoma block and closed reduction without multiple attempts of either as are frequently required when only conventional techniques are used.
T85537 280116-280279 Sentence denotes Methods Sonographically guided hematoma block and closed reduction was performed in three patients in the emergency department for an acute distal radial fracture.
T96360 280280-280373 Sentence denotes The effi cacy of this method was evaluated and compared with that of conventional techniques.
T60857 280374-280528 Sentence denotes The ultrasound images helped giving the hematoma block under direct vision and delineated the fractures as accurately as did the conventional radiographs.
T13211 280529-280647 Sentence denotes All parameters measured on the ultrasound images showed substantial restoration of anatomic alignment after reduction.
T91910 280648-280785 Sentence denotes Under direct vision, the hematoma block helped reduce the number of attempts and was less painful and achieved more patient satisfaction.
T43543 280786-280883 Sentence denotes Conclusions Sonography is an accurate, simple, time-saving, less painful and radiation-free tool.
T69004 280884-280986 Sentence denotes Reducing badly displaced or angulated forearm fractures in the emergency department can be diffi cult.
T45228 280987-281130 Sentence denotes Multiple attempts at reduction may be required, with repeated trips to the radiology department, before an adequate reduction is achieved [2] .
T61562 281131-281348 Sentence denotes Therefore ultrasound-guided hematoma block and reduction of diffi cult forearm fractures reduces the number of needle attempts and allows the physician to assess the adequacy of the reduction at the patient's bedside.
T46692 281349-281521 Sentence denotes Introduction Patients with acute cardiogenic pulmonary edema require rapid assessment and therapy to prevent progression to respiratory failure and cardiovascular collapse.
T14203 281522-281749 Sentence denotes Lisbon city has emergency medical teams that respond to situations where the life of the patient is at risk and whose goal is to begin treatment if indicated and assure transport to the hospital in the best conditions possible.
T89650 281750-281839 Sentence denotes We studied the intervention of one of these teams on patients with acute pulmonary edema.
T92868 281841-281933 Sentence denotes We designed our study to fi nd a useful USG pattern for diagnosis and assessment of dyspnea.
T44294 281934-282040 Sentence denotes We also compared utilities of chest radiograms in a supine position, thorax CT and bedside USG techniques.
T4722 282041-282249 Sentence denotes Methods In Selcuk University Meram Medical Faculty, during the year 2009, 60 patients who had acute dyspnea were included in our study (30 patients with chest trauma and 30 patients with nontraumatic causes).
T12311 282250-282287 Sentence denotes We designed our study as prospective.
T94580 282288-282398 Sentence denotes We tried to determine pathologies that have positive and negative Sliding Lung Sign (SLS) in USG examinations.
T34932 282399-282480 Sentence denotes We also investigated its reliability in diff erential diagnosis of acute dyspnea.
T23288 282481-282569 Sentence denotes Results First of all we performed chest radiograms on all patients in a supine position.
T97951 282570-282603 Sentence denotes After that we performed CT scans.
T26427 282604-282666 Sentence denotes All of the results were interpreted by a detached radiologist.
T88389 282667-282743 Sentence denotes Then we performed bedside thoracic USG to fi nd SLS by physicians in the ER.
T71299 282744-282855 Sentence denotes We conceded CT results as the golden standard and compared the results with chest radiograms and USG fi ndings.
T39985 282856-282936 Sentence denotes The SPSS 13.0 program and Χ 2 test were used for statistical analysis (P <0.05).
T91483 282937-283111 Sentence denotes According to our fi ndings, SLS in USG examinations has a sensitivity of 84% and a specifi city of 97% with a 97% positive predictive value and 83% negative predictive value.
T42651 283112-283282 Sentence denotes Conclusions Throughout the years, USG examinations were defi ned as inappropriate in lung examinations but in our study we reached a conclusion that they are a necessity.
T26084 283283-283342 Sentence denotes Bedside sonographic examination allows impetuous diagnosis.
T79676 283343-283432 Sentence denotes But every respiratory failure has its own sonographic pattern so mistakes are inevitable.
T45306 283433-283641 Sentence denotes Nevertheless we believe that if profound studies like ours keep coming and if more and more clinicians begin to use USG examinations, the SLS diagnostic value will rise and become a routine element in the ER.
T85270 283642-283819 Sentence denotes Introduction Many air medical transport programs use pulse oximeters, end-tidal carbon dioxide monitors and other devices as indirect measures of respiratory and cardiac status.
T72482 283820-283947 Sentence denotes Thus, these methods do not replace cardiac auscultation during fl ight, which may be needed to identify sudden critical change.
T32253 283948-284129 Sentence denotes And the ability to compare left-sided and right-sided breath sounds may be essential to confi rm the appropriate placement of endotracheal tubes as well as to diagnose pneumothorax.
T74782 284130-284232 Sentence denotes The ability for auscultation during air medical transport is compromised by high ambient noise levels.
T60636 284233-284472 Sentence denotes The aim of this study was to assess the capabilities of a traditional and an amplifi ed stethoscope (which is expected to reduce background and ambient noise) to assess heart and breath sounds during medical transport in a FALCON 50 plane.
T87027 284473-284541 Sentence denotes Methods A prospective, double-blind, randomized study was performed.
T68600 284542-284670 Sentence denotes We tested one model of traditional stethoscope (Littman® cardiology III) and one model of amplifi ed stethoscope (Littman 3100).
T48568 284671-284763 Sentence denotes The sound level was amplifi ed in six of the eight increments of the amplifi ed stethoscope.
T84966 284764-284833 Sentence denotes Practitioners on board were all experienced in air medical transport.
T79168 284834-284869 Sentence denotes They had normal audiologic testing.
T71277 284870-285012 Sentence denotes We studied 18 heart and lung auscultations, during real medical evacuations on board the Falcon 50 (medically confi gured; Dassault aviation).
T79730 285013-285112 Sentence denotes For each, the quality of Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T11181 285113-285256 Sentence denotes auscultation was described using a numeric rating scale (ranging from 0 to 10, 0 corresponding to 'I hear nothing' , 10 to 'I hear perfectly').
T54758 285257-285320 Sentence denotes Comparisons were accomplished using a t test for paired values.
T48299 285321-285379 Sentence denotes Results Age of patients was 42 ± 11 years, 78% were males.
T67983 285380-285415 Sentence denotes The body mass index was 29.5 ± 4.7.
T75703 285416-285574 Sentence denotes For cardiac auscultation, the value of the rating scale was 5.7 ± 1.4 and 6.5 ± 1.8, respectively, for the traditional and amplifi ed stethoscope (P = 0.027).
T52718 285575-285732 Sentence denotes For lung sounds, quality of auscultation was estimated at 3.6 ± 2.3 for the traditional stethoscope, at 3.9 ± 2.9 for the amplifi ed stethoscope (P = 0.193).
T40151 285733-285977 Sentence denotes Conclusions We concluded that fl ight practitioners in the Falcon 50 are more able to hear cardiac sounds with an amplifi ed than with a traditional stethoscope, whereas there is no signifi cant diff erence concerning breath sound auscultation.
T22579 285978-286200 Sentence denotes These fi ndings suggested to the investigators that Falcon 50 noise and human breath sounds might share a common or substantially overlapping frequency spectrum, with amplifi cation of one necessarily amplifying the other.
T4837 286201-286335 Sentence denotes To assess this hypothesis, further studies are needed to evaluate the sound frequency spectrum in the medically confi gured Falcon 50.
T77980 286336-286347 Sentence denotes Performance
T62941 286349-286463 Sentence denotes We studied the performance of two respirators employing an advanced turbine delivery system: LTV 1000, Tbird VSO2.
T92384 286464-286624 Sentence denotes We assessed the ability of the ventilators to deliver to a normal lung model a set fraction of inspired oxygen (FiO 2 ) at diff erent simulated cabin altitudes.
T89958 286625-286800 Sentence denotes Methods We used a decompression chamber to mimic the hypobaric environment at a range of simulated cabin altitudes of 1,500, 2,000 and 3,000 meters (4,000, 5,333, 8,000 feet).
T28222 286801-286833 Sentence denotes A model of normal lung was used.
T9816 286834-286886 Sentence denotes Concerning the Tbird VSO2, cabin altitude was input.
T66568 286887-286954 Sentence denotes Ventilators were tested with FiO 2 set at 50% and Vt set at 700 ml.
T8343 286955-287037 Sentence denotes We noted the eff ective FiO 2 assessed by the ventilators (paramagnetic analysis).
T87847 287038-287192 Sentence denotes We measured the FiO 2 really delivered with a dedicated instrument of the French physiological laboratory of aviation and space medicine of the Air Force.
T68131 287193-287310 Sentence denotes Comparisons of preset and assessed FiO 2 to actual measured FiO 2 were accomplished using a t test for each altitude.
T37482 287311-287365 Sentence denotes Results Figure 1 shows the data with FiO 2 set at 50%.
T34482 287366-287468 Sentence denotes Conclusions On one hand, both ventilators showed a moderate variation between FiO 2 set and delivered.
T65950 287469-287633 Sentence denotes On the other hand, variations between FiO 2 delivered and assessed are high, suggesting ineffi cacity of ventilators' paramagnetic analysis in hypobaric conditions.
T63751 287634-287716 Sentence denotes Conclusions Both teams evacuated red codes before the yellow ones in similar time.
T46599 287717-287801 Sentence denotes T-AMP was shorter considering global, yellow and green codes for T as opposed to NT.
T66790 287802-287872 Sentence denotes Global and green LOS was also shorter in the T group as opposed to NT.
T61732 287873-288017 Sentence denotes Training seems to infl uence global exercise management, less aff ecting red codes but with an impact on yellow and green evacuation strategies.
T43151 288018-288086 Sentence denotes Introduction Exacerbation of asthma can appear during air transport.
T99415 288087-288174 Sentence denotes Severe patients, not responding to conventional therapy can require ventilator support.
T96394 288175-288360 Sentence denotes We evaluated the performance of two transport ventilators, built with turbine technology -the T-bird VSO2 and the LTV 1000 -for use during aeromedical evacuation of acute severe asthma.
T15074 288361-288549 Sentence denotes We have assessed the ability of both ventilators to deliver to an acute severe asthma model a tidal volume (Vt) set at diff erent simulated altitudes, by changing the ambient air pressure.
T75422 288550-288725 Sentence denotes Methods We used a decompression chamber to mimic the hypobaric environment at a range of simulated cabin altitudes of 1,500, 2,500 and 3,000 meters (4,000, 6,670, 8,000 feet).
T4363 288726-288776 Sentence denotes Ventilators were tested with realistic parameters.
T1209 288777-288846 Sentence denotes Vt was set at 700 ml and 400 ml in an acute severe asthma lung model.
T63223 288847-288916 Sentence denotes The protocol included three measurements for each simulated altitude.
T14533 288917-289016 Sentence denotes Comparisons of preset to actual measured values were accomplished using a t test for each altitude.
T59254 289017-289054 Sentence denotes Results Figure 1 summarizes the data.
T22960 289055-289124 Sentence denotes With altitude, the T-bird VSO2 showed a decrease in volume delivered.
T2226 289125-289396 Sentence denotes Comparisons of actual delivered Vt and set Vt demonstrated a signifi cant diff erence starting at 1,500 m for a Vt set of 700 ml, at 2,500 m for Vt set of 400 ml, with a negative variation of more than 10% compared with tidal volume set at respectively 3,000 and 2,500 m.
T7605 289397-289493 Sentence denotes With decreasing barometric pressure, the LTV 1000 showed mostly an increase in volume delivered.
T62077 289494-289649 Sentence denotes Comparisons of actual delivered Vt and set Vt demonstrated a signifi cant diff erence at 1,500 m for a Vt set of 700 ml, at 2,500 m for a V test of 400 ml.
T43777 289650-289711 Sentence denotes The delivered tidal volume remained within 10% of the set Vt.
T68942 289712-290009 Sentence denotes The T-bird VSO2 progressively delivered lower volumes as barometric pressure decreased; whereas the LTV 1000 showed a moderate increase in volume delivered for the acute severe asthma lung model, with increasing altitude, but maintained the delivered volume within 10% of the set Vt up to 3,000 m.
T72697 290010-290071 Sentence denotes We tested inter-rater and intra-rater agreement respectively.
T47037 290072-290155 Sentence denotes As concerns inter-rater agreement, nine triage nurses sorted the same 100 patients.
T29085 290156-290270 Sentence denotes The assigned classifi cations compared the reference assignment and were analyzed with Cohen's kappa coeffi cient.
T57916 290271-290429 Sentence denotes Intra-rater agreement was tested by asking 30 triage nurses to sort the same 10 patients at two diff erent times (T1 was early morning and T2 was late night).
T45379 290430-290578 Sentence denotes We compared the classifi cation at T1 and T2 with the null hypothesis being no diff erence and determined whether diff erences were nurse dependent.
T49064 290579-290761 Sentence denotes Results Statistical analysis of intra-rater agreement revealed that the mean diff erence between classifi cation at T1 and T2 did not signifi cantly depend on the nurse (P = 0.3487).
T96169 290762-290869 Sentence denotes This result allowed pooling of the data and testing to determine whether the mean was diff erent from zero.
T67920 290870-290987 Sentence denotes We used the Sign test and found that classifi cation at T1 was not diff erent from classifi cation at T2 (P = 0.581).
T77103 290988-291154 Sentence denotes As concerns inter-rater agreement, we used Cohen's kappa coeffi cient, which revealed an almost perfect agreement between classifi cation by nurses and the reference.
T72232 291155-291273 Sentence denotes The need for a specifi c triage tool in our emergency department led us to develop a new French-language triage scale.
T81632 291274-291397 Sentence denotes The present study demonstrates that this scale is a valid triage tool with very good inter-rater and intra-rater agreement.
T81666 291398-291464 Sentence denotes Such results now allow a future study to evaluate its effi ciency.
T12484 291465-291573 Sentence denotes Introduction In 1996, a UK audit suggested suboptimal involvement of consultant care in acute medicine [1] .
T95961 291574-291684 Sentence denotes Acute medicine has since evolved as a specialty to improve medical inpatient care in the fi rst 48 hours [2] .
T33782 291685-291808 Sentence denotes Many hospitals now incorporate an acute short stay unit through which up to 70% of medical admissions can be directed [3] .
T82234 291809-291871 Sentence denotes These units reduce the length of hospital inpatient stay [4] .
T11410 291872-291994 Sentence denotes Methods We conducted a review of case notes for 100 consecutive medical admissions to the Emergency Short Stay ward (ESS).
T68667 291995-292105 Sentence denotes Data collected included diagnoses on admission and discharge, length of stay on ESS and discharge destination.
T78781 292106-292260 Sentence denotes On reviewing each initial medical clerking, an assessment was made regarding the suitability of the admission to ESS, standardized against local criteria.
T3321 292261-292320 Sentence denotes Results Data on 100 patients (age 17 to 89) were collected.
T35364 292321-292403 Sentence denotes Eighty-nine per cent were admitted from the medical admissions unit, most commonly
T54677 292405-292607 Sentence denotes We analysed triage reliability among nursing students at an Italian university before and after a course on a new Triage Emergency Method, TEM v2, which showed good reliability in a previous study [1] .
T40159 292608-292668 Sentence denotes Few studies compared triage reliability in nursing students.
T95153 292669-292729 Sentence denotes To our knowledge there are no Italian studies on this topic.
T94193 292730-292873 Sentence denotes Methods This is an observational study conducted in the University of Parma using a triage scenarios database used in previous studies [1, 2] .
T66070 292874-293105 Sentence denotes Fifty students attending the third year of a nursing course were selected to assign a triage level to 105 paper scenarios, without triage protocols (before course) and with TEMv2 (1 month after a 2-hour course on triage and TEMv2).
T61444 293106-293242 Sentence denotes To prevent communication between participants, they assigned triage codes in diff erent rooms, and in the presence of two investigators.
T7353 293243-293304 Sentence denotes The triage scenarios were given randomly to the participants.
T72719 293305-293632 Sentence denotes We measured: the inter-reliability using the weighted kappa statistics; the complete disagreement (when nurses of the same group assigned to the same scenario triage codes that diff ered in more than two priority levels); the complete agreement (when all fi ve nurses assigned the same triage code) before and after the course.
T87002 293633-293783 Sentence denotes Of the 105 patients included in triage scenarios, 66 (63%) were women, the mean age was 43.7 years (SD ± 26.3), and 22 were under the age of 18 years.
T5792 293784-293848 Sentence denotes The most frequent presentation at triage was minor trauma (30%).
T92134 293849-293883 Sentence denotes There were 30 hospital admissions:
T12771 293884-293928 Sentence denotes 27 in non-intensive wards and three in ICUs.
T50605 293929-293968 Sentence denotes The mean age of students was 24 ± 3 SD.
T96290 293969-294066 Sentence denotes Few participants attended triage training before (18%) and they declared scarce triage knowledge.
T56399 294067-294112 Sentence denotes Inter-rater reliability was k = 0.42 (95% CI:
T53224 294113-294148 Sentence denotes 0.37 to 0.46) and k = 0.61 (95% CI:
T65416 294149-294255 Sentence denotes 0.56 to 0.67) before the course (without triage protocol) and after the course (with TEMv2), respectively.
T68402 294256-294352 Sentence denotes Complete disagreement occurred in 98% of scenarios evaluated before and in 64% after the course.
T45633 294353-294388 Sentence denotes Complete agreement was always zero.
T203 294389-294481 Sentence denotes Conclusions Our data suggest that TEM v2 improves triage reliability among nursing students.
T68586 294482-294527 Sentence denotes It seems to be easy to understand and to use.
T61923 294529-294750 Sentence denotes International guidelines for trauma care still recommend the traditional advanced trauma life support investigations for the primary survey: plain radiographs of the chest, cervical spine and pelvis with FAST ultrasounds.
T56932 294751-294848 Sentence denotes However, an increasing amount of data suggest that plain X-rays have excessively low sensitivity.
T4830 294849-295066 Sentence denotes Cervical X-ray may miss up to 35% of the spine injuries, chest X-ray may miss as many as many as 50% of traumatic pneumothorax and a signifi cant percentage of pelvic fractures may not be detected on the pelvis X-ray.
T59345 295067-295176 Sentence denotes CT scan and extended emergency ultrasound (EUs) have a much higher sensitivity if compared with plain X-rays.
T87347 295177-295219 Sentence denotes Moreover, EUs is even less time consuming.
T50481 295220-295352 Sentence denotes Therefore since 2004 we have adopted EUs and/or total body CT scan as the fi rstline diagnostic tools for major trauma (MT) victims.
T85693 295353-295492 Sentence denotes In a benchmarking analysis of Italian trauma centers (TCs), our hospital ranked fi rst for patient mortality and long-term disability [1] .
T46358 295493-295557 Sentence denotes These results were associated with the shortest diagnostic time.
T50984 295558-295676 Sentence denotes The aim of this study is to assess whether these results were associated with a real change in the diagnostic process.
TextSentencer_T383 295677-295830 Sentence denotes Methods In order to evaluate the diagnostic approach to MT we retrospectively analyzed all MT cases (ISS >15) admitted to our TC over a 2-year time span.
TextSentencer_T384 295831-295956 Sentence denotes All investigations performed in the emergency department (ED) are entered in an electronic shift just before being performed.
TextSentencer_T385 295957-296039 Sentence denotes Data for all investigations requested within 2 hours from admission were analyzed.
TextSentencer_T386 296040-296129 Sentence denotes Results From 1 November 2007 to 31 October 2009, 743 MT patients were admitted to the ED.
TextSentencer_T387 296130-296203 Sentence denotes EUs was performed in 515 patients (69%), total body CT scan in 679 (91%).
TextSentencer_T388 296204-296340 Sentence denotes Patients who were not submitted to CT either died soon after admission or were rushed to the operating room on the basis of EUs results.
TextSentencer_T389 296341-296468 Sentence denotes Thirty-eight patients had a chest X-ray taken in the ED (5.1%), 11 (1.5%) a pelvic X-ray and only three a cervical spine X-ray.
TextSentencer_T390 296469-296768 Sentence denotes Conclusions Although many international guidelines for trauma care still recommend traditional plain radiographic investigations, our TC as well as many other European institutions with a high volume of trauma patients have adopted a diff erent strategy based on the extended use of EUs and CT scan.
TextSentencer_T391 296769-296909 Sentence denotes This may improve the accuracy of the diagnosis in the stabilized patients and reduce time to the operating room in the highly instable ones.
TextSentencer_T392 296910-296986 Sentence denotes We suggest that a change in the recommended guidelines should be considered.
TextSentencer_T393 296987-297185 Sentence denotes Results Of these patients, 317 blunt trauma patients (mean age, 43.9 ± 23.8 (SD) years) were examined by fi eld FAST and enrolled in the study; all participants were also examined by FAST in the ED.
TextSentencer_T394 297186-297238 Sentence denotes The mean Injury Severity Score was 16.1 ± 15.4 (SD).
TextSentencer_T395 297239-297338 Sentence denotes Forty-seven patients (14.8%) were ultimately diagnosed with pericardial and intraperitoneal fl uid.
TextSentencer_T396 297339-297377 Sentence denotes Field FAST detected 12 of these cases.
TextSentencer_T397 297378-297563 Sentence denotes The sensitivity of fi eld FAST was signifi cantly lower than that of FAST in the ED (P <0.01), whereas the specifi cities of FAST in the two settings were not signifi cantly diff erent.
TextSentencer_T398 297564-297658 Sentence denotes Emergency surgery was performed in nine of the 12 patients who were positive with fi eld FAST.
T9862 297660-297838 Sentence denotes The aim of the investigation was to analyze the diagnostic and prognostic signifi cance of serum proapoptosis and antiapoptosis markers in the patients with severe trauma injury.
T38196 297839-298056 Sentence denotes Methods Thirty-three patients with severe trauma injury were enrolled into our investigation (we excluded patients with severe brain injury, the middle age was 39 ± 8, initial TRISS scale 7.8 ± 1.8, APACHE II 14 ± 5).
T19533 298057-298267 Sentence denotes All of the patients demonstrated signs of systemic infl ammatory response, in 12 patients the infectious pulmonary complications were revealed and in 21 patients the infectious complications were not developed.
T66541 298268-298362 Sentence denotes Venous blood serum EDTA samples were investigated every day during a week in the -25°C freeze.
T5876 298363-298567 Sentence denotes We investigated antiapoptotic markers (soluble Fas-L, soluble APO-1/Fas, Cu/Zn superoxide dismutase), proapoptotic markers (protein p53, protein Bcl-2), and high-sensitivity CRP (ELISA, Bender Medsystem).
T9960 298568-298784 Sentence denotes We observed an increase in proapoptotic markers in patients with infectious complications from the fi rst day in the ICU, antiapoptotic markers (Cu/Zn superoxide dismutase) were lower with regard to reference points.
T49770 298785-298914 Sentence denotes The patients demonstrated a maximum of Fas-L, protein p53, and protein Bcl-2 (near 50% relative to fi rst day) on the second day.
T11654 298915-299280 Sentence denotes In patients without infection complications we identifi ed a decreased level of proapoptotic markers and an increased level of antiapoptotic markers (SOD, soluble Fas-L, soluble APO-1/Fas Introduction Inadequate or delayed imaging of the unconscious patient with traumatic brain injury or of the unconscious polytrauma patient may lead to catastrophic consequences.
T70403 299281-299427 Sentence denotes The need for comprehensive imaging needs to be balanced against the patient's condition, the resources available and excessive radiation exposure.
T89082 299428-299516 Sentence denotes We have introduced regional evidence-based guidelines in the Southwest region of the UK.
T74392 299517-299745 Sentence denotes The aim of these guidelines was to standardise practice, minimise delayed or missed diagnosis of serious injuries, facilitate treatment of associated injuries (such as head injuries) and to obviate the need for repeated imaging.
T31233 299746-299994 Sentence denotes Methods The notes of all unconscious polytrauma patients transferred from the emergency department or other hospitals and all patients transferred to our institution for ongoing neurosurgical care were retrospectively reviewed over a 1-year period.
T97240 299995-300135 Sentence denotes Adherence to the imaging protocol was assessed and the need for any further radiological investigations within 48 hours was also documented.
T83621 300136-300242 Sentence denotes Results A total of 46 patients were identifi ed who fulfi lled the criteria for the introduced guidelines.
T57859 300243-300374 Sentence denotes Of these patients, 21% were transferred from other hospitals while the remainder was admitted from the onsite emergency department.
T35985 300375-300446 Sentence denotes Eighty-three per cent of all eligible patients adhered to the protocol.
T18868 300447-300545 Sentence denotes Two patients (4%) required further radiological investigation in the 48 hours following admission.
T41981 300546-300693 Sentence denotes Both had isolated head injury and required further imaging to exclude cervical injuries following inadequate imaging which did not follow protocol.
T83622 300694-300774 Sentence denotes One further patient (2%) required repeated imaging to exclude mesenteric injury.
T59661 300775-300975 Sentence denotes Conclusions Regional adoption of imaging guidelines aimed at obtaining early comprehensive imaging of both head-injured and polytrauma patients results in high compliance and a low rate of re-imaging.
T73745 300976-301143 Sentence denotes Introduction Blunt cerebrovascular injuries (BCVI) are more common than previously reported and, if not promptly recognized and treated, may have devastating sequelae.
T26671 301144-301359 Sentence denotes When these injuries are diagnosed before the onset of stroke, and patients receive early antiplatelet or anticoagulation therapy, a substantial reduction in BCVI-related neurologic events has been demonstrated [1] .
T48309 301360-301508 Sentence denotes Methods The study setting was a level 1 trauma center with a catchment population of more than 2 million people, admitting 350 major traumas yearly.
T80092 301509-301626 Sentence denotes To assess the incidence of asymptomatic BCVI in the severely injured patients, we planned a prospective cohort study.
T60820 301627-301975 Sentence denotes According to the study design, all of the severely injured patients presenting with at least one of the following criteria [2] were submitted to a screening 16-channel CT angiography within 24 hours from admission: diff use axonal injuries; fracture of the cervical vertebrae or of the skull base; Lefort II or III or other severe facial fractures.
T79535 301976-302165 Sentence denotes Results During the fi rst 5 months of the study, 24 major trauma patients (ISS >15) with at least one of the above listed risk factors were submitted to a screening CT angiography for BCVI.
T69082 302166-302228 Sentence denotes All of the patients were sedated and artifi cially ventilated.
T96389 302229-302269 Sentence denotes None of them was symptomatic for stroke.
T70889 302270-302432 Sentence denotes Three patients (12.5%) in this high-risk group had an asymptomatic BCVI: pseudoaneurysm (one), traumatic stenosis (one) or dissection (one) of the carotid artery.
T82480 302433-302513 Sentence denotes They were immediately treated with antiplatelet therapy (clopidogrel + aspirin).
T9052 302514-302594 Sentence denotes They experienced no episodes of cerebral infarction and no cerebral haemorrhage.
T24937 302595-302666 Sentence denotes Conclusions There are limited data in the literature on traumatic BCVI.
T65303 302667-302804 Sentence denotes The available data as well as the preliminary results of our prospective study show that BCVI are more common than previously recognized.
T4631 302805-302915 Sentence denotes Aggressive screening and earlier therapy may signifi cantly reduce complications and improve patient outcomes.
T42222 302916-303140 Sentence denotes Introduction The aim of this study was to determine the effi cacy of 8.4% sodium bicarbonate for intracranial pressure (ICP) reduction in adult patients with severe traumatic brain injury (TBI) and intracranial hypertension.
T20352 303141-303230 Sentence denotes Methods The study examined 10 episodes of ICP >20 mmHg in seven patients with severe TBI.
T31034 303231-303362 Sentence denotes Eighty-fi ve milliliters of 8.4% sodium bicarbonate was infused over 30 minutes when osmotherapy was indicated after standard care.
T4175 303363-303496 Sentence denotes ICP, mean arterial pressure (MAP), and cerebral perfusion pressure (CPP) were recorded at baseline and then continuously for 6 hours.
T15230 303497-303613 Sentence denotes Serum pH, pCO 2 , (Na + ), and (Cl -) were measured at baseline, 30 minutes, 60 minutes and then hourly for 6 hours.
T70740 303614-303689 Sentence denotes Serum osmolality was measured at baseline and at 6 hours in three patients.
T32343 303690-303782 Sentence denotes All other care was identical to the institutional protocol for the management of raised ICP.
T79863 303783-303918 Sentence denotes Results At the completion of the infusion, the mean ICP was reduced to 36.2% of baseline, from 28.5 mmHg (±2.62) to 10.33 mmHg (±1.89).
T73693 303919-303975 Sentence denotes Mean ICP remained below 20 mmHg for 6 hours (Figure 1) .
T39817 303976-304039 Sentence denotes CPP was increased after the infusion due to the eff ect on ICP.
T96369 304040-304059 Sentence denotes MAP did not change.
T56455 304060-304192 Sentence denotes Mean pH was elevated at t = 30 minutes (from 7.45 ± 0.02 to 7.50 ± 0.02) and remained elevated for the duration of the study period.
T91236 304193-304301 Sentence denotes Serum (Na + ) increased (from 145.4 ± 1.9 mOsm/l to 147.1 ± 1.9 mOsm/l) at 30 minutes. pCO 2 did not change.
T25352 304302-304326 Sentence denotes Osmolality was elevated.
T659 304327-304537 Sentence denotes Conclusions Eighty-fi ve milliliters of 8.4% sodium bicarbonate infused over 30 minutes is eff ective at reducing sustained ICP >20 mmHg to within accepted treatment targets (ICP <20 mmHg) for at least 6 hours.
T89372 304538-304701 Sentence denotes Introduction Water-electrolyte imbalance and endocrine disorders make the problem of maintaining patients with severe traumatic brain injury (TBI) more diffi cult.
T79063 304702-304769 Sentence denotes A plasma sodium level ≥160 mmol/l is associated with 75% mortality.
T29823 304770-304915 Sentence denotes The purpose of this investigation was to fi nd the relationship between hypernatraemia and the rate of unfavorable outcomes in children with TBI.
T28812 304916-305045 Sentence denotes Methods A total of 77 children <18 years of age with TBI (admission GCS score <8) were divided retrospectively into three groups:
T4808 305046-305214 Sentence denotes Group A included children without hypernatraemia (n = 51), Group B children with hypernatraemia (n = 14) and Group C (n = 12) children with hypernatraemia and polyuria.
T36064 305215-305298 Sentence denotes Group C was considered the group of patients with central diabetes insipidus (CDI).
T94996 305299-305524 Sentence denotes Hypernatraemia was defi ned as a twice elevation of the plasma sodium level over 149 mmol/l within 24 hours, while polyuria was defi ned as an increase in the hourly diuresis of more than 3 ml/kg/hour in no less than 6 hours.
T74445 305525-305583 Sentence denotes The mean sodium level at admission was 140.1 ± 4.1 mmol/l.
T5004 305584-305635 Sentence denotes Hypernatraemia was detected in 26 patients (33.8%).
T51200 305636-305829 Sentence denotes The mean duration of the period of hypernatraemia in Group B was 4 days (3 to 6 days), while the mean sodium level during the period of hypernatraemia was 158.3 ± 3.3 mmol/l (max 176.8 mmol/l).
T89482 305830-305950 Sentence denotes The duration of the period of hypernatraemia in Group C was 4.5 days with max 181.1 mmol/l and average 161 ± 4.7 mmol/l.
T83132 305951-305996 Sentence denotes Polyuria was diagnosed in 15.5% of the cases.
T47228 305997-306080 Sentence denotes The highest diuresis in this group was 4.1 mmol/kg/hour, mean 3.7 ± 0.5 ml/kg/hour.
T34711 306081-306133 Sentence denotes Such changes were considered a manifestation of CDI.
T3875 306134-306229 Sentence denotes All 12 patients in Group C received desmopressin (DDAVP) for more than 48 hours (mean 56.8 ± 4.
T77755 306230-306239 Sentence denotes 5 hours).
T248 306240-306275 Sentence denotes The doses were 0.025 to 0.2 mg/day.
T87925 306276-306439 Sentence denotes In four out of 14 children in Group B (29%), an increase hourly diuresis up to 3 ml/kg/hour was considered the onset of CDI; thus, they were also prescribed DDAVP.
T70926 306440-306544 Sentence denotes Unfavorable outcomes (GOS score 1 to 3) during a 30-day assessment were observed only in Groups B and C.
T36155 306545-306772 Sentence denotes In a comparison of unsuccessful outcomes between Groups B and C, there was an increase in the unfavorable outcome rate in patients of Group C (with hypernatraemia and polyuria) -10 children (84%) and Group Bfour children (28%).
T46835 306773-306859 Sentence denotes The risk factor in the comparison between patients of Groups B and C was 0.3, P <0.05.
T4950 306860-306980 Sentence denotes Conclusions Our results demonstrate that hypernatraemia increases the rate of unfavorable outcomes in children with TBI.
T94501 306981-307030 Sentence denotes Thirty-day outcomes were worse with CDI patients.
T84335 307031-307098 Sentence denotes Presumably, the used of DDAVP prevents dehydration and CDI advance.
T75396 307099-307212 Sentence denotes Introduction Secondary ischemic insult after severe traumatic brain injury (TBI) is correlated with poor outcome.
T93638 307213-307310 Sentence denotes Transcranial Doppler sonography (TCD) permits a non-invasive measurement of cerebral blood fl ow.
T17972 307311-307403 Sentence denotes The purpose of this study is to determine the usefulness of TCD in patients with severe TBI.
T44977 307404-307521 Sentence denotes Methods TCD was performed on 73 patients with severe TBI, defi ned as a Glasgow Coma Scale of 8 or less on admission.
T51433 307522-307566 Sentence denotes All patients were on mechanical ventilation.
T87612 307567-307616 Sentence denotes TCD was performed on hospital days 1, 2, 3 and 7.
T33882 307617-307872 Sentence denotes Hypoperfusion was defi ned by having two out of three of the following: mean velocity of the middle cerebral artery less than 35 cm/ second, diastolic velocity of the middle cerebral artery less than 20 cm/ second and a pulsatility index greater than 1.4.
T80317 307873-308024 Sentence denotes Vasospasm was defi ned by the following: mean velocity of the middle cerebral artery greater than 120 cm/second and/or Landegaard index greater than 3.
T338 308025-308084 Sentence denotes Results Thirty-four patients (64%) had normal measurements.
T18151 308085-308179 Sentence denotes Thirteen were discharged home, 16 were discharged to a long-term care facility and fi ve died.
T55667 308180-308264 Sentence denotes Two of these patients were comatose and their families requested withdrawal of care.
T40032 308265-308303 Sentence denotes The other three died from brain death.
T11390 308304-308383 Sentence denotes Eighteen patients (25%) had hypoperfusion and all 18 progressed to brain death.
T32132 308384-308424 Sentence denotes Twenty-one patients (29%) had vasospasm.
T13616 308425-308515 Sentence denotes Four of these patients were discharged home, 11 to a long-term care facility and six died.
T71405 308516-308683 Sentence denotes The vasospasm was detected on hospital day 1 in three patients, hospital day 2 in seven patients, hospital day 3 in four patients and hospital day 7 in seven patients.
T73049 308684-308785 Sentence denotes Nimodipine was administered in six patients and all six were discharged to a long-term care facility.
T25473 308786-308874 Sentence denotes However, in one patient, nimodipine caused hemodynamic instability and was discontinued.
T76694 308875-308916 Sentence denotes In 15 patients, nimodipine was not given.
T98894 308917-308964 Sentence denotes Six of these patients expired from brain death.
T43669 308965-309059 Sentence denotes Twelve of 21 patients (57%) with subarachnoid hemorrhage on computed tomography had vasospasm.
T79285 309060-309138 Sentence denotes Conclusions Most patients with normal measurements can be expected to survive.
T77838 309139-309189 Sentence denotes Patients with hypoperfusion have a poor prognosis.
T37368 309190-309332 Sentence denotes In patients with vasospasm, the use of nimodipine should be considered; however, further studies are needed to determine safety and effi cacy.
T98154 309333-309382 Sentence denotes TCD may be useful in determining early prognosis.
T79992 309383-309488 Sentence denotes Further studies are also needed to determine whether TCD can improve outcome in patients with severe TBI.
T91762 309490-309512 Sentence denotes is not yet confi rmed.
T45937 309513-309660 Sentence denotes We suppose that HBO could make the oxygen stay longer in the injured tissue, because of poor circulation or perfusion of blood in the injured area.
T79021 309661-309743 Sentence denotes This mechanism may help to explain the longer eff ect of HBO, after HBO treatment.
T69347 309744-309777 Sentence denotes That is the purpose of our study.
T61161 309778-309903 Sentence denotes Methods Patients suff ering from sub-acute traumatic brain injury, who would be treated with HBO, were enrolled in the study.
T43813 309904-310052 Sentence denotes They were divided into two groups: frontal lobe lesion and nonfrontal lobe lesion groups (n = 20) depending on their iconography check (X-CT or MR).
T29218 310053-310315 Sentence denotes The regional cerebral oxygen saturation (rSO 2 ) was measured by a Somanetics INVOS 5100 monitor before and after 90 minutes treatment with HBO (15 minutes compression, 40 minutes breathing oxygen of FiO 2 99% by mask, 10 minutes rest, 15 minutes decompression).
T30168 310316-310401 Sentence denotes Meanwhile, the arterial blood was sampled to measure blood gas analysis and cytokine.
T18085 310402-310584 Sentence denotes The parameter of rSO 2 showed no signifi cant diff erence following HBO treatment in two groups (t = 0.352, P >0.05); however, there were inconceivable results in blood gas analysis.
T1173 310585-310755 Sentence denotes Partial pressure of oxygen (PaO 2 ) was signifi cantly decreased after HBO treatment (P <0.05), although these changes did not take eff ect on the clinical manifestation.
T30160 310756-310872 Sentence denotes Otherwise, the measurement of cytokines (TNF, IL-1) before and after HBO has no diff erence (P >0.05) in all groups.
T52152 310873-310952 Sentence denotes Conclusions HBO has no eff ect on brain oxygen saturation, after HBO treatment.
T97256 310953-311006 Sentence denotes But PaO 2 was signifi cantly decreased following HBO.
T4979 311007-311049 Sentence denotes The mechanism needs to be studied further.
T7004 311050-311416 Sentence denotes Introduction This study evaluated relationships between CSF levels of brain biomarkers, glial fi brillary acidic protein (GFAP), ubiquitin C-terminal hydrolase (UCH-L1) and α II -spectrin breakdown (SBDP145), partial pressure of brain tissue oxygen (ptiO 2 ) and brain temperature (Licox system) during the fi rst 24 hours and for up to 10 days following severe TBI.
T29451 311417-311641 Sentence denotes Methods We studied 27 severe TBI patients having CSF drainage and invasive monitoring of partial brain tissue oxygen tension (PbtO 2 ) and brain temperature using the Licox (Integra Neurosciences, Plainsboro, NJ, USA) probe.
T71772 311642-311787 Sentence denotes CSF SBDP145, UCH-L1 and GFAP levels were measured by quantitative ELISA assay on admission and every 6 hours thereafter for a maximum of 10 days.
T76734 311788-311867 Sentence denotes Using a double lumen bolt, ptiO 2 and temperature were measured with the Licox.
T14710 311868-312019 Sentence denotes This study focused on the recordings of the fi rst 24 hours following injury (27 patients), as well as preliminary data from four patients for 10 days.
T38444 312020-312069 Sentence denotes The total duration of monitoring was 1,512 hours.
T98342 312070-312158 Sentence denotes During the fi rst 24 hours, biomarker levels decreased while levels of PbrO 2 increased.
T867 312159-312254 Sentence denotes All three biomarkers correlated with PbrO 2 (P <0.0001, P = 0.016 and P = 0.023, respectively).
T27378 312255-312475 Sentence denotes After the fi rst 24 hours, there were statistically signifi cant changes in levels of brain biomarkers (SBDP145, UCH-L1 and GFAP) as well as in levels of ptiO 2 (respectively, P = 0.025, P <0.0001, P = 0.033, P <0.0001).
T50876 312476-312600 Sentence denotes However, the correlation between biomarkers and brain tissue oxygenation was sustained, and for UCH-L1 improved (P <0.0001).
T97523 312601-312688 Sentence denotes No signifi cant correlations between biomarker levels and brain temperature were found.
T59686 312689-312737 Sentence denotes There were no complications from the monitoring.
T25690 312738-312932 Sentence denotes Conclusions Our fi ndings show that CFS levels of SBDP145, UCH-L1 and GFAP are related to brain tissue oxygenation in acute and possibly the subacute (≤10 days post injury) phases of severe TBI.
T51382 312933-313082 Sentence denotes Future studies will more directly address relationships between changes in tissue oxygenation and biochemical markers of injury following severe TBI.
T84047 313083-313265 Sentence denotes CSF levels of biomarkers and brain tissue oxygenation could yield insights into pathophysiological events following severe TBI and aid in clinical assessments of severe TBI patients.
T97194 313266-313472 Sentence denotes Introduction After traumatic brain injury (TBI), structural lesions are heterogeneous, but the spatial heterogeneity of consequences of insults as hypoxia-hypotension (HH) and/or TBI has never been studied.
T59402 313473-313653 Sentence denotes The objective of this study was to compare the eff ect of standardized insults (HH, TBI and both) on brain energy metabolism in two diff erent regions: frontal cortex and thalamus.
T92517 313654-313728 Sentence denotes Methods Twenty-eight Sprague-Dawley rats were randomized into four groups:
T57820 313729-313925 Sentence denotes Sham, TBI (impact acceleration alone, 450 g weight drop from 1.8 m), HH (blood depletion to mean arterial pressure 40 mmHg, FiO 2 10%, 15 minutes) and TBI-HH (TBI followed by HH, 45 minute delay).
T34059 313926-314001 Sentence denotes Cerebral perfusion pressure (CPP) was continuously and invasively measured.
T45748 314002-314116 Sentence denotes Brain microdialysis and PtiO 2 probes were both inserted stereotaxically in the right thalamus and frontal cortex.
T45339 314117-314189 Sentence denotes Results Except during the HH phase, CPP was always greater than 60 mmHg.
T19908 314190-314339 Sentence denotes During the hour following the HH period, a signifi cant increase in cerebral lactate/pyruvate ratio (Figure 1 ), glycerol and glutamate was observed.
T77276 314340-314441 Sentence denotes This increase was higher in the cortex than in the thalamus in all groups subjected to HH (P <0.001).
T71953 314442-314611 Sentence denotes In the TBI-HH groups, the increase in glycerol in the cortex was signifi cantly higher compared with the HH group (P <0.001), as well as thalamic and cortical glutamate.
T36765 314612-314829 Sentence denotes During 15 minutes following the HH phase (after reinjection and reoxygenation), an increase in PtiO 2 was observed in the cortex and thalamus, but with diff erent profi les (lower increase in the cortex) ( Figure 1 ).
T61478 314830-314971 Sentence denotes Conclusions Diff erent profi les of cerebral response to HH and TBI were observed with higher sensitivity in the cortex than in the thalamus.
T34269 314972-315103 Sentence denotes The post-ischemic hyperemia seems to be altered in the traumatized cortex but conserved into the thalamus and nontraumatized brain.
T78693 315104-315206 Sentence denotes Introduction Decompressive craniectomy is indicated for treatment of severe intracranial hypertension.
T55744 315207-315289 Sentence denotes However, this procedure is invasive and potentially associated with complications.
T80847 315290-315417 Sentence denotes We present a preliminary result of a study comparing early and late decompressive craniectomy in severe traumatic brain injury.
T78403 315418-315577 Sentence denotes Methods Patients studied were all admitted to the ICU of a tertiary referral center (Careggi Teaching Hospital, Florence, Italy) during 4 years (2005 to 2009).
T38188 315578-315969 Sentence denotes In total, data of 62 brain-injured patients, who underwent decompressive craniectomy, were retrospectively examined and included in two groups based on decompressive craniectomy execution: early decompressive craniectomy group (decompressive craniectomy performed within 24 hours after brain injury, group A; n = 41) and late decompressive craniectomy (later than 24 hours, group B; n = 21).
T71144 315970-316105 Sentence denotes For all patients, demographic, scores, clinical data, length of stay and fi nal outcome were collected from the institutional database.
T76668 316106-316244 Sentence denotes Traumatic lesions were compared at admission using the Marshall score and 24 hours after decompressive craniectomy execution with CT scan.
T5495 316245-316308 Sentence denotes The Glasgow Outcome Scale (GOS) at 6 months was also collected.
T25299 316309-316420 Sentence denotes Results Demographic and clinical characteristics of groups are shown in Figure 1 (data expressed as mean ± SD).
T5161 316421-316728 Sentence denotes Patients who underwent decompressive craniectomy within 24 hours after injury (group A) had a signifi cant worst Marshall score if compared with group B (3.1 ± 0.7 vs 2.4 ± 0.8, respectively; P <0.05), but also showed a signifi cant enlargement of contusions compared with group B (52.7% vs 16.6%; P <0.01).
T25656 316729-316822 Sentence denotes ICU/ hospital length of stay and mortality were not signifi cantly diff erent between groups.
T5506 316823-316961 Sentence denotes The GOS evaluated at 6 months showed a good recovery of surviving patients in both groups (3.7 ± 1.0 in group A and 3.2 ± 0.9 in group B).
T70211 316962-317120 Sentence denotes Conclusions Our data, limited by the retrospective nature of the study, do not encourage an early decompressive treatment of severe intracranial hypertension.
T27604 317121-317235 Sentence denotes Decompressive craniectomy should be considered in case of lack of response to a medical, even intensive, approach.
T98876 317236-317381 Sentence denotes Introduction The purpose of this study is to verify the reliability of optic nerve ultrasound (ONU) for detecting intracranial hypertension (IH).
T92364 317382-317456 Sentence denotes IH is a frequent and potentially fatal complication of severe head injury.
T16144 317457-317543 Sentence denotes Actually, intraventricular catheters represent the gold standard for ICP measurements.
T30941 317544-317662 Sentence denotes Unfortunately they present serious complications and relative contraindications like thrombocytopenia or coagulopathy.
T21327 317663-317787 Sentence denotes Computed tomography and transcranial Doppler (TCD) represent noninvasive methods to evaluate ICP but they present drawbacks.
T96637 317788-317858 Sentence denotes ONU has been recently suggested as a non-invasive tool to diagnose IH.
T9204 317859-317967 Sentence denotes Its reliability has been showed in patients with severe head injury or with intracranial hemorrhage [1, 2] .
T36486 317968-318133 Sentence denotes Methods The study was conducted on 10 patients admitted to the neurointensive care unit for moderate/severe head injury in the period January to June 2009 (Group 1).
T27649 318134-318200 Sentence denotes Ten healthy subjects were enrolled as the control group (Group 2).
T41653 318201-318306 Sentence denotes Estimated ICP (eICP) was calculated with TCD using the equation proposed by Czosnyka and colleagues [3] .
T57020 318307-318358 Sentence denotes It was measured twice a day for 3 consecutive days.
T34997 318359-318519 Sentence denotes In the same sonographic session, the optic nerve sheath diameter (ONSD) was measured in the sagittal and transverse plane 3 mm behind the papilla, in both eyes.
T78366 318520-318602 Sentence denotes No signifi cant diff erences have been found between groups regarding age and sex.
T13285 318603-318647 Sentence denotes The ONSD distribution is shown in Figure 1 .
T71883 318648-318728 Sentence denotes ONSD, eICP and ICP values were signifi cantly higher in Group 1 than in Group 2.
T20361 318729-318870 Sentence denotes Linear regression analysis identifi ed a signifi cant relationship Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T49305 318871-318904 Sentence denotes between ONSD and ICP (r = 0.588).
T35601 318905-319084 Sentence denotes By calculating the receiver operating characteristic curve, an ONSD value of 5.35 mm resulted as the optimal cut-off point with a sensitivity of 95.1% and a specifi city of 96.2%.
T53429 319085-319182 Sentence denotes Conclusions ONSD measurements correlated with invasive and noninvasive (TCD) measurements of ICP.
T96974 319183-319240 Sentence denotes It is a useful, non-invasive bedside tool to diagnose IH.
T66476 319241-319332 Sentence denotes It is safe, easy to perform and can rapidly give reproducible information on patients' ICP.
T94879 319333-319400 Sentence denotes Introduction Traumatic brain injury (TBI) is a multiphasic disease.
T95509 319401-319560 Sentence denotes Follow ing the initial impact, secondary injury, including oxidative stress and infl ammation, is thought to contribute signifi cantly to death and disability.
T97502 319561-319695 Sentence denotes This ongoing damage in the penumbra of the brain leads to the demise of neuronal populations, and ultimately decreased brain function.
T42491 319696-319942 Sentence denotes Identifi cation of various neural markers such as neuronal specifi c enolase (NSE) at various time points following TBI may help us better understand the magnitude of secondary injury following TBI, and may help predict outcome in these patients.
T35566 319943-320113 Sentence denotes Methods Early serial cerebrospinal fl uid (CSF) samples were collected from patients with severe TBI (GCS 3 to 8) who required placement of a therapeutic ventriculostomy.
T99062 320114-320275 Sentence denotes Following ventriculostomy placement, CSF samples were obtained every 4 hours for the fi rst 24 hours post-injury, then every 8 hours for post-injury days 2 to 5.
T42163 320276-320336 Sentence denotes The levels of NSE were then measured using the ELISA method.
T29113 320337-320572 Sentence denotes Results Following sample analysis in 11 patients, we found that in TBI patients that had a good neurological outcome, the levels of NSE in the CSF rose early (between 25 and 60 ng/ml) within 12 to 16 hours following the initial injury.
T22708 320573-320758 Sentence denotes The NSE levels then rapidly decreased to normal levels (~5 ng/ml) at approximately 20 hours following injury, with these levels persisting until day 5 (day of fi nal sample collection).
T54179 320759-320976 Sentence denotes Patients with a poor outcome (lack of ability to return to pre-injury activities or death) showed signifi cantly higher levels of NSE persisting out to 5 days post injury, with late levels ranging from 35 to 50 ng/ml.
T45074 320977-321165 Sentence denotes Conclusions In TBI patients with a good outcome, there was an increase in NSE levels in the CSF noted at early time points (~16 hours), which abated at approximately 20 hours after injury.
T84728 321166-321315 Sentence denotes In TBI patients with a poor clinical outcome, CSF levels of NSE were signifi cantly elevated at later time points over the fi rst 5 days post injury.
T66796 321316-321569 Sentence denotes Introduction The aim of the study was to determine whether serum levels of biomarkers -hyperphosphorylated neurofi lament NF-H, S100β protein and NSE -correlate with severity of brain injury and outcome in children with traumatic brain injury (TBI [1] .
T27890 321570-321669 Sentence denotes Glasgow Outcome Scale (GOS) was calculated at 12 months by the patient's general practitioner [2] .
T5652 321670-321731 Sentence denotes Unfavourable outcome was defi ned as DDS 3, 4 or GOS 1, 2, 3.
T22780 321732-321880 Sentence denotes Correlation between DDS and GOS was measured and the ability of DDS to predict GOS at 12 months in survivors was assessed using logistic regression.
T53154 321881-322002 Sentence denotes Sensitivity and specifi city of dichotomised DDS for prediction of unfavourable outcome at 12 months was also calculated.
T23605 322003-322049 Sentence denotes Results Data were available on 1,227 patients.
T41835 322050-322174 Sentence denotes A highly correlated linear relationship was evident between DDS and GOS (spearman correlation coeffi cient 0.77, P <0.0001).
T24531 322175-322361 Sentence denotes Unfavourable outcome measured by DDS showed sensitivity of 73% (95% CI 69 to 76%) and specifi city of 56% (53 to 59%) for prediction of unfavourable outcome at 12 months defi ned by GOS.
T93205 322362-322529 Sentence denotes DDS showed a strong association with GOS at 12 months for survivors at discharge, with fully dependent patients having 15 times higher odds of an unfavourable outcome.
T27779 322530-322695 Sentence denotes Adjusting for known TBI prognostic factors attenuated the strength of the association, however DDS remained a statistically signifi cant strong predictor of outcome.
T87673 322696-322860 Sentence denotes Conclusions DDS is strongly associated with 12-month GOS and could potentially be used to replace missing data or provide a surrogate outcome measure in TBI trials.
T47199 322861-322974 Sentence denotes A valid prediction score may also aid the clinician's ability to discuss patient prognosis at hospital discharge.
T44615 322975-323082 Sentence denotes References to BT-CPA and PT-CPA treated with our strategy including emergency department thoracotomy (EDT).
T30163 323083-323156 Sentence denotes Methods This study is a population-based case series observational study.
T17323 323157-323974 Sentence denotes We have taken three approaches to these patients: our private aggressive treatment strategy (resuscitation for 30 minutes, aggressive infusion using sheath introducer into the subclavian vein, and EDT); in-hospital system supporting this aggressive resuscitation (logistic issue such as the close location between ED and the room for catheter intervention and CT, and direct entrance to the OR by exclusive lift, and common instruments interchangeable between ED and OR including the bed); and prehospital EMS in our city (CPA patients are transferred in about 7 minutes to the nearest of selected 11 hospitals which can receive and treat CPA patients). ) is a bag-valve-mask resuscitator (BVM) equipped with a valve limiting fl ow-rate and peak airway pressure to decrease hyperventilation and gastric insuffl ation.
T16513 323975-324199 Sentence denotes We studied this device used by hospital staff without training to evaluate the possibility to change the standard BVM to the SB in hospital wards where positive pressure ventilation is rarely needed and training is sporadic.
T88432 324200-324350 Sentence denotes The participants (12 physicians, 38 nurses) were randomised to use the standard BVM or SB to ventilate a resuscitation training manikin over 1 minute.
T75303 324351-324451 Sentence denotes The mechanism of the SB was shortly described in the SB group but no hands-on training was provided.
T60996 324452-324563 Sentence denotes Participants were asked to ventilate the patients as they would do if patients have a pulse but do not breathe.
T75264 324564-324633 Sentence denotes Tidal volumes were registered to a computer connected to the manikin.
T68997 324634-324808 Sentence denotes The medians of minute ventilation were 6.1 (interquartile range 2.6 to 8.1) and 3.9 (IQR 1.7 to 5.4) litres per minute in the SB and control groups, respectively (Figure 1 ).
T97986 324809-324885 Sentence denotes Hyperventilation >10 l/minute occurred only in the control group (P = 0.23).
T20603 324886-325071 Sentence denotes Conclusions Using the SB without previous hands-on training is possible for the majority of nursing and medical staff and decreases hyperventilation in comparison with the standard BVM.
T62025 325072-325199 Sentence denotes In the current study, therefore, we investigated the effi cacy of ECC in the dental chair in comparison with ECC on the fl oor.
T6352 325200-325347 Sentence denotes Methods Two dentists and two nurses with experience of ECC participated in this study; 30 ± 5 years old, 160 ± 5 cm in height, 65 ± 7 kg in weight.
T9219 325348-325524 Sentence denotes Before the study, they were educated about CPR and performed ECC for 5 minutes on the resuscitation manikin in two diff erent situations; on the fl oor and in the dental chair.
T21135 325525-325622 Sentence denotes On separate days, they repeated these ECC procedures on the fl oor and in the dental chair again.
T90059 325623-325706 Sentence denotes The depth of compression and the percentage of adequate compression were evaluated.
T63618 325707-325818 Sentence denotes In addition, each participant commented on the preferable situation in the questionnaire after each set of ECC.
T79668 325819-325977 Sentence denotes Results Four dental personnel performed ECC fi ve times on the fl oor and fi ve times in the dental chair and commented on the preferable setting fi ve times.
T62642 325978-326181 Sentence denotes The effi cacy of ECC was evaluated by the average depth and the percentage of ECC with adequate depth; 39.8 ± 8.2 mm and 46.8 ± 48.8% on the fl oor and 34.4 ± 6.9 mm and 41.7 ± 42.7% in the dental chair.
T35243 326182-326361 Sentence denotes The percentage of ECC with adequate depth was higher for the fl oor setting than that of the dental chair setting, although it did not reach statistical signifi cance (P = 0.079).
T6519 326362-326536 Sentence denotes In the 20 questionnaires, three of them preferred the dental chair setting, two of them were no diff erence between both settings and 15 of them preferred the fl oor setting.
T8691 326537-326680 Sentence denotes Conclusions ECC on the fl oor can be performed eff ectively and easy and we can start CPR immediately after moving the patient onto the fl oor.
T82297 326681-326780 Sentence denotes Introduction Today, the emergency medical service (EMS) system has been developing in each country.
T49523 326781-326920 Sentence denotes However, it is not known whether people are willing to perform CPR and whether they are prepared to perform CPR under telephone CPR advice.
T77694 326921-327081 Sentence denotes In this study, we examined how Japanese citizens are interested in the importance of immediate CPR and defi brillation, and how they understand this importance.
T39695 327082-327221 Sentence denotes Methods Patients with out-of-hospital cardiac arrest due to nontraumatic etiology treated in our center for the past 2 years were enrolled.
T59820 327222-327266 Sentence denotes Cardiac arrest after the scene was excluded.
T11729 327267-327329 Sentence denotes Patients' records from our emergency department were reviewed.
T29580 327330-327455 Sentence denotes In Japan, the ambulance service, dispatch service and emergency life-saving technician (ELST) belong to the fi re department.
T56778 327456-327694 Sentence denotes ELSTs perform not only advanced CPR for CPA patients on the job but also education of call takers in the central operation center under medical control about the importance of the recognition of CPA and advice for immediate bystander CPR.
T16091 327695-327741 Sentence denotes Results A total of 747 patients were enrolled.
T6344 327742-327862 Sentence denotes Telephone CPR advice was performed for bystanders of 336 (45%) patients and 304 bystanders actually performed CPR (90%).
T61665 327863-328079 Sentence denotes Five percent (40) of all 747 cases underwent voluntarily bystander CPR before telephone advice, 40% underwent bystander CPR according to telephone advice, and 4% (32) did not undergo CPR against telephone CPR advice.
T68592 328080-328265 Sentence denotes In 344 patients with bystander CPR, 33% reached ROSC, 11% survived more than 24 hours, and 3% were discharged, and in 391 patients without bystander CPR, 30%, 11%, and 6%, respectively.
T41131 328266-328528 Sentence denotes Restricted in 302 witnessed patients, of 125 with bystander CPR, 52% reached ROSC, 16% survived more than 24 hours, and 3% were discharged, and in 177 without bystander CPR, 44% reached ROSC, 14% survived more than 24 hours, and 1% were discharged, respectively.
T43900 328529-328580 Sentence denotes Conclusions Most people are willing to perform CPR.
T38184 328581-328659 Sentence denotes Bystanders are prepared to perform CPR with telephone CPR advice to help them.
T85578 328660-328764 Sentence denotes However, bystander CPR is not always adequate, resulting in no distinct eff ect of CPR on survival rate.
T38157 328765-328871 Sentence denotes We should educate citizens beforehand and guide bystanders with more proper and quick advice by telephone.
T49347 328872-329028 Sentence denotes Introduction The purpose of the study was to analyze the eff ects of the type and nature of CPR on the prognosis of out-of-hospital cardiac arrests (OHCAs).
T64249 329029-329174 Sentence denotes Methods We analyzed 1,612 OHCAs, witnessed by citizens and handled by the dispatch system in Ishikawa, Japan, from 1 April 2003 to 31 March 2008.
T44874 329175-329335 Sentence denotes Bystander CPR was classifi ed into four groups according to type (CC only or CC + MMV) and nature (under one's own initiative or telephoneassisted instruction).
T84376 329336-329417 Sentence denotes The presence of bystander CPR signifi cantly augmented the 1-month survival rate.
T32428 329418-329496 Sentence denotes However, there were no signifi cant diff erences among the four groups of CPR.
T10302 329497-329718 Sentence denotes The multivariate logistic regression analysis identifi ed three time factors including intervals of collapse-to-call, call-tofi rst CPR, call-to-arrival to patients as independent factors associated with 1-month survival.
T22815 329719-329740 Sentence denotes See Figures 1 and 2 .
T21507 329741-329873 Sentence denotes Conclusions Signifi cance of correctable time factors rather than type of CPR should be considered in the future guideline revision.
T53367 329874-330000 Sentence denotes Conclusions As an alternative airway device recommended by the ERC, the LT may enable airway control rapidly and eff ectively.
T18796 330001-330095 Sentence denotes Additionally, by using the LT, a reduced 'no-fl ow-time' and a better outcome may be possible.
T47569 330096-330206 Sentence denotes LT may be a good alternative airway device for providing and maintaining a patent airway during resuscitation.
T72032 330207-330347 Sentence denotes Introduction Besides the gold standard endotracheal tube, supraglottic airway devices are alternatives for emergency airway management [1] .
T86662 330348-330480 Sentence denotes The goal of the study was to identify airway devices that provide successful ventilation, even 12 months after training in manikins.
T69553 330481-330592 Sentence denotes Conclusions One year after training, time for successful ventilation for all devices was lower than 25 seconds.
T83225 330593-330802 Sentence denotes This is acceptable compared with the gold standard endotracheal tube, but due to the rising gastric infl ation rate and high amount of insuffi cient tidal volume, shorter intervals of training maybe necessary.
T34144 330803-330946 Sentence denotes Introduction The purpose of the study was to clarify the infl uence of aging on attitudes toward the initial three links in chains of survival.
T11204 330947-331112 Sentence denotes Methods We gave questionnaires to attendants of compulsory programs for basic life support (BLS) or driving technique at the beginning in authorized driving schools.
T5611 331113-331159 Sentence denotes The questionnaires included their backgrounds.
T20143 331160-331394 Sentence denotes We studied their willingness in four hypothetical scenarios related to the initial three links: early emergency call, cardiopulmonary resuscitation (CPR) under one's own initiative, telephone-assisted chest compression and use of AED.
T10577 331395-331547 Sentence denotes The respondents were divided into young (17 to 29 years, n = 6,122), middle-aged (29 to 59 years, n = 827), older person (>59 years, n = 15,743) groups.
T30172 331548-331715 Sentence denotes Results There were signifi cant diff erences in gender, occupation, residential area and experience of BLS training, and knowledge of AED use between the three groups.
T95010 331716-331849 Sentence denotes The proportions of respondents who are willing to perform the desirable BLS actions were lowest in the older person group (Table 1) .
T79917 331850-331995 Sentence denotes Multiple logistic regression analysis confi rmed that aging is one of the independent factors relating to negative attitude in all the scenarios.
T92229 331996-332171 Sentence denotes Gender, occupation, resident area, experience of BLS training, and knowledge for AED use were other independent factors relating to negative attitude to some of the scenarios.
T63286 332172-332246 Sentence denotes Conclusions The aged population is more negative to the chain of survival.
T53936 332247-332329 Sentence denotes More are willing to follow the telephone-assisted direction for chest compression.
T50557 332330-332460 Sentence denotes The BLS training should be modifi ed for them to gain confi dence and to be aware of the signifi cance and benefi t of early call.
T13513 332462-332632 Sentence denotes The ECG tracings recorded during a ventricular fi brillation (VF) using an automated external defi brillator (AED) contain useful information predictive of shock outcome.
T45710 332633-332678 Sentence denotes The focus is on the VF waveforms' morphology.
T90616 332679-332801 Sentence denotes The amplitude and the spectral properties of VF may predict the likelihood of successful defi brillation [1] [2] [3] [4] .
T25889 332802-332921 Sentence denotes In almost all previous studies, the amplitude or the spectral properties of the ECG tracings have been singularly used.
T26033 332922-333005 Sentence denotes However, these approaches have led to methods lacking suffi cient predictive power.
T41615 333006-333118 Sentence denotes Methods Five hundred patients with out-of-hospital cardiac arrest on arrival in an emergency room were examined.
T40694 333119-333196 Sentence denotes The rhythm was identifi ed as VF and confi rmed by two trained investigators.
T39450 333197-333309 Sentence denotes ECG data were stored in modules in digitized form over a period of 20 minutes and were analyzed retrospectively.
T60464 333310-333381 Sentence denotes ECG traces containing CPR artefacts were removed by digital fi ltering.
T30577 333382-333576 Sentence denotes Times of collapse, dispatch, scene arrival, CPR, and initial defi brillation were determined from dispatch records, recordings of arrest events, interviews with bystanders, and hospital records.
T21664 333577-333684 Sentence denotes The preshock VF waveform morphology was studied and diff erent parameters of VF ECG signals were extracted.
T76455 333685-333803 Sentence denotes We then introduced a pattern classifi cation machine that combines the amplitude and spectral features simultaneously.
T72395 333804-333982 Sentence denotes The use of the pattern classifi cation machine which combines amplitude and spectral features of VF ECG signals shows an improved predictive power as compared with other methods.
T31988 333983-334181 Sentence denotes Conclusions This technique could help to determine which patients should receive shock fi rst and which should receive a period of CPR prior to shock, thereby increasing the probability of survival.
T31789 334182-334345 Sentence denotes The potential impact of this research is high in the direction of generating a new methodology able to increase the probability of survival after a cardiac crisis.
T48243 334346-334556 Sentence denotes References Introduction Recent studies report an increase of asystole and pulseless electrical activity (PEA) as the fi rst monitored cardiac arrest rhythms after arrival of the Emergency Medical Services [1] .
T76343 334557-334689 Sentence denotes The asystolic patients presumably undergo ischaemia for a longer time and may benefi t from treatment reducing hypoxic brain injury.
T74550 334690-334790 Sentence denotes Therapeutic hypothermia (TH) has expanded into prehospital care to be initiated as soon as possible.
T84763 334791-334917 Sentence denotes Rapid cold crystalloid infusion is the most frequent method; however, severe haemodynamic instability is its contraindication.
T31343 334918-335122 Sentence denotes The aim of the study was to assess the adverse eff ects of prehospital volume expansion in patients with initial nonshockable rhythms when used in a setting with only restricted cardiovascular monitoring.
T3245 335123-335343 Sentence denotes Methods All patients who were deemed eligible for advance cardiac life support (ACLS) were included as long as the arrest was witnessed and cardiopulmonary resuscitation (CPR) was initiated within 20 minutes of collapse.
T10445 335344-335400 Sentence denotes Patients were randomized to treatment or control groups.
T84789 335401-335516 Sentence denotes The trial was designed to determine the safety and eff ectiveness of early cooling initiated at the site of arrest.
T36392 335517-335573 Sentence denotes Survival and time to target temperature were documented.
T38828 335574-335660 Sentence denotes Results Data are presented as the mean ± SD or median (interquartile range (25, 75%)).
T16436 335661-335759 Sentence denotes Mean age was 67.8 ± 14 years in the intervention group and 65.4 ± 13.9 years in the control group.
T18777 335760-335886 Sentence denotes On average, cooling therapy was started in 33 ± 12 minutes in the RhinoChill™ group and 170 ± 97 minutes in the control group.
T38658 335887-335971 Sentence denotes Temperatures at hospital admission were signifi cant lower in the RhinoChill™ group.
T51435 335972-336140 Sentence denotes Time to target tympanic temperature, refl ecting brain temperature, were signifi cant faster in the RhinoChill™ group (211 ± 124 minutes vs 424 ± 217 minutes; P <0.05).
T54750 336141-336180 Sentence denotes Adverse events occurred in 12 patients.
T55866 336181-336221 Sentence denotes None was related to the cooling therapy.
T40976 336222-336323 Sentence denotes In the intervention group fi ve patients (20%) survived and three patients (12%) had a CPC of 1 to 2.
T56053 336324-336424 Sentence denotes In the control group only four patients (12.5%) survived and one patient (3.1%) had a CPC of 1 to 2.
T58817 336425-336530 Sentence denotes Conclusions Using the intranasal cooling method, cooling was much faster and earlier in treated patients.
T41478 336531-336614 Sentence denotes Neurologically intact survival and discharge rates were higher in treated patients.
T88933 336615-336784 Sentence denotes Transnasal cooling for the induction of therapeutic hypothermia during prehospital resuscitation is feasible and highly eff ective in lowering brain temperature rapidly.
T50540 336785-336903 Sentence denotes The method off ers the possibility for immediate introduction and realization of mild hypothermia in the fi eld. [1] .
T554 336904-337028 Sentence denotes We sought to investigate whether a hospitalwide approach to TH after CA would reduce delays and result in improved outcomes.
T60793 337029-337117 Sentence denotes Methods We conducted a retrospective analysis of all TH interventions from 2007 to 2008.
T38233 337118-337212 Sentence denotes Following this we implemented a hospital-wide approach to TH and re-evaluated in 2008 to 2009.
T85916 337213-337419 Sentence denotes The hospital-wide approach included an educational programme, TH guidelines in the resuscitation room in the ED, and a cooling pack stored in the ICU which could be taken immediately to the post-CA patient.
T79948 337420-337483 Sentence denotes Results CA-ROSC and CA-Hosp delays were similar between groups.
T86301 337484-337612 Sentence denotes The hospital-wide approach signifi cantly reduced the time to initiate TH and time to achieve target temperature (see Table 1 ).
T83362 337613-337699 Sentence denotes The small sample size may have prohibited demonstration of outcome diff erences. [1] .
T1727 337700-338055 Sentence denotes The objectives of this study were: to demonstrate a diff erence in chest compression eff ectiveness with bed height, and provide a suggestion for an optimal and achievable bed height for eff ective chest compressions; and to demonstrate fatigue during chest compressions, and provide a suggestion for an upper time limit for eff ective chest compressions.
T6206 338056-338195 Sentence denotes Methods Exclusion criterion for this trial; no previous basic life support training in the past 4 years, or refused consent to participate.
T79252 338196-338308 Sentence denotes A modifi ed Laerdal manikin was connected to a Dragor ventilator (to measure intrathoracic pressures generated).
T84845 338309-338488 Sentence denotes The manikin was placed on a hospital trolley, and CPR was performed by candidates at three diff erent bed heights: mid thigh; anterior superior iliac spine; and xiphisternal area.
T19126 338489-338627 Sentence denotes Chest compressions were continuous and asynchronous with ventilation, and allowed to continue for 30 seconds before recordings were taken.
T53285 338628-338675 Sentence denotes Results One hundred and one subjects took part.
T99691 338676-338917 Sentence denotes The diff erences in intrathoracic pressures generated at diff erent bed heights were compared using ANOVA variance testing for multiple groups, and were statistically Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T73537 338918-338957 Sentence denotes signifi cant with P <0.01 ( Figure 1 ).
T26878 338958-339166 Sentence denotes We also found that the eff ectiveness of CPR decreased 17% over a 2-minute period (Figure 2 Introduction Therapeutic hypothermia is defi ned as controlled cooling of body temperature for therapeutic purposes.
T29089 339167-339290 Sentence denotes At present, the use of mildmoderate hypothermia (32 to 34°C) in patients with neurological damage is increasing in the ICU.
T61771 339291-339464 Sentence denotes In this regard, recent studies suggest that it is able to improve the neurological outcome in patients with anoxic cerebral damage following sudden cardiac death (SCA) [1] .
T10462 339465-339646 Sentence denotes The aim of this study is to assess the role of therapeutic hypothermia on neurological outcome in patients who experienced SCA with ensuing return of spontaneous circulation (ROSC).
T59384 339647-340002 Sentence denotes Methods Ninety adult patients, aged between 18 and 85, referred to our ICU after SCA due to cardiac disease with following ROSC were randomly allocated to the following treatment groups: patients in group 1 were treated immediately after admission with therapeutic hypothermia plus standard treatment, patients in group 2 received only standard treatment.
T71832 340003-340046 Sentence denotes All patients at entry presented with GCS 3.
T15806 340047-340230 Sentence denotes Neurological outcome was assessed on discharge and after 6 months, by means of GOS scale (0 = dead, 1 = vegetative, 2 = severely disabled, 3 = moderately disabled, 4 = good recovery).
T57984 340231-340323 Sentence denotes We consider scores 0 to 1 as unfavourable outcome, scores from 2 to 4 as favourable outcome.
T33219 340325-340542 Sentence denotes We conducted a retrospective study looking at infection rates in patients treated with therapeutic hypothermia (TH) following cardiac arrest who were admitted to the ICU of the Bristol Royal infi rmary since May 2007.
T27161 340543-340634 Sentence denotes TH is recommended in all patients presenting with persistent coma following cardiac arrest.
T71211 340635-340683 Sentence denotes One complication of TH is the risk of infection.
T40648 340684-340862 Sentence denotes Hypothermia suppresses the immune system by inhibiting the release of proinfl ammatory cytokines and by suppressing the chemotactic migration of leukocytes and phagocytosis [1] .
T56576 340863-341041 Sentence denotes In patients with traumatic brain injury, TH for more than 48 hours is associated with a higher risk of infection, but not if the period of hypothermia is less than 24 hours [2] .
T57120 341042-341140 Sentence denotes In patients following cardiac arrest, infection is common, reported in up to 73% of patients [3] .
T21260 341141-341387 Sentence denotes Methods Data were collected retrospectively, and information about ICU length of stay, whether they had a protected catheter (PC) specimen taken, whether they had any positive cultures and whether they were treated with antibiotics was extracted.
T88752 341388-341434 Sentence denotes Data for ICU length of stay was also obtained.
T17182 341435-341561 Sentence denotes Infections were defi ned as >10 5 colony-forming units (cfu) grown from either PC specimens or from peripheral blood cultures.
T75852 341562-341625 Sentence denotes We identifi ed 82 patients treated with TH post cardiac arrest.
T84411 341626-341707 Sentence denotes Nineteen (29%) had proven infection either on PC or on peripheral blood cultures.
T48393 341708-341753 Sentence denotes PC specimens were taken in 21 (25%) patients.
T97536 341754-341831 Sentence denotes Of the 21 patients who had PC specimens taken, 16 (76%) had proven infection.
T36687 341832-342058 Sentence denotes We also found that an increase in ICU length of stay was associated with increased infection rates, 44% in patients with a length of stay of greater than 3 days and 55% in patients with a length of stay of greater than 4 days.
T6070 342059-342181 Sentence denotes We have shown, in our ICU, that of patients who were treated with TH following cardiac arrest, 29% had a proven infection.
T55342 342182-342284 Sentence denotes On PC sampling, there was a much higher rate of infection with 76% of patients with positive cultures.
T77651 342285-342471 Sentence denotes This suggests that the risk of infection in patients treated with therapeutic hypothermia post cardiac arrest is higher than that for patients who are cooled post traumatic brain injury.
T70964 342472-342627 Sentence denotes Introduction In this presentation we will review the process used for developing a therapeutic hypothermia program and our outcomes during the fi rst year.
T17877 342628-342836 Sentence denotes Despite the fact that therapeutic hypothermia has been shown to improve survival and neurologic outcome after cardiac arrest [1] , it is underused [2] and has been only slowly introduced in many institutions.
T59724 342837-342942 Sentence denotes One of the reasons that it is not more widely used may be the diffi culty of implementation of a program.
T2885 342943-343086 Sentence denotes Methods A multidisciplinary team was assembled in 2007 to explore the opportunity for therapeutic hypothermia in patients after cardiac arrest.
T24511 343087-343172 Sentence denotes Pertinent literature was reviewed and a guideline and electronic orders were drafted.
T61754 343173-343339 Sentence denotes The team investigated all available options for cooling and chose a method that was non-invasive and did not require a large fi nancial investment by the institution.
T47299 343340-343447 Sentence denotes Nurses were sent to an international program to learn about hypothermia and become advocates and educators.
T45783 343448-343583 Sentence denotes Education was done for caregivers in the prehospital setting, emergency department, cardiac catheterization laboratory, and adult ICUs.
T17298 343584-343674 Sentence denotes Advertising to community and other hospitals was done by newspaper, radio, and television.
T90455 343675-343765 Sentence denotes The team continued to meet regularly to assess and modify the program based on experience.
T90256 343766-343882 Sentence denotes Results Prior to the start of this program, therapeutic hypothermia was essentially not utilized at the institution.
T75819 343883-344030 Sentence denotes Twenty-one patients were cooled after cardiac arrest and resuscitation at our institution in the fi rst year (2008), with few missed opportunities.
T44840 344031-344437 Sentence denotes Fifteen (71%) survived, and 12 (57%) had good neurologic outcome. (Post-cardiac arrest survival rates without hypothermia in the literature range from less than 5% to 35% [1] .) Challenges included altering historic practice patterns, integrating sectors of the healthcare delivery system that had historically drifted apart, and interacting with extra-institutional regulations governing prehospital care.
T15241 344438-344569 Sentence denotes Conclusions The therapeutic hypothermia program at our institution is successful in improving patient outcome after cardiac arrest.
T76241 344570-344851 Sentence denotes The elements that contributed to a successful program included: teamwork; multidisciplinary nature of the team; promoting awareness of the program; buy-in by nurses who championed the program in the ICU; positive patient outcomes; and low fi nancial investment for the institution.
T23777 344852-345018 Sentence denotes Introduction Measurement of body temperature using the tympanic method (TTM) represents a standard non-invasive method which best approximates core temperature (CTM).
T74180 345019-345109 Sentence denotes However, published evidence increasingly casts doubt on the agreement between TTM and CTM.
T89047 345110-345235 Sentence denotes The aim of this study was to assess the agreement of these two methods of temperature measurement in critically ill patients.
T39606 345236-345386 Sentence denotes Methods We recruited 20 consecutive critically ill patients, who required indwelling thermistor-tipped arterial catheters for haemodynamic monitoring.
T21365 345387-345568 Sentence denotes For each patient we simultaneously collected the core temperature, obtained from the arterial catheter, and tympanic temperatures in the left and right ears, in the supine position.
T1800 345569-345779 Sentence denotes Tympanic temperature was recorded using the ear setting (TTMe) and the core setting tympanic temperature (TTMc) in accordance with the manufacturer's instructions (Genius™ 2; Kendall, Tyco Healthcare, MA, USA).
T70961 345780-345882 Sentence denotes Local ethics committee approval was waived and the study was conducted as a service improvement audit.
T13946 345883-345971 Sentence denotes Bland-Altman analysis was used to measure agreement between the two set of measurements.
T12368 345972-346033 Sentence denotes Results From the 20 patients we made 102 paired measurements.
T47960 346034-346173 Sentence denotes Comparison of the TTM in the right and left ears resulted in high variability in the recorded temperature with a percentage error of 34.4%.
T86994 346174-346309 Sentence denotes In view of this observed large variability, the mean TTM between the two ears was used for subsequent comparison with core temperature.
T47004 346310-346509 Sentence denotes Comparison of core measurements against tympanic measurements using ear settings (TTMe) showed a small positive mean bias (limits of agreement (LOA); percentage error) of 0.3°C (-0.4 to 1.1°C, 2.4%).
T52680 346510-346710 Sentence denotes However, when the CTM and TTM were compared using the core temperature setting of the thermometer, the bias (LOA) increased to -0.97°C (-1.6 to -0.4°C), creating a larger bias than the unadjusted TTM.
T54196 346711-346893 Sentence denotes Conclusions Tympanic temperature measurements showed a large random variability compared with core temperatures and suggest bilateral averaged tympanic measurements may be necessary.
T54947 346894-346995 Sentence denotes In our series, using the core setting increased error and increased the bias between the two methods.
T98639 346996-347186 Sentence denotes Our fi ndings raise the possibility that the diagnosis of fever and the need for further investigation may be aff ected by the choice of temperature measurement site and device setting used.
T72024 347187-347275 Sentence denotes Can we predict neurological prognoses with computed tomography just after resuscitation?
T92106 347276-347379 Sentence denotes Introduction Technological improvements in ventilator design may confound the diagnosis of brain death.
T98643 347380-347521 Sentence denotes We describe a series of patients clinically perceived to be breathing spontaneously even though they satisfi ed the criteria for brain death.
T87824 347522-347645 Sentence denotes The misdiagnosis of cerebral function in these patients delayed the diagnosis of brain death and subsequent organ donation.
T93691 347646-347757 Sentence denotes Resource utilization, patient/family suff ering, and staff morale are all negatively impacted when this occurs.
T71774 347758-347826 Sentence denotes Methods The ventilator triggering mode was recorded in all patients.
T90827 347827-347949 Sentence denotes Patients were identifi ed by the authors with a high likelihood of brain death and receiving pressure support ventilation.
T32971 347950-348021 Sentence denotes Patients without cranial nerve function underwent formal apnea testing.
T26754 348022-348155 Sentence denotes Results Seven patients were identifi ed with cessation of cranial nerve function, but thought to have spontaneous breathing activity.
T8845 348156-348228 Sentence denotes All patients were on pressure support ventilation with fl ow triggering.
T52563 348229-348275 Sentence denotes Formal apnea testing was performed (Table 1) .
T48674 348276-348368 Sentence denotes Conclusions Improvement in triggering ventilation may confound the diagnosis of brain death.
T41338 348369-348615 Sentence denotes Considering the unmet need for transplantation and the negative impact of not recognizing death on families, staff , resource utilization and both patients and potential recipients of organs mandates a simple solution to eliminate these problems.
T67342 348616-348766 Sentence denotes We propose that Introduction Studies of patients presenting with coma are limited and little is known about the prognosis of these cases [1] [2] [3] .
T25853 348767-348880 Sentence denotes The aim of this study was to investigate the acute and long-term prognosis after an episode of nontraumatic coma.
T47055 348881-349083 Sentence denotes Methods Adults admitted consecutively to an emergency department in Stockholm, Sweden between February 2003 and May 2005 with a Glasgow Coma Scale (GCS) score of 10 or below were enrolled prospectively.
T28457 349084-349177 Sentence denotes All available data were used to explore the cause of the impaired consciousness on admission.
T88193 349178-349261 Sentence denotes Patients surviving hospitalization were followed up for 2 years regarding survival.
T85407 349262-349570 Sentence denotes The fi nal study population of 865 patients had the following eight diff erent coma etiologies: poisoning (n = 329), stroke (n = 213), epilepsy (n = 113), circulatory failure (n = 60), infection (n = 56), metabolic disorder (n = 44), respiratory insuffi ciency (n = 33), and intracranial malignancy (n = 17).
T96309 349571-349697 Sentence denotes The hospital mortality rate among the 865 patients was 26.5%, varying from 0.9% for epilepsy to 71.7% for circulatory failure.
T7543 349698-349810 Sentence denotes The accumulated total 2-year mortality rate was 43.0%, varying from 13.7% for poisoning to 88.2% for malignancy.
T57687 349811-349905 Sentence denotes The level of consciousness on admission also infl uenced the prognosis: a GCS score of 3 to 6.
T41422 349906-350089 Sentence denotes Conclusions The prognosis in patients presenting with nontraumatic coma is serious and depends largely both on the level of consciousness on admission and on the etiology of the coma.
T34537 350090-350218 Sentence denotes Adding the suspected coma etiology to the routine coma grading of these emergencies may more accurately predict their prognosis.
T2415 350219-350564 Sentence denotes Introduction Recently, near-infrared time-resolved spectroscopy (TRS), which is quite eff ective in quantitative monitoring tissue oxygenation, because it off ers the actual measurement of photon migration in the tissues, and the photon mean path length is easily obtained from the center of gravity of the temporal profi le, has been developed.
T34596 350565-350783 Sentence denotes In this study, we investigated whether the changes in the cerebral oxygen saturation (T-SO 2 ) obtained with the TRS and the jugular venous oxygen saturation (SjvO 2 ) predicted cognitive decline after cardiac surgery.
T67453 350784-350946 Sentence denotes Methods With institutional approval and informed consent, we studied 10 patients (68.7 ± 6.1 years) undergoing cardiac surgery under cardiopulmonary bypass (CPB).
T71488 350947-351039 Sentence denotes T-SO 2 was continuously monitored using a TRS-10 (Hamamatsu Photonics KK, Hamamatsu, Japan).
T11283 351040-351169 Sentence denotes For measurement of SjvO 2 , a 5.5 Fr oximetry catheter was inserted by retrograde cannulation of the right internal jugular vein.
T81832 351170-351377 Sentence denotes The values of T-SO 2 and SjvO 2 were compared with each point: before CPB, 5 minutes after the onset of CPB, before aorta clamp, after aorta clamp, rewarming, aorta declamp, end of rewarming, and end of CPB.
T48337 351378-351485 Sentence denotes The cognitive decline was evaluated by Mini Mental State Examination before and 7 days after the operation.
T75014 351486-351578 Sentence denotes The statistical analysis was performed by repeated-measures ANOVA followed by Fisher's PLSD.
T66337 351579-351629 Sentence denotes P <0.05 was considered statistically signifi cant.
T53508 351630-351694 Sentence denotes Results Four of 10 cases showed postoperative cognitive decline.
T27403 351695-351923 Sentence denotes The mean values of T-SO 2 and SjvO 2 during operation in patients without postoperative cognitive decline (n = 6) were 63.9 ± 4.6% and 60.5 ± 9.7%, respectively, and there were no statistical signifi cances between these values.
T64369 351924-352060 Sentence denotes However, the mean values of T-SO 2 and SjvO 2 during operation in patients with postoperative cognitive decline (n = 4) were 62.8 ± 5.6%
T24504 352061-352306 Sentence denotes (T-SO 2 ) and 70.4 ± 14.9% (SjvO 2 ), and showed signifi cant diff erences between two values (P = 0.0024), and at the rewarming period, the values of SjvO2 was signifi cantly higher than those of T-SO 2 (87.9 ± 6.3% vs 65.0 ± 5.3%, P = 0.0014).
T43639 352307-352410 Sentence denotes Systemic hypertension and smoking showed strong association with the rupture of intracranial aneurysms.
T9462 352411-352498 Sentence denotes The arteries of the previous segment were those that had higher incidence of aneurysms.
T81475 352499-352581 Sentence denotes More than onehalf of the patients did not have complications during the procedure.
T58247 352582-352659 Sentence denotes Embolization of cerebral aneurysms was revealed to be a low lethality method.
T10475 352661-352892 Sentence denotes The objective of this work was to assess the usefulness of monitoring regional brain oxygen saturation (rSO 2 ) in the identifi cation of intraoperative episodes of cerebral ischemia during the surgical clipping of brain aneurysms.
T87287 352893-353016 Sentence denotes Moreover it aimed to verify whether this kind of monitoring aff ects the incidence of postoperative neurological defi cits.
T78956 353017-353144 Sentence denotes Methods We monitored 50 patients undergoing cerebral aneurysm clipping with the use of Somanetics INVOS Cerebral Oximeter 4100.
T76263 353145-353284 Sentence denotes The alarm threshold of rSO 2 was defi ned as a minimum of 20% drop from baseline, triggering intervention aimed at increasing rSO 2 values.
T69494 353285-353401 Sentence denotes Results Eleven cases of postoperative deterioration of neurological status were noted, of which six were reversible.
T51392 353402-353555 Sentence denotes Additional intraoperative events, such as numerous surgical clip displacements, temporary clipping, aneurysm ruptures, and trapping occurred in 16 cases.
T7051 353556-353722 Sentence denotes On the operated side, a rapid, lasting increase of rSO 2 values was noted in nearly one-half of the cases; implying an artifact caused by the neurosurgical procedure.
T40878 353723-353821 Sentence denotes On the nonoperated side, seven cases of rSO 2 values dipping below the alarm threshold were noted.
T13448 353822-353928 Sentence denotes In all cases intervention led to an increase and normalization of rSO 2 values in a relatively short time.
T78593 353929-354146 Sentence denotes Since the values registered in the frontal lobe on the nonoperated side were considered representative of the entire brain, the balance of cerebral oxygen supply and consumption was seen as intraoperatively preserved.
T81507 354147-354411 Sentence denotes The comparison between two groups of patients, with and without neurological defi cits developed in the postoperative period, revealed no disparities in cerebral oximetry values on the nonoperated side, nor in the range of other monitored physiological parameters.
T90957 354412-354611 Sentence denotes In 10 out of 16 cases involving additional intraoperative events, deterioration of neurological status was noted (62.5%), while in the remaining cases only one such occurrence was registered (2.95%).
T8815 354612-354807 Sentence denotes Conclusions Monitoring regional brain oxygen saturation on the operated side is a method hampered by a large percentage of false results, and thus is a monitoring tool of little prognostic value.
T6121 354808-355185 Sentence denotes Assuming that the frontal lobe on the nonoperated side is representative of the entire brain with regard to rSO 2 measures, the maintenance of oxygen supply and demand balance does not safeguard the brain against ischemic lesions in the supply area of the operated artery. stiff ness was assessed by sonographic measurements of the carotid to femoral pulse wave velocity (PWV).
T80913 355186-355364 Sentence denotes The above sonographic measurements along with BNP measurements were obtained upon admission and repeated measurements were performed 20 ± 2 days following the acute phase of SAH.
T12408 355365-355457 Sentence denotes All patients were mechanically ventilated under the same conditions during all measurements.
T2181 355458-355552 Sentence denotes Results Patients with severe SAH showed depressed LV function and increased aortic stiff ness.
T68165 355553-355896 Sentence denotes Both Hunt-Hess and Fisher scales were associated with LVEF (r = -0.460, P = 0.004 and r = -0.512; P = 0.001, respectively) and PWV values (r = 0.359, P = 0.029 and r = 0.363; P = 0.027, respectively Introduction Anemia is frequently encountered in critically ill patients and adversely aff ects cerebral oxygen delivery and metabolic function.
T26019 355897-356055 Sentence denotes However, there is limited evidence to support the use of packed red blood cell (PRBC) transfusion to optimize brain homeostasis after subarachnoid hemorrhage.
T78375 356056-356215 Sentence denotes The objective of this study was to investigate the eff ect of PRBC transfusion on cerebral oxygenation and metabolism in patients with subarachnoid hemorrhage.
T12027 356216-356303 Sentence denotes Methods Prospective observational study in a neurological ICU of a university hospital.
T3982 356304-356512 Sentence denotes Nineteen PRBC transfusions were studied in 15 consecutive patients with subarachnoid hemorrhage that underwent multimodality monitoring (intracranial pressure, brain tissue oxygen and cerebral microdialysis).
T52777 356513-356583 Sentence denotes Data were collected at baseline and during 12 hours after transfusion.
T57466 356584-356786 Sentence denotes The relationship between Hb change and lactate/pyruvate ratio (LPR) and brain tissue oxygen (PbtO 2 ) was tested in univariate and multivariable analyses. , the other 14 were in the coiling group (35%).
T32830 356787-357084 Sentence denotes But HHH therapy and CSF drainage with lumber puncture was started more liberally, in 57 and 35 patients respectively, due to at least two of the following fi ndings or clinician's decision: headache, agitation, elevated leukocyte level (without infection), new motor defi cit and worsening in GCS.
T43663 357085-357177 Sentence denotes The severity of cases on admission in the clipping and coiling groups were similar for both.
T12179 357178-357313 Sentence denotes Although mortality and morbidity rates were higher in the coiling group there was no statistical diff erence in both groups (Table 2) .
T40774 357314-357361 Sentence denotes GOS, Glasgow outcome score; H&H, Hunt and Hess.
T52986 357362-357610 Sentence denotes Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1 S115 Conclusions This study demonstrated that although mortality, morbidity rates and DCI incidence were lower in the surgical group, there was no statistical signifi cance.
T72491 357611-357801 Sentence denotes Conclusions According to the outcome, we can conclude that Group 1 obtained a greater protection on the vasospasm incidence in comparison with Group 2 but showed no diff erence in mortality.
T10706 357802-357890 Sentence denotes The P value was signifi cant for vasospasm but was still not signifi cant for mortality.
T14111 357891-358043 Sentence denotes Introduction Vasospasm is the main cause of death and cognitive defi cits in patients with subarachnoid hemorrhage after rupture of the aneurysm (aSAH).
T92167 358044-358176 Sentence denotes Some trials have shown that statins in the acute phase of aSAH reduces the incidence, morbidity and mortality of cerebral vasospasm.
T89760 358177-358419 Sentence denotes Methods We realized a prospective, randomized, nonblind study, with the use of 80 mg SVT (at night) in the fi rst 72 hours of the beginning of bleeding, and a control group that did not use SVT, for 21 days, between January and December 2008.
T62438 358420-358467 Sentence denotes Informed consent was obtained for all patients.
T27642 358468-358568 Sentence denotes CT scans was performed as control and another CT scan in patients with altered neurological signals.
T38017 358569-358774 Sentence denotes In the presence of changes suggestive of vasospasm or correlation in clinical and CT scans, the patients were taken for cerebral arteriography examination followed by an angioplasty procedure if necessary.
T34294 358775-358871 Sentence denotes Liver and renal function, LDL cholesterol evaluated weekly, and CK total evaluated every 3 days.
T82747 358872-359049 Sentence denotes Exclusion criteria: liver and renal disease, pregnant elevation of serum transaminases (three times the value of normal), creatinine ≥2.5, rhabdomyolysis or CK total ≥1,000 U/l.
T25463 359050-359112 Sentence denotes We excluded two patients with bleeding for more than 72 hours.
T21623 359113-359197 Sentence denotes There was no signifi cant change in the levels of CK total, renal or liver function.
T55135 359198-359273 Sentence denotes We included 20 patients, 11 in the SVT group and nine in the control group.
T83284 359274-359371 Sentence denotes Mortality was eight patients (38%), six patients in the control group and two from the SVT group.
T74238 359372-359586 Sentence denotes Vasospasm was confi rmed by Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1 S116 cerebral arteriography examination in four patients in the control group and one patient in the SVT group.
T74894 359587-359629 Sentence denotes All patients who died had Fisher scale IV.
T7089 359630-359889 Sentence denotes Conclusions SVT at a dose of 80 mg was eff ective in reducing the mortality (18.1% against 66%) compared with the group that did not use SVT, and also decreased the incidence of cerebral vasospasm despite higher APACHE II score in the group that used SVT (14.
T40027 359890-359990 Sentence denotes 3 Conclusions We can conclude that the group with patients with SAH is predominantly female (74:29).
T17027 359991-360050 Sentence denotes The APACHE II in Group I was 10.9, while Group II was 17.9.
T58503 360051-360243 Sentence denotes Regarding the criteria used to assess patients with SAH was observed that the only criterion which showed statistical signifi cance in the prediction of death was the serum sodium (P = 0.002).
T99034 360244-360352 Sentence denotes The other criteria evaluated did not have statistical signifi cance in predicting the prognosis of patients.
T50483 360353-360362 Sentence denotes Reference
T15291 360363-360585 Sentence denotes Introduction The objective of this study was to investigate the relationship between cardiac output response to a fl uid challenge and changes in brain tissue oxygen pressure (PbtO 2 ) in patients with severe brain injury.
T10763 360586-360683 Sentence denotes Methods Prospective observational study conducted in a neurological ICU in a university hospital.
T25255 360684-360870 Sentence denotes Seventy-eight fl uid challenges were administered to 17 consecutive comatose patients that underwent multimodality monitoring of cardiac output, intracranial pressure (ICP), and PbtO 2 .
T17791 360871-361017 Sentence denotes The relationship between cardiac output and PbtO 2 was analyzed with logistic regression utilizing GEE with an exchangeable correlation structure.
T31400 361018-361108 Sentence denotes Of the 78 fl uid boluses analyzed, 34 (44%) resulted in a ≥10% increase in cardiac output.
T18385 361109-361315 Sentence denotes Median absolute (+5.4 vs +0.7 mmHg) and percentage (20% vs 3%) changes in PbtO 2 were greater in cardiac output responders than in nonresponders within 30 minutes after the end of the fl uid bolus infusion.
T67847 361316-361642 Sentence denotes In a multivariable model, a cardiac output response was independently associated with PbtO 2 response (adjusted odds ratio 15.4, 95% CI 1.9 to 122.0, P = 0.01) after adjusting for mean arterial pressure, Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1 S117 intracranial pressure and end-tidal CO 2 .
T41074 361643-361796 Sentence denotes Stroke volume variation showed a good ability to predict cardiac output response with an area under the ROC curve of 0.85 with a best cutoff value of 8%.
T34571 361797-361818 Sentence denotes See Figures 1 and 2 .
T25328 361819-361961 Sentence denotes Conclusions Bolus fl uid resuscitation resulting in augmentation of cardiac output can improve cerebral oxygenation after severe brain injury.
T87558 361962-362048 Sentence denotes Introduction ICM + software encapsulates our 20 years' experience in brain monitoring.
T89901 362049-362191 Sentence denotes It collects data from a variety of bedside monitors and produces time trends of parameters defi ned using confi gurable mathematical formulae.
T46902 362192-362266 Sentence denotes To date it is being used in nearly 40 clinical research centres worldwide.
T50549 362267-362387 Sentence denotes We present its application for continuous monitoring of cerebral autoregulation using near-infrared spectroscopy (NIRS).
T57139 362388-362521 Sentence denotes Methods Data from multiple bedside monitors are processed by ICM + in real time using a large selection of signal processing methods.
T48016 362522-362636 Sentence denotes These include various time and frequency domain analysis functions as well as fully customisable digital fi lters.
T53219 362637-362807 Sentence denotes The fi nal results are displayed in a variety of ways including simple time trends, as well as time window based histograms, cross histograms, correlations, and so forth.
T91798 362808-363033 Sentence denotes All this allows complex information from bedside monitors to be summarized in a concise fashion and presented to medical and nursing staff in a simple way that alerts them to the development of various pathological processes.
T79150 363034-363240 Sentence denotes Conclusions ICM + software is proving to be a very useful tool for enhancing the battery of available means for monitoring cerebral vasoreactivity and potentially facilitating autoregulation guided therapy.
T91362 363241-363545 Sentence denotes Complexity of data analysis is also hidden inside loadable profi les, thus allowing investigators to take full advantage of validated protocols including advanced processing formulas. dysbalances and their relationship to outcome in the neurologicneurosurgical care unit (NNICU) over a period of 5 years.
T1973 363546-363706 Sentence denotes Methods We prospectively evaluated patients with brain diseases, who developed serum sodium below 135 mmol/l (hyponatremia) or above 150 mmol/l (hypernatremia).
T12905 363707-363864 Sentence denotes We compared the incidence of cerebral complications, Glasgow Outcome Scale upon discharge from the NNICU and mortality in the NNICU between these two groups.
T53066 363865-363955 Sentence denotes In the 5-year observation period, serum sodium dysbalances occurred in 378 (24%) patients.
T28370 363956-364070 Sentence denotes The majority of them had hyponatremia (245 patients, 65%); hypernatremia was less frequent, in 133 (35%) patients.
T44123 364071-364232 Sentence denotes Hypernatremic patients stayed in the NNICU longer (P = 0.035), onset of hypernatremia arose in patients with signifi cantly lower Glasgow Coma Scale (P = 0.001).
T73272 364233-364456 Sentence denotes These patients had more cerebral complications (P <0.001), worse Glasgow Outcome Scale upon discharge from the NNICU (P <0.001), higher mortality in the NNICU (P = 0.003) and higher incidence of pulmonary edema (P = 0.021).
T80258 364457-364533 Sentence denotes They received more antiedematic therapy (P <0.001) and diuretics (P <0.001).
T76484 364534-364698 Sentence denotes On the other hand, hyponatremia was more frequent upon entry to the NNICU (P <0.001) and arose later after brain damage (P <0.001) in comparison with hypernatremia.
T88461 364699-364837 Sentence denotes Conclusions In neurointensive care, hypernatremia was a prognostically more serious and less frequent sodium dysbalance than hyponatremia.
T33168 364838-364964 Sentence denotes 19%) , cerebral contusion in 17 patients (17%), brain oedema in 15 patients (15%), and subdural hematoma in two patients (2%).
T75938 364965-365088 Sentence denotes Glasgow Coma Scores (range 3 to 10); 60 patients were mechanically ventilated; 10% were diabetic and 22% were hypertensive.
T18317 365089-365165 Sentence denotes Hypernatremia was documented in 40 patients (40%) of the total TBI patients.
T77602 365166-365323 Sentence denotes The total inhospital mortality was 36/100 (36%), 10 of them had normal sodium levels all through their in-hospital course and 26 patients were hypernatremic.
T89578 365324-365509 Sentence denotes After adjustment for the baseline risk, the incidence of hypernatremia over the course of the ICU stay was signifi cantly related to increased mortality (hazard ratio 3.2 (P = 0.0001)).
T69375 365510-365661 Sentence denotes However, there was positive correlation between serum sodium levels and duration of the ICU stay (Spearman correlation coeffi cient 0.5 and P = 0.002).
T27069 365662-365785 Sentence denotes Conclusions Hypernatremia in patients with severe TBI is associated with an increased risk of death, and a longer ICU stay.
T42323 365786-365883 Sentence denotes This association is independent of other outcome predictors including age and Glasgow Coma Score.
T16096 365884-365963 Sentence denotes Strategies to prevent hypernatremia in neurocritical ICUs should be encouraged.
T70323 365964-366070 Sentence denotes Reference In addition, chemical prophylaxis should be initiated as soon as determined to be safe to do so.
T90364 366071-366211 Sentence denotes Limited data exist describing the use of chemical prophylaxis and the timing of it in relation to IVCF placement in this patient population.
T63082 366212-366281 Sentence denotes We aim to describe such use and timing in relation to IVCF placement.
T88699 366282-366443 Sentence denotes Methods All trauma patients with a retrievable prophylactic IVCF inserted over 3.5 years with an age ≥18 and an ISS ≥15 were enrolled into the descriptive study.
T95070 366444-366557 Sentence denotes Patients were identifi ed using the local trauma registry and data collected from the registry and patient chart.
T7910 366558-366636 Sentence denotes Results One hundred and three patients with a prophylactic IVCF are described.
T37501 366637-366720 Sentence denotes Mean age was 42.8 ± 17.9 years, 68% were male and they had a mean ISS of 38.6 ± 12.
T2182 366721-366754 Sentence denotes A total of 36.9% had ≥3 injuries.
T2291 366755-366945 Sentence denotes A total of 60.2% had an injury with maximum AIS score ≥5 and the type of injury associated with maximal AIS was head (53.4%), pelvic (19.4%), thoracic (15.5%) and spinal cord injury (11.7%).
T998 366946-367112 Sentence denotes Shock was present on admission in 8.7% patients, 98.1% required ICU admission, 88.4% required intubation and 27.2% patients required ≥4 PRBC over the fi rst 24 hours.
T99786 367113-367237 Sentence denotes The retrievable IVCF was inserted prophylactically after a mean of 1.7 ± 1.9 days (range 0 to 9 days) of hospital admission.
T76859 367238-367432 Sentence denotes Chemical prophylaxis was initiated 5.7 ± 5.1 days after IVCF in 77.7% patients, and dalteparin or enoxaparin were the initial agents of choice in 93.8% while heparin was chosen in 6.2% of cases.
T57422 367433-367531 Sentence denotes The time from hospital admission to the start of chemical prophylaxis ranged from 6.3 to 8.5 days.
T94189 367532-367665 Sentence denotes Conclusions Chemical prophylaxis was initiated in the majority of trauma patients with an IVCF, albeit 22% still did not receive any.
T34385 367666-367729 Sentence denotes When administered, a low-molecular-weight heparin was selected.
T50173 367730-367867 Sentence denotes Although rapidly inserted after admission, there was considerable delay between insertion of IVCF and initiation of chemical prophylaxis.
T30751 367868-368023 Sentence denotes For studying ICU lower limb DVT incidence, compressive ultrasonography (CUS) was performed by three trained ultrasonographers twice a week until discharge.
T67037 368024-368119 Sentence denotes SM and MR administration was registered daily: the drugs considered are presented in Figure 1 .
T62166 368120-368296 Sentence denotes MR-treated patients were excluded from statistical analysis; the diff erence in SM administration in the No DVT group vs the DVT-positive group was assayed by chi-squared test.
T44246 368297-368358 Sentence denotes Results Over the period of study, 380 patients were enrolled.
T7229 368359-368441 Sentence denotes Lower limb DVT was diagnosed in 23 of 380 patients, with a DVT incidence of 6.05%.
T17461 368442-368535 Sentence denotes MRs were administered in 121 patients and they were associated with DVT incidence (P <0.001).
T93599 368536-368744 Sentence denotes Statistical analysis results performed on 259 patients are shown in Figure 1 : none of the considered SM resulted to be associated with DVT incidence, nor sedation as a whole or the number of SM administered.
T76333 368745-368833 Sentence denotes Conclusions Our study confi rms prior fi ndings [1] on the MR role as a DVT risk factor.
T8421 368834-368940 Sentence denotes Nevertheless, SM administration in patients not treated with MR is not associated with increased DVT risk.
T57762 368941-369181 Sentence denotes Introduction Despite the evidence of perioperative hypercoagulability in cancer patients, there are no consistent data evaluating the extent, duration, and specifi c contribution of platelets and procoagulatory proteins by in vitro testing.
T19119 369182-369305 Sentence denotes This study compared effi cacy of haemoviscoelastography versus thromboelastography for monitoring of coagulation imbalance.
T16476 369306-369455 Sentence denotes Methods Two hundred and forty-one patients undergoing surgery for abdominal cancer were examined for the effi cacy of a variety of coagulation tests.
T87381 369456-369597 Sentence denotes A complete coagulation screening, thromboelastography (TEG) and haemoviscoelastography (HVG) were performed before and at the end of surgery.
T86866 369598-369765 Sentence denotes We calculated the elastic shear modulus of standard MA (Gt) and HVG MA (Gh), which refl ect the total clot strength and procoagulatory protein component, respectively.
T30437 369766-369829 Sentence denotes The diff erence was an estimate of the platelet component (Gp).
T2927 369830-369990 Sentence denotes There was a 16% perioperative increase of standard MA, corresponding to a 51% increase of Gt (P <0.05) and a 79% to 87% contribution of the calculated Gp to Gt.
T57680 369991-370172 Sentence denotes We conclude that serial standard thromboelastography and the HVG viscoelastic test may reveal the independent contribution of platelets and procoagulatory proteins to clot strength.
T41467 370173-370300 Sentence denotes Using multiple linear regression, all coagulation, TEG and HVG variabilities were used to model postoperative hypercoagulation.
T34062 370301-370402 Sentence denotes Results showed that some components of the TEG failed to identify hypercoagulation (r <0.2, P >0.75).
T87716 370403-370472 Sentence denotes All components of the HVG test refl ect postoperative coagulopathies.
T71689 370473-370647 Sentence denotes Conclusions Hypercoagulability is not refl ected completely by standard coagulation monitoring and TEG, and seems to be predominantly caused by increased platelet reactivity.
T11837 370648-370825 Sentence denotes HVG provides a fast and easy-toperform bedside test to quantify in vitro coagulation, and may be useful in determining the coagulation status of cancer patients perioperatively.
T47585 370826-371013 Sentence denotes The aim was to study the incidence, the etiology and to assess the severity of thrombocytopenia in surgical ICU (SICU) patients admitted to the central army hospital of Algiers (Algeria).
T11326 371014-371143 Sentence denotes Methods We conducted a retrospective study; all admitted patients during the year 2008 were enrolled in the study (351 patients).
T57855 371144-371234 Sentence denotes All charts were reviewed and diff erent hemograms recorded from admission until discharge.
T70515 371235-371356 Sentence denotes One hundred and fi fty-three thrombocytopenia cases defi ned as a platelet count (plt) <150 x 10 9 were reported (43.6%).
T6405 371357-371467 Sentence denotes Results Among 351 patients (227 survivors, 124 died), 153 developed thrombocytopenia, 96 males and 57 females.
T9098 371468-371575 Sentence denotes The onset of thrombocytopenia was for the majority of patients (98%) at 24 to 72 hours after ICU admission.
T96350 371576-371635 Sentence denotes Only 26% were severe (plt <50 x 10 9 ) and 3% <20 x 10 9 ).
T23119 371636-371707 Sentence denotes The etiopathology is multifactorial and diffi cult to obtain precisely:
T96936 371708-371738 Sentence denotes 77% Figure 1 (abstract P362) .
T14877 371739-371760 Sentence denotes Statistical analysis.
T21870 371761-372139 Sentence denotes of cases were hemodynamically unstable multitrauma patients (with or without ARDS and fat embolism), and necessitated volume and blood product administration through an intravascular device; sepsis was present in 47% of cases; disseminated intravascular coagulopathy in 33%; and fi ve thrombocytopenia cases were related to drug administration with late onset after the 5th day.
T82727 372140-372305 Sentence denotes Reported mortality was 57% (P <10 -6 ) compared with the overall mortality (35.3%), related to the severity of underlying diseases and the associated co-morbidities.
T5273 372306-372506 Sentence denotes Conclusions Thrombocytopenia is frequent among chirurgical patients, especially multitrauma patients with cardiovascular instability where aggressive volume and blood product administration is needed.
T71383 372507-372598 Sentence denotes Introduction Thrombocytopenia is a common occurrence in the critically ill population [1] .
T89467 372599-372690 Sentence denotes We aimed to determine the incidence, severity and prognosis of thrombocytopenia in our ICU.
T42679 372691-372816 Sentence denotes Methods A retrospective laboratory result review of 330 consecutive admissions to the Victoria Infi rmary ICU was undertaken.
T10721 372817-372919 Sentence denotes Demographics, APACHE II score and outcome data were retrieved from the Ward Watcher system in the ICU.
T68673 372920-373122 Sentence denotes We compared survivors' and nonsurvivors' platelet levels on admission to the ICU and the trough level in the ICU and looked at correlation with the length of stay and duration of mechanical ventilation.
T3995 373123-373238 Sentence denotes Data were analysed using Student's t test, Pearson correlation coeffi cient and chi-squared test where appropriate.
T76096 373239-373293 Sentence denotes Results Complete data were available for 274 patients.
T64924 373294-373475 Sentence denotes Population demographics were as follows -61.3% male, mean age 56.3 ± 2.1 years, median APACHE II 20 (IQR 15 to 27), crude ICU mortality 25.6% and mean length of stay 5.2 ± 0.7 days.
T20923 373476-373630 Sentence denotes Incidence of thrombocytopenia (platelet count <150 x 10 9 /l) was 29.8% on admission to the ICU, increasing to 46.9% when considering the entire ICU stay.
T78588 373631-373760 Sentence denotes Comparing survivors and nonsurvivors, nonsurvivors had a lower trough platelet count (140 x 10 9 /l vs 181 x 10 9 /l, P = 0.005).
T28360 373761-373869 Sentence denotes Patients with platelet counts less than 50 x 10 9 /l have the highest mortality (45.7% vs 27.6%, P = 0.006).
T78722 373870-373977 Sentence denotes Platelet data were used to construct an ROC curve, demonstrating an area under the curve of 0.66, P <0.001.
T79282 373978-374147 Sentence denotes Platelet count correlated negatively with APACHE II (r = -0.20, P <0.001) but did not correlate signifi cantly with length of stay or duration of mechanical ventilation.
T41135 374148-374211 Sentence denotes Conclusions Thrombocytopenia occurs in 47% of our ICU patients.
T22402 374212-374454 Sentence denotes It correlates signifi cantly with severity of illness as measured by APACHE II and decreasing platelet count correlates with increasing mortality, with the highest mortality in those with a trough ICU platelet count of less than 50 x 10 9 /l.
T43152 374455-374555 Sentence denotes The ROC characteristics also demonstrate that the platelet count is a useful predictor of mortality.
T86142 374556-374764 Sentence denotes Introduction Heparin-induced thrombocytopenia (HIT) is a lifethreatening and limb-threatening, immune-mediated, prothrombotic disease resulting from an interaction between heparin and platelet factor 4 (PF4).
T44046 374765-374939 Sentence denotes Due to the many causes of thrombocytopenia in critically ill patients, the diagnosis of HIT is diffi cult, requiring both a high clinical suspicion and confi rmatory testing.
T63308 374940-375093 Sentence denotes The ELISA test is the most commonly performed method to detect anti-PF4 antibodies; however, the ELISA results generally take one or more days to report.
T43008 375094-375231 Sentence denotes The particle immunofi ltration assay (PIFA) test has the advantage of being done rapidly; with results generally available within 1 hour.
T31441 375232-375455 Sentence denotes Methods Starting in July 2009, patients in our MICU were screened daily for thrombocytopenia; defi ned as either a platelet count that decreased by at least 30% from baseline or an absolute platelet count less than 150,000.
T71703 375456-375553 Sentence denotes Patients with thrombocytopenia underwent both PIFA and GTI ELISA testing for anti-PF4 antibodies.
T18354 375554-375623 Sentence denotes PIFA is a qualitative test reporting results as positive or negative.
T93498 375624-375725 Sentence denotes The GTI ELISA test reports an optical density (OD), with an OD greater than 0.40 considered positive.
T1733 375726-375773 Sentence denotes Patients were followed through hospitalization.
T3811 375774-375937 Sentence denotes Introduction Heparin-induced thrombocytopenia (HIT) is a lifethreatening and limb-threatening immune-mediated prothrombotic complication caused by heparinic drugs.
T41928 375938-376023 Sentence denotes The aim of this study was to evaluate the incidence of HIT in a mixed ICU population.
T14709 376024-376279 Sentence denotes Methods Patients admitted to the ICU of a regional referral center (Careggi Teaching Hospital, Florence, Italy) who underwent unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) administration were prospectively observed from October 2008.
T99469 376280-376386 Sentence denotes Exclusion criteria: haematological malignancy, platelet count <50,000/mm 3 before anticoagulant treatment.
T23590 376387-376651 Sentence denotes After anticoagulant administration start, patients showing a fall of platelet count >50% or a nadir <150,000/mm 3 were clinically evaluated with the 4T score (4Ts) [1] : cases with a 4Ts of at least 2 were investigated with the laboratory antigen assay, the ELISA.
T87963 376652-376770 Sentence denotes Positive tests underwent to a functional confi rmation test, the heparin-induced platelet activation (HIPA) test [2] .
T32018 376771-376849 Sentence denotes Results Preliminary results refer to the period from the start to August 2009.
T68473 376850-376916 Sentence denotes Patients admitted to the ICU were 369; 327 enrolled for the study.
T34671 376917-377072 Sentence denotes Clinical evaluation with 4Ts was performed for 31 patients, 23 of 31 (74%) had a value of at least 2; eight of 23 were on UFH and the remaining 15 on LMWH.
T79365 377073-377135 Sentence denotes Potential etiologies of thrombocytopenia have been considered:
T40375 377136-377266 Sentence denotes 21 patients were septic, three were on extracorporeal membrane oxygenation, two were admitted to the ICU due to cardiogenic shock.
T14196 377267-377422 Sentence denotes The ELISA test resulted positive in three of 23 (13%) suspected HIT cases; none of the three cases resulted positive in the HIPA test, so HIT was excluded.
T87419 377423-377565 Sentence denotes The medium 4Ts of the 23 suspected HIT cases was 4.1 ± 1.7 whereas 4Ts did not diff er between patients with positive and negative ELISA test.
T22129 377566-377656 Sentence denotes Conclusions HIT incidence in the ICU is extremely rare, with no cases shown in this study.
T29715 377657-377737 Sentence denotes HIT was suspected in 23 of 327 patients (7.03%), but the HIT incidence was 0.0%.
T23579 377738-377856 Sentence denotes ICU patients show numerous potential etiologies of thrombocytopenia and in this population sepsis was the most common.
T77546 377857-377956 Sentence denotes References Introduction Many procedures in cardiac surgery require extracorporeal circulation (EC).
T89134 377957-378066 Sentence denotes During EC, blood is pumped from a venous line to an oxygenator, cooled and infused back via an arterial line.
T85446 378067-378168 Sentence denotes This procedure is known to compromise the coagulation system, especially under prolonged hypothermia.
T20817 378169-378297 Sentence denotes The aim of the present study was to investigate the eff ects of EC and hypothermia on the coagulation system in a porcine model.
T80490 378298-378463 Sentence denotes The effi cacy of a substitution therapy with a prothrombin complex concentrate (PCC) regarding normalization of coagulation and decrease in hemorrhage was evaluated.
T10263 378464-378536 Sentence denotes Methods A total of 17 male anesthetized pigs were included in the study.
T15762 378537-378656 Sentence denotes EC was performed in 12 animals by a hollowfi ber oxygenator with a priming solution containing saline, HES and heparin.
T90769 378657-378701 Sentence denotes Five animals without EC served as a control.
T53275 378702-378865 Sentence denotes The coagulation system was characterized by thromboelastography (TEG), thrombin generation, coagulation factor levels, platelet numbers and function (aggregation).
T56012 378866-378963 Sentence denotes A GoreTex patch was inserted into the carotid artery, bleeding occurred from the stitch channels.
T18019 378964-379135 Sentence denotes The eff ects of intravenous substitution therapy by PCC (Beriplex P/N, 30 U/kg, n = 6) compared with placebo (n = 6) on bleeding from the stitch channels was investigated.
T18219 379136-379198 Sentence denotes Results EC and hypothermia compromised the coagulation system.
T50538 379199-379287 Sentence denotes Coagulation factor levels were decreased, TEG and thrombin generation became pathologic.
T90872 379288-379334 Sentence denotes Platelet count and aggregation were decreased.
T59886 379335-379458 Sentence denotes Blood loss from the stitch channels of the GoreTex patch was doubled in the EC group when compared with animals without EC.
T25593 379459-379647 Sentence denotes After substitution therapy with PCC, blood loss decreased signifi cantly from 83.0 ± 48.4 ml in the EC + placebo to 27.2 ± 35 ml in the EC + PCC group (P <0.025, Wilcoxon test; Figure 1 ).
T55443 379648-379688 Sentence denotes PCC normalized the impaired coagulation.
T61872 379689-379795 Sentence denotes Conclusions Hypothermia and EC led to a compromised coagulation system, resulting in increased hemorrhage.
T53366 379796-379875 Sentence denotes The defi cit in coagulation could be overcome by substitution therapy with PCC.
T87409 379876-379971 Sentence denotes Elevated blood loss from stitch channels was decreased signifi cantly after treatment with PCC.
T24783 379972-380098 Sentence denotes It was concluded that PCC should be benefi cial in patients undergoing cardiovascular surgery with an EC-induced coagulopathy.
T43965 380099-380286 Sentence denotes Introduction Dilutional coagulopathy following massive bleeding is the result of clotting factor dilution and impaired fi brin polymerization after infusion of colloidal plasma expanders.
T37285 380287-380458 Sentence denotes Although fi brinogen has been clinically used to treat dilutional coagulopathy [1, 2] , the eff ects of fi brinogen dosages on normalizing coagulation function is unclear.
T51751 380459-380540 Sentence denotes This study investigated the eff ect of six diff erent fi brinogen dosages (range:
T2822 380541-380647 Sentence denotes 37.5 to 600 mg/kg) on ROTEM® parameters and overall blood loss in a pig model for dilutional coagulopathy.
T43136 380648-380727 Sentence denotes Methods Forty-two pigs underwent a 60% hemodilution with Voluven® (HES130/0.4).
T11290 380728-380806 Sentence denotes A standardized bone injury was performed after the completion of hemodilution.
T78115 380807-380933 Sentence denotes Animals were then randomized to receive 37.5, 75, 150, 300, 450 or 600 mg/kg fi brinogen (FGTW, LFB, France) or 500 ml saline.
T41067 380934-381020 Sentence denotes Four hours after fi brinogen administration a standardized liver injury was performed.
T68242 381021-381075 Sentence denotes Animals were then observed for 2 hours or until death.
T85161 381076-381158 Sentence denotes Blood loss was measured and tissue samples were collected at the end of the study.
T81705 381159-381365 Sentence denotes Hemodynamic and coagulation parameters were measured at baseline (BL), after hemodilution, 15 minutes, 1, 2 and 4 hours after drug infusion and 2 hours after liver injury or right before the animal's death.
T36084 381366-381411 Sentence denotes Statistical signifi cance was set at P <0.05.
T67324 381412-381685 Sentence denotes Results Fibrinogen dosages of 150 mg/kg and higher completely reversed dilutional coagulopathy: the maximum clot fi rmness (MCF) which was decreased after hemodilution (36 ± 3 vs 65 ± 4 mm at BL, P <0.05), returned to BL levels after fi brinogen administration (69 ± 5 mm).
T79673 381686-381784 Sentence denotes Blood loss from bone and liver injury signifi cantly decreased with increased fi brinogen dosages:
T70701 381785-381874 Sentence denotes 42 ± 19 (sham), 34 ± 14 (75 mg/kg), 29 ± 13 (150 mg/kg) and 28 ± 10 ml/kg BW (600 mg/kg).
T48691 381875-381905 Sentence denotes No thrombotic events occurred.
T679 381906-382072 Sentence denotes Conclusions In a swine model of 60% hemodilution with bone and liver injury, fi brinogen administration (150 mg/kg and above) normalized MCF and decreased blood loss.
T17664 382073-382162 Sentence denotes Infusions of 12 times the dosage recommended in humans did not induce hypercoagulability.
T1272 382163-382242 Sentence denotes Introduction Postpartum haemorrhage (PPH) is a leading cause of maternal death.
T4439 382243-382414 Sentence denotes Present guidelines for PPH management focus on uterotonic treatments, while the potential effi cacy of antifi brinolytic drugs has been poorly explored in this indication.
T66207 382415-382694 Sentence denotes Methods After approval by the ethics committee, we randomly assigned women with PPH >800 ml after vaginal delivery to receive intravenous tranexamic acid (TXA) (4 g within 1 hour, followed by 1 g/hour during 6 hours) (TXA group) or no antifi brinolytic treatment (Control group).
T67430 382695-382764 Sentence denotes Monitoring and management were performed according to the guidelines.
T19368 382765-382934 Sentence denotes Additional procoagulant treatments (coagulant concentrates, fresh frozen plasma, platelets) were used only when PPH became intractable (>2,500 ml or >500 ml/30 minutes).
T30631 382935-383010 Sentence denotes Embolization or surgery was performed when considered clinically necessary.
T3001 383011-383168 Sentence denotes Blood loss, maternal morbidity and safety were collected at four time points: inclusion (T1), T1 + 30 minutes (T2), T1 + 2 hours (T3), and T1 + 6 hours (T4).
T47500 383169-383352 Sentence denotes The study plan, based on the hypothesis that TXA would induce a 20% blood loss reduction with an α risk of 5% and a β risk of 10%, required the inclusion of 72 patients in each group.
T28365 383353-383394 Sentence denotes Statistical analysis used the SAS system.
T97823 383395-383502 Sentence denotes Results One hundred and forty-four patients were included, 72 in the TXA group and 72 in the control group.
T89931 383503-383555 Sentence denotes Management data were similar between the two groups.
T28219 383556-383629 Sentence denotes In the TXA group, as compared with the control Figure 1 (abstract P368) .
T73641 383630-383671 Sentence denotes Blood loss from a GoreTex Patch after EC.
T36980 383672-384135 Sentence denotes group: blood loss was 46% lower between T2 and T3 (P = 0.026), and 49% lower between T2 and T4 (P = 0.0012); bleeding duration was shorter (31 ± 28 vs 65 ± 95 minutes, P = 0.004); and maternal morbidity was reduced (hemoglobin drop >4 g/dl: n = 15 vs 34, P <0.001; blood transfusion requirement: n = 14 vs 20, P = NS; overall number of transfused packed red blood cells: n = 42 vs 62, P <0.001; number of severe PPH (Charbit criteria 1): n = 23 vs 36, P = 0.028).
T42929 384136-384248 Sentence denotes Invasive procedures were needed in four women in the TXA group and in seven women in the control group (P = NS).
T84680 384249-384387 Sentence denotes Transient visual and digestive side eff ects were observed more frequently in the TXA group than in the control group (17 vs 4 P = 0.028).
T74133 384388-384588 Sentence denotes Conclusions These results show, for the fi rst time, that TXA, when administered early in the management of PPH, reduces blood loss and maternal morbidity, with only minor and transient side eff ects.
T89678 384589-384738 Sentence denotes As TXA is a readily available and cheap hemostatic agent, we strongly suggest that it should be further investigated as an adjuvant treatment in PPH.
T91881 384740-384861 Sentence denotes In 1999 the fi rst publication appeared of the use of recombinant factor VIIa (rFVIIa) for uncontrolled haemorrhage [1] .
T45873 384862-384943 Sentence denotes Since then there has been widespread international use of rFVIIa in this setting.
T64698 384944-385046 Sentence denotes Consensus guidelines have been published [2] , but there is much variation in its administration [3] .
T47896 385047-385237 Sentence denotes Methods Review of the blood bank databases of all six acute hospitals in the southwest of England between January 2000 and February 2009 was undertaken to reveal all prescriptions of rFVIIa.
T80714 385238-385402 Sentence denotes Case notes were analysed and the administration of all blood products for 24 hours either side of rFVIIa administration was extracted from the blood bank databases.
T286 385403-385485 Sentence denotes Results Eighty-two patients were identifi ed who had received off -licence rFVIIa.
T69598 385486-385536 Sentence denotes Of these, full data were available on 67 patients.
T27992 385537-385638 Sentence denotes There was unequal use between hospitals; Plymouth had 33% of use compared with Taunton, with only 4%.
T27578 385639-385707 Sentence denotes A total 65.7% of patients were male and the mean age was 56.6 years.
T85545 385708-385787 Sentence denotes The mean APACHE II score was 18.4 (± 7.4) and 40.3% patients died in ≤96 hours.
T68677 385788-385841 Sentence denotes The mean dosage administered was 80.9 μg/kg (± 21.3).
T30733 385842-385929 Sentence denotes The number of annual prescriptions shows a bimodal pattern with peaks in 2005 and 2008.
T16430 385930-386281 Sentence denotes The distribution of usage was predominantly with general and vascular surgical patients (39%), but trauma (14.9%), obstetrics (13.4%) and cardiac surgery (13.4%) were the next most frequent specialties. rFVIIa was given after a mean of 17.6 (± 11.2) units of packed red cells, 8.8 (± 5.9) units of fresh frozen plasma and 2.3 (± 1.9) pooled platelets.
T63656 386282-386409 Sentence denotes Following rFVIIa transfusion of all blood products was markedly less, and only three patients received a repeat dose of rFVIIa.
T17024 386410-386502 Sentence denotes The prothrombin time decreased from a mean of 18.9 seconds to 13.9 seconds following rFVIIa.
T50179 386503-386606 Sentence denotes Thirty-six per cent of patients had <50 platelets at administration and 40% were acidotic with pH <7.2.
T13530 386607-386698 Sentence denotes Sixty-eight per cent patients had a haematocrit <0.25 and 30% of patients were hypothermic.
T39728 386699-386786 Sentence denotes Conclusions Off -label prescribing of rFVIIa varies widely across the southwest region.
T43416 386787-386877 Sentence denotes Its use as an adjunctive therapy for uncontrolled haemorrhage has often been unsuccessful.
T246 386878-387094 Sentence denotes Our analysis of prescribing rFVIIa in this setting refl ects the practice of the larger Australian series in terms of indications and dosage; however, the mortality at 28 days of 32% is lower than in our series [3] .
T68930 387095-387203 Sentence denotes There is still heterogeneity in prescribing rFVIIa and its use does not conform to European guidelines [2] .
T66930 387204-387300 Sentence denotes Introduction Bleeding after cardiac surgery is a common state, associated with adverse eff ects.
T10317 387301-387409 Sentence denotes Factor VIIa is a recombinant factor able to restore blood coagulation without signifi cant adverse eff ects.
T71811 387410-387514 Sentence denotes We aimed to evaluate whether the early use of factor VIIa reduces bleeding and the rates of transfusion.
T40603 387515-387667 Sentence denotes Methods We studied 241 patients submitted to cardiac surgery who presented bleeding after heparin reversal and a fi rst replacement of clotting factors.
T63929 387668-387841 Sentence denotes From these, 81 patients were submitted to valve procedures, 51 coronary artery bypass surgery (CABG), 60 valve + CABG, 35 aortic ascending surgery and 14 cardiac transplant.
T56562 387842-387951 Sentence denotes From these, 131 received factor VIIa early (in the intraoperative room) and 110 received the drug in the ICU.
T29910 387952-388093 Sentence denotes Results Both groups of patients presented a statistically signifi cant reduction of blood transfusion after receiving factor VIIa (P <0.001).
T88696 388094-388328 Sentence denotes The group of patients undergoing early use presented a lower rate of reoperations due to bleeding (P <0.01), and received less units of red blood cells (P <0.01), fresh frozen plasma (P <0.01), cryoprecipitate and platelets (P <0.01).
T10270 388329-388436 Sentence denotes Also, we detected a low incidence of infection in the group who received the factor in intraoperative room.
T77463 388437-388626 Sentence denotes Conclusions Early use of factor VIIa in patients who bleed after cardiac surgery is associated with lower rates of reoperations, lower rates of transfusion and lower incidence of infection.
T4422 388627-388755 Sentence denotes This suggests the drug should not be used as a last therapeutic tool and may be indicated earlier in the management of bleeding.
T56615 388756-388945 Sentence denotes Reference Introduction Venous thromboembolism is of the most common complications in cancer patients and may be due to the hypercoagulable state of malignancy and to its surgical treatment.
T93961 388946-389215 Sentence denotes Methods Patients undergoing planned curative open surgery for abdominal cancer received MEDNORD (Ukraine Co. analyzer) analysis (HVG), a viscoelastic test that measures clot formation and includes information on the cellular as well as the plasmatic coagulation system.
T38850 389216-389276 Sentence denotes We examined the effi cacy of a variety of coagulation tests.
T67270 389277-389560 Sentence denotes A complete coagulation screen, activated clotting time, thromboelastography (TEG) and haemoviscoelastography (HVG) were performed before surgery, at the end of surgery, and on postoperative days 1, 2, 3, and 7; they were analyzed for the reaction time and the maximal amplitude (MA).
T88877 389561-389728 Sentence denotes We calculated the elastic shear modulus of standard MA (Gt) and HVG MA (GH), which refl ect the total clot strength and procoagulatory protein component, respectively.
T75533 389729-389792 Sentence denotes The diff erence was an estimate of the platelet component (Gp).
T47970 389793-389953 Sentence denotes There was a 14% perioperative increase of standard MA, corresponding to a 48% increase of Gt (P <0.05) and an 80 to 86% contribution of the calculated Gp to Gt.
T41842 389954-390135 Sentence denotes We conclude that serial standard thromboelastography and the HVG viscoelastic test may reveal the independent contribution of platelets and procoagulatory proteins to clot strength.
T75341 390136-390260 Sentence denotes Using multiple linear regressions, all coagulation, TEG and HVG variables were used to model postoperative hypercoagulation.
T84853 390261-390461 Sentence denotes However, three components of the routine coagulation assay, including bleeding time, prothrombin time and platelet count, could be modeled to show prolonged postoperative hypercoagulability (P <0.01).
T79711 390462-390666 Sentence denotes We conclude that all components of the HVG test refl ect postoperative coagulopathies; these results suggest that it may be useful in determining the coagulation status of cancer patients perioperatively.
T56344 390667-390761 Sentence denotes Introduction A number of studies have observed decreased survival associated with transfusion.
T17751 390762-390856 Sentence denotes Leukocyte-mediated immunosuppression may contribute to postoperative infectious complications.
T81578 390857-390983 Sentence denotes There is evidence for a benefi t with the use of leukocyte reduced transfusion, but it is unclear among septic shock patients.
T95992 390984-391054 Sentence denotes In Japan, leukocyte-depleted blood products have been used since 2007.
T71421 391055-391237 Sentence denotes We assessed the eff ect of transfusion and the effi cacy of the use of leukocyte-depleted blood products for new onset of septic shock and mortality among patients with septic shock.
T11433 391238-391345 Sentence denotes Methods A total of 101 septic shock patients at a single university general ICU were enrolled in the study.
T92259 391346-391694 Sentence denotes A target hemoglobin (Hb) concentration of 10 g/dl (Ht 30%) was considered for allogeneic red cell transfusion (to maintain central venous saturation >70%) during the early phase of severe sepsis, and Hb was kept in the range of 7 to 9 g/dl in the stable phase except for the patients with particular disease (acute coronary syndrome, and so forth).
T73268 391695-391854 Sentence denotes Fresh frozen plasma was used to keep PT-INR <1.67, and platelet transfusion was done due to the patient's condition (for example, postoperative, and so forth).
T11868 391855-392034 Sentence denotes Results Eighty-six patients (85%) received transfusion (group T: age 68 ± 12, APACHE II 25.9 ± 9.5) and 15 received no blood product (group NT: age 63 ± 14, APACHE II 27.4 ± 3.2).
T9514 392035-392173 Sentence denotes Frequent sites of infection were the lung (46%), peritoneum (17%), mediastinum (12%), and gastrointestinal tract (7%) (NS between groups).
T76511 392174-392257 Sentence denotes Overall mortality for group T vs group NT was 27/86 (31%) vs 3/15 (20%) (P = 0.54).
T7445 392258-392349 Sentence denotes Onset of new septic shock for group T vs group NT was 27/86 (31%) vs 4/15 (27%) (P = 0.71).
T96958 392350-392548 Sentence denotes Survivors received 26.6 ± 31.2 Japanese units of total blood product and 44.6 ± 35.6 units for patients who died, respectively (1 American unit is almost equivalent to 2 Japanese units) (P = 0.013).
T8449 392549-392661 Sentence denotes For group T, 56 patients received leukocytereduced blood product (LRB) and 29 received ordinary product (Cont.).
T25404 392662-392739 Sentence denotes Overall mortality for LRB vs Cont. was 40/56 (71%) vs 18/29 (62%) (P = 0.38).
T18065 392740-392933 Sentence denotes Conclusions The total amount of blood products received was highly associated with increased mortality, but there was no obvious adverse eff ect of transfusion to the onset of new septic shock.
T97076 392934-393061 Sentence denotes No association between overall mortality and the use of leukocyte depleted blood was identifi ed in patients with septic shock.
T92898 393063-393176 Sentence denotes There are no prospective studies comparing outcomes between restrictive or liberal strategies in cardiac surgery.
T6169 393177-393383 Sentence denotes This study is a double-blind randomized study to determine whether a restrictive strategy of red cell transfusion and a liberal strategy produced equivalent results in patients submitted to cardiac surgery.
T95331 393384-393744 Sentence denotes Methods Until November 2009 we enrolled 380 patients undergoing elective cardiac surgery and randomly assigned 185 patients to a restrictive strategy of transfusion, in which red cells were transfused if the hematocrit concentration dropped below 24%, and 195 patients to a liberal strategy, in which transfusions were given when the hematocrit fell below 30%.
T84792 393745-393835 Sentence denotes Both transfusion strategies were followed into the operative room and during the ICU stay.
T60341 393836-393974 Sentence denotes We compared the rates of complications and death from all causes during the hospital stay and clinical outcomes of patients after 90 days.
T55599 393975-394216 Sentence denotes Adult patients, after written informed consent, were allocated if they would be submitted to elective primary surgery or were redone adult cardiac surgical patients for coronary artery bypass grafting, valve procedure or combined procedures.
T50990 394217-394308 Sentence denotes Results Overall, hospital mortality was similar in the two groups (4.7% vs 5.3%, P = 0.11).
T95799 394309-394366 Sentence denotes The rates of complications were similar in the two groups
T82462 394368-394539 Sentence denotes The deleterious eff ects of red blood cell (RBC) transfusion are well known [1] and restrictive transfusion practices are safe in patients without active haemorrhage [2] .
T22356 394540-394716 Sentence denotes Our objective was to determine transfusion practices in critically ill patients without evidence of ongoing bleeding to establish our conformity with published guidelines [3] .
T98631 394717-394849 Sentence denotes Methods All adult ICU patients receiving RBC transfusions between 1 September 2008 and 31 August 2009 were included in the analysis.
T23507 394850-395081 Sentence denotes Data were collected on demographics, APACHE II score, ICU and hospital length of stay (LOS), ICU and hospital mortality, presence of ischaemic heart disease (IHD), and pre/post-transfusion haemoglobin concentrations in g/dl ([Hb]).
T42835 395082-395169 Sentence denotes Subgroup analyses were performed for patients with IHD, age <55 years or APACHE II ≤20.
T21856 395170-395369 Sentence denotes We analysed patients with IHD because benefi t from liberal transfusion has not been confi rmed [1] whereas the latter two subgroups have shown a mortality benefi t with restrictive transfusion [2] .
T66466 395370-395453 Sentence denotes Results A total of 1,723 patients were admitted to the ICU during the study period.
T43564 395454-395579 Sentence denotes Two hundred and fi ve patients (11.9%) received RBCs, of whom 47 had active bleeding and were excluded from further analysis.
T81454 395580-395694 Sentence denotes It is important to restrict transfusions to limit morbidity and mortality and to make effi cient use of RBCs [4] .
T60901 395695-395795 Sentence denotes This study demonstrates the importance of regular audit and will be used to inform local guidelines.
T4688 395796-395947 Sentence denotes Introduction Transfusion of red blood cells has been used with the objective of improving oxygen delivery to the tissues in the critically ill patient.
T11444 395948-396051 Sentence denotes However, the appropriate hemoglobin (Hb) level is still controversial in septic shock patients [1, 2] .
T93564 396052-396263 Sentence denotes The objective of this study was to evaluate the eff ect of red blood cell transfusion on the central venous saturation (SvcO 2 ) and lactate levels in patients with septic shock with two diff erent levels of Hb.
T19995 396264-396431 Sentence denotes Methods Patients with less than 48 hours of septic shock and Hb levels under 9.0 g/dl were randomized to maintain Hb over 9.0 g/dl (Group 1) or over 7.0g/dl (Group 2).
T41014 396432-396519 Sentence denotes Before and up to 1 hour after each transfusion, Hb, lactate and SvcO 2 were determined.
T67841 396520-396644 Sentence denotes Results were expressed as median (25% to 75% percentile) or percentage and analyzed through chi-square or Mann-Whitney test.
T58344 396645-396681 Sentence denotes P <0.05 was considered signifi cant.
T28069 396682-396873 Sentence denotes Results Forty-six patients were included with a total of 74 transfusions, being 39 in Group 1 and 35 in Group 2, without any diff erence in demographic or hemodynamic data between the groups.
T66626 396874-397052 Sentence denotes Before and after Hb levels were 8.5 (8.2 to 8.7) g/dl and 9.4 (9.1 to 9.5) g/dl in Group 1 (P = 0.000) and 6.8 (6.6 to 6.9) g/dl and 7.6 (7.4 to 7.8) g/dl in Group 2 (P = 0.000).
T1520 397053-397280 Sentence denotes A reduction in median lactate after transfusion was found in In patients with altered lactate levels a reduction was found regardless of the basal levels of hemoglobin (P = 0.002 and P = 0.001 for Groups 1 and 2, respectively).
T20619 397281-397395 Sentence denotes The same was demonstrated in patients with SvcO 2 <70% (P = 0.007 and P = 0.000 for Groups 1 and 2, respectively).
T12921 397396-397549 Sentence denotes On the other hand, patients with normal levels of both perfusion parameters did not present a worsening of those variables, either in Group 1 or Group 2.
T78218 397550-397688 Sentence denotes Conclusions Red blood cell transfusion improved tissue perfusion in patients with signs of hypoperfusion regardless of basal levels of Hb.
T21487 397689-397833 Sentence denotes Transfusion did not seem to worsen tissue perfusion in patients without signs of hypoperfusion, even in the group with Hb levels above 9.0 g/dl.
T18644 397834-397931 Sentence denotes References Introduction Uncontrolled haemorrhage is a leading cause of early mortality in trauma.
T20686 397932-398113 Sentence denotes Administration of blood products, packed red cells and fresh frozen plasma (PRBC:FFP) in the ratio of 1:1 is associated with improved mortality in major haemorrhage in adult trauma.
T42802 398114-398234 Sentence denotes However, there is little evidence available for the management of major haemorrhage in the context of paediatric trauma.
T65305 398235-398464 Sentence denotes Methods We retrospectively analysed the local paediatric trauma database of all children following trauma call activation on arrival at the emergency department of The Royal London Hospital, a major urban trauma centre in London.
T75853 398465-398526 Sentence denotes The study period was over 15 months, May 2008 to August 2009.
T5114 398527-398630 Sentence denotes During this period, there has been no major haemorrhage policy within the centre for paediatric trauma.
T32158 398631-398764 Sentence denotes We collected data on demographic profi le, injury severity scores, blood products transfused in the fi rst 24 hours and the outcomes.
T87902 398765-398904 Sentence denotes We defi ned massive transfusion as the requirement of packed red cells >40 ml/kg in the fi rst 4 hours or >80 ml/kg in the fi rst 24 hours.
T6214 398905-399047 Sentence denotes Results Two hundred and twenty-seven children presented to the emergency department during this period following major trauma call activation.
T12751 399048-399094 Sentence denotes The median age at presentation was 10.2 years.
T78480 399095-399142 Sentence denotes Thirteen (5.7%) children had major haemorrhage.
T39261 399143-399180 Sentence denotes The median ISS was 35 (IQR 10 to 60).
T89951 399181-399204 Sentence denotes All but one were males.
T52908 399205-399280 Sentence denotes Three had penetrating trauma, one of whom made it to theatre, but all died.
T88009 399281-399323 Sentence denotes Four had emergency damage control surgery.
T12154 399324-399465 Sentence denotes Abnormal results were seen in three patients, each having one abnormal result (INR =1.9 and APTT = 86, low Hb = 7.6, thrombocytopaenia = 63).
T13712 399466-399585 Sentence denotes Eight of the 13 patients received additional blood products such as fresh frozen plasma, platelets and cryoprecipitate.
T38218 399586-399691 Sentence denotes However, no patient received the ratio of blood products of PRBC:FFP of 1:1 as practised in adult trauma.
T23872 399692-399734 Sentence denotes Two patients had no admission bloods done.
T12215 399735-399924 Sentence denotes Worsening coagulation parameters were seen in two patients when measured post transfusion and the remaining 11 patients did not have routine monitoring of blood parameters post transfusion.
T42852 399925-400000 Sentence denotes Eight (62%) patients died, of which seven died in the emergency department.
T73765 400001-400101 Sentence denotes Conclusions Major haemorrhage is associated with a very high mortality in severely injured children.
T6909 400102-400214 Sentence denotes We recommend rigorous monitoring of laboratory parameters to guide appropriate administration of blood products.
T33121 400215-400358 Sentence denotes There is a need for instituting a major haemorrhage policy in paediatric trauma and consideration of point-of-care testing of blood parameters.
T85605 400359-400448 Sentence denotes Methods Twenty-one pigs were anesthetized, instrumented and randomized into three groups:
T46288 400449-400470 Sentence denotes Control, HES and GEL.
T72929 400471-400651 Sentence denotes Animals in the HES and GEL groups were submitted to acute isovolemic anemia to a target hematocrit of 15% with volume replacement performed with HES 130/0.4 and GEL at a 1:1 ratio.
T14820 400652-400733 Sentence denotes The withdrawn blood was returned to the animals 120 minutes after the end of AIA.
T82683 400734-400866 Sentence denotes TNF, IL-1, IL-6 and IL-10 measurements were performed with blood samples collected at the femoral vein at the following time points:
T29881 400867-401082 Sentence denotes Baseline, after instrumentation (INST), immediately after AIA (AIA), 60 minutes after AIA (60AIA), 120 minutes after AIA (120AIA), 60 minutes after blood infusion (60BI) and 120 minutes after blood infusion (120BI).
T14262 401083-401191 Sentence denotes The cytokines were measured in serum by a commercially available ELISA with specifi c monoclonal antibodies.
T20608 401192-401294 Sentence denotes Two-way analyses of variance (ANOVA) and a Tukey test were used to assess its signifi cance (P <0.05).
T33951 401295-401377 Sentence denotes Results TNF varied signifi cantly among the groups in diff erent time points (AIA:
T97006 401378-401429 Sentence denotes Control, 91 ± 16 and GEL, 221 ± 61; P <0.05; 60AIA:
T36654 401430-401507 Sentence denotes Control, 76 ± 15; HES, 172 ± 42; P <0.05 and GEL, 323 ± 77; P <0.001; 120AIA:
T67291 401508-401558 Sentence denotes Control, 98 ± 6 and GEL, 304 ± 66; P <0.01; 120BI:
T99738 401559-401603 Sentence denotes Control, 71 ± 7 and GEL, 211 ± 71; P <0.05).
T83916 401604-401765 Sentence denotes In relation to IL-1, only in the GEL group (224 ± 56) was verifi ed a statistical signifi cant at time point 60AIA when compared with Control (84 ± 17; P <0.05).
T68086 401766-401912 Sentence denotes When IL-6 levels were studied, GEL presented a statistically signifi cant at 60AIA (GEL, 331 ± 65) when compared with Control (146 ± 19; P <0.05).
T73488 401913-402105 Sentence denotes Serum IL-10 levels in GEL-treated animals were statistically signifi cantly elevated at 60AIA (Control, 17 ± 3 and GEL, 46 ± 12; P <0.01) and 120BI (Control, 21 ± 5 and GEL, 59 ± 11; P <0.05).
T63731 402106-402285 Sentence denotes Conclusions Fluid replacement infl uences the cytokine measurements during acute isovolemic anemia expressed by serum TNF, IL-1, IL-6 and IL-10 increases, especially in GEL group.
T59178 402286-402398 Sentence denotes Introduction Community-acquired sepsis at an early stage is common, but haemodynamic alterations remain unclear.
T94490 402399-402602 Sentence denotes The aim of the study was to characterize cardiovascular alterations in patients of our ProFS (monocentric observational) study, which was to characterize patients with sepsis in the emergency department.
T66673 402603-402791 Sentence denotes Methods Systemic vascular resistance (SVR) and cardiac output (CO) were measured non-invasively using a TaskForce monitor (CNSystems, Graz, Austria) after admission, 24 hours and 72 hours.
T71237 402792-402874 Sentence denotes Indexed values were calculated (SVRI (dyn·second/cm 5 /m 2 ), CI (l/minute/m 2 )).
T54159 402875-402924 Sentence denotes Procalcitonin (PCT, ng/ml) was measured in serum.
T58255 402925-403016 Sentence denotes Results A sample of 64 patients of 208 included patients received haemodynamic examination.
T93857 403017-403065 Sentence denotes Mean age was 61.8 ± 18.0 years, 62.7% were male.
T43012 403066-403105 Sentence denotes Patients were divided by PCT <2 and ≥2.
T18966 403106-403178 Sentence denotes Age, gender and previous medical history were comparable in both groups.
T14362 403179-403317 Sentence denotes The heart rate was 99.8 ± 21.6 vs 104.6 ± 23.0/minute (P = NS) and the mean artery pressure was 89.5 ± 15.6 vs 81.6 ± 21.5 mmHg (P <0.01).
T30041 403318-403419 Sentence denotes Mean SVRI in patients with PCT <2 was 2,934 ± 1,045 vs 2,376 ± 842, P <0.05 at the time of admission.
T31729 403420-403553 Sentence denotes No diff erence was found after 24 hours (2,959 ± 1,002 vs 2,924 ± 1,324, P = NS) and 72 hours (3,123 ± 931 vs 3,556 ± 1,524, P = NS).
T82505 403554-403651 Sentence denotes On the contrary, for patients with PCT ≥2 the increase after 72 hours was signifi cant (P <0.05).
T14457 403652-403745 Sentence denotes Diff erences after admission could not be observed for CI between patients with PCT <2 vs ≥2.
T20421 403746-403889 Sentence denotes Mean values after admission were 2.7 ± 1.0 vs 2.8 ± 0.8, after 24 hours 2.5 ± 0.8 vs 2.5 ± 0.5, and after 72 hours 2.3 ± 0.7 vs 2.3 ± 0.6 (all:
T3244 403890-403898 Sentence denotes P = NS).
T39190 403899-404013 Sentence denotes See Figure 1 Conclusions Patients with community-acquired sepsis in the emergency department had an elevated SVRI.
T1163 404014-404121 Sentence denotes At the time of admission patients with high PCT had a signifi cantly lower SVRI than patients with low PCT.
T98188 404122-404214 Sentence denotes Cardiac index at the time of admission was at a lower limit of normal range in all patients.
T7270 404215-404344 Sentence denotes These fi ndings are in strong contrast to the classic pattern of sepsis on the ICU, where SVRI is keenly reduced and CI elevated.
T47919 404345-404514 Sentence denotes They implicate that patients with sepsis in the emergency department may benefi t more from application of fl uid and positive inotrope substances than from vasopressor.
T26009 404515-404739 Sentence denotes Introduction A multicentre, prospective, observational study conducted in four intensive therapy units (ITUs) in India from June 2006 to June 2009 to determine the incidence and outcome of severe sepsis among adult patients.
T97401 404740-404880 Sentence denotes Methods All patients admitted to the ITU were screened daily for SIRS, organ dysfunction and severe sepsis as defi ned by the ACCP and SCCM.
T9873 404881-404929 Sentence denotes Patient with severe sepsis were further studied.
T62287 404930-404983 Sentence denotes Results A total of 5,478 ITU admissions were studied.
T93641 404984-405088 Sentence denotes SIRS with organ dysfunction was found in 1,385 (25%) patients, of which 731 (52.77%) were due to sepsis.
T62504 405089-405149 Sentence denotes The incidence of severe sepsis was 16.45% of all admissions.
T74300 405150-405237 Sentence denotes Mean age of the study population was 58.17 years (SD 18.66), of which 57.71% were male.
T75608 405238-405331 Sentence denotes The median APACHE II score was 13 (IQR 13 to 14) with predominant (90.93%) medical admission.
T98057 405332-405412 Sentence denotes ITU mortality of all admissions was 12.08% and that of severe sepsis was 59.26%.
T36110 405413-405505 Sentence denotes Hospital mortality and 28-day mortality of severe sepsis were 65.2% and 64.6%, respectively.
T24137 405506-405574 Sentence denotes The standardized mortality ratio of severe sepsis patients was 1.45.
T58905 405575-405679 Sentence denotes Median duration of stay in the ITU for the severe sepsis cohort who survived was 13 days (IQR 11 to 17).
T93189 405680-405778 Sentence denotes The number of episodes where infection was the primary reason for admission to the ITU was 86.32%.
T73839 405779-405817 Sentence denotes Culture positivity was found in 61.6%.
T69901 405818-405873 Sentence denotes The lung was the predominant source of sepsis (57.45%).
T16685 405874-405963 Sentence denotes Gram-negative organisms were responsible for 72.45% of cases and Grampositive for 13.13%.
T65881 405964-406016 Sentence denotes The rest were parasitic, viral and fungal infection.
T9715 406017-406069 Sentence denotes Conclusions Severe sepsis was common in Indian ITUs.
T73752 406070-406128 Sentence denotes ITU mortality was higher compared with western literature.
T15718 406129-406253 Sentence denotes Gram-positive infections were less common although incidences of parasitic and viral infection were higher than in the West.
T87470 406254-406620 Sentence denotes Methods In a randomised, prospective trial 807 paediatric patients admitted to the interdisciplinary PICU of a tertiary university hospital were assigned to either a control or an interventional group, the latter receiving inline fi ltration (infusion fi lter Pall ELD96LLCE/ NOE96E, Braun Intrapur Lipid/Intrapur Neonat Lipid) throughout the whole infusion therapy.
T63885 406621-406747 Sentence denotes Prior to this study, the infusion regimen was optimised to prevent precipitation and incompatibilities of solutions and drugs.
T96675 406748-406897 Sentence denotes Primary objectives included a reduction in the incidence of sepsis, thrombosis, SIRS, organ failure (liver, lung, kidney, circulation) and mortality.
T57961 406898-407150 Sentence denotes Results eight hundred and seven children (343 female, 464 male) with a heterogeneous background of underlying diagnoses and a Gaussian distribution to either the control group (406 patients) or the inline fi ltration group (401 patients) were included.
T60340 407151-407319 Sentence denotes According to the study criteria, a signifi cant reduction in the incidence of SIRS for the interventional group (95% CI, 145 versus 200 patients, P <0.001) was evident.
T7416 407320-407504 Sentence denotes No diff erences were demonstrated for the occurrence of sepsis, thrombosis, organ failure (liver, lung, kidney, circulation) or mortality between the control and interventional groups.
T95308 407505-407599 Sentence denotes Conclusions The occurrence of SIRS often complicates the treatment in intensive care medicine.
T68160 407600-407710 Sentence denotes Inline fi ltration is most eff ective, reducing the incidence of SIRS, and off ers a novel therapeutic option.
T85833 407711-407952 Sentence denotes Introduction Intravenous catheter-related bloodstream infections (ICR-BSI) are a major contributing factor to in-hospital mortality and morbidity, extending the inpatient stay by 10 days and expenditure per patient by £2,000 to £30,000 [1] .
T73388 407953-408221 Sentence denotes A prospective survey was conducted in our unit on all patients with central venous catheters to ascertain the incidence of ICR-BSI, identify the organisms and determine the occurrence of infection from the various sites -femoral, internal jugular and subclavian lines.
T97926 408222-408275 Sentence denotes The survey was carried out over a period of 13 weeks.
T15483 408276-408441 Sentence denotes Data collected from patients' case notes included site of central line insertion, length of line in situ, reason for line removal and positive blood culture reports.
T54100 408442-408513 Sentence denotes Results During the study period, 104 patients were treated on the unit.
T78492 408514-408666 Sentence denotes Fifty-two central venous lines were inserted in 36 patients (63.5% femoral (n = 33), 32.7% internal jugular (n = 17) and 3.9% subclavian lines (n = 2)).
T24914 408667-408789 Sentence denotes The lines were reviewed daily and removed if indicated clinically (pyrexia or raised white cell count) or if not required.
T85458 408790-408948 Sentence denotes A total 51.5% of femoral lines (n = 17) were removed due to clinical indications, as were 29% (n = 5) of internal jugular and 50% (n = 1) of subclavian lines.
T28041 408949-409084 Sentence denotes The average duration of a line remaining in situ was 4.5 days for femoral, 6 days for internal jugular and 5 days for subclavian lines.
T44739 409085-409139 Sentence denotes Blood cultures were taken at the time of line removal.
T37149 409140-409236 Sentence denotes These yielded positive results in eight femoral, seven internal jugular and one subclavian line.
T753 409237-409430 Sentence denotes Our survey indicated that the incidence of ICR-BSI in our unit is 30.8% (of this 62.5% coagulase-negative staphylococci (CNS), 12.5% E. coli and Pseudomonas each, and 6.25% MSSA and MRSA each).
T94642 409431-409629 Sentence denotes Conclusions The distribution of microorganisms causing bacteraemia is broadly similar in our unit to that in other teaching hospitals in the UK [2] , in that CNS was the commonest organism isolated.
T61312 409630-409781 Sentence denotes However, E. coli and Pseudomonas were the next common organisms, unlike other units where Staphylococcus aureus was the second most prevalent organism.
T43540 409782-410037 Sentence denotes The incidence of bacteraemia from femoral lines (53.7/1,000 catheter-days) was lower than that from internal jugular lines (68.6/1,000 catheter-days) possibly due to a higher index of suspicion in the case of femoral lines and earlier removal (Figure 1 ).
T74725 410038-410244 Sentence denotes Our study highlights the fact that femoral lines, which are often the safest option for unstable patients with head injury, can be eff ectively managed with strict adherence to guidelines to reduce ICR-BSI.
T70408 410246-410308 Sentence denotes The central venous catheter (CVC) is indispensable in the ICU.
T98692 410309-410471 Sentence denotes Catheter-related bloodstream infection (CR-BSI) is the leading cause of healthcare-associated infections and one of the most important complications from the CVC.
T53762 410472-410645 Sentence denotes Nowadays there are two well-known ways to diagnose CR-BSI: the standard method (withdrawal of the catheter) and the conservative method (without withdrawal of the catheter).
T35634 410646-410782 Sentence denotes Our objective was to compare the in-hospital mortality between the two methods in patients with CR-BSI (short-term catheter) in the ICU.
T46485 410783-410861 Sentence denotes Methods This study was conducted in a 38-bed mixed ICU in a tertiary hospital.
T17084 410862-410957 Sentence denotes We reviewed all episodes of CR-BSI that occurred in our ICU from January 2000 to December 2008.
T19235 410958-411267 Sentence denotes The standard method was defi ned in a patient with a CVC with at least one positive blood culture obtained from a peripheral vein and a positive semiquantitative (>15 CFU) catheter segment culture whereby the same organism (species and antibiogram) was isolated from the catheter segment and peripheral blood.
T60492 411268-411613 Sentence denotes The conservative method was defi ned in a patient with a CVC with at least one positive blood culture obtained from a peripheral vein and one of the following: diff erential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or simultaneous quantitative blood culture with a ratio ≥5:1 (CVC versus peripheral).
T61225 411614-411831 Sentence denotes Results During the study period, 247 episodes of bloodstream infection were identifi ed; of these, 192 were catheter-associated bloodstream infection and 55 were CR-BSI (39 standard method and 17 conservative method).
T79531 411832-412144 Sentence denotes Considering the CR-BSI patients, the mean age ± standard variation (SD) was 64 ± 19.29 (years), 75% were under mechanical ventilation, 55% were under vasopressors, 40% were under total parental nutrition, 40% were under hemodialysis, 72% were double lumen and the mean time ± SD in place was 16.32 ± 8.56 (days).
T83610 412145-412278 Sentence denotes The in-hospital mortality of the standard method versus the conservative method did not show any diff erence (57% vs 75%, P = 0.208).
T98085 412279-412460 Sentence denotes Conclusions This study showed that there is no diff erence in the inhospital mortality between the standard method versus the conservative method in patients in the ICU with CR-BSI.
T29969 412461-412809 Sentence denotes Introduction In previous guidelines of the Centers for Disease Control and Prevention (CDC) [1] and in the recently published Guidelines of the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) [2] it is recommended to avoid the femoral access to reduce the risk of catheter-related bacteremia (CRB).
T78536 412810-413054 Sentence denotes However, in these guidelines there are no recommendations for the catheter site regarding the presence of tracheostomy, and we have not found data about the incidence of CRB comparing a central jugular site with tracheostomy and a femoral site.
T82296 413055-413191 Sentence denotes The objective of this study was to determine whether a jugular site with tracheostomy may have a higher risk of CRB than a femoral site.
T31874 413192-413389 Sentence denotes Methods A prospective, observational, 4-year study (from 1 May 2000 to 30 April 2004) was carried out in the medical-surgical ICU of the University Hospital of the Canary Islands (Tenerife, Spain).
T91660 413390-413512 Sentence denotes We included all patients undergoing a central jugular catheterization with tracheostomy or femoral venous catheterization.
T86196 413513-413649 Sentence denotes In the period of study, were used 208 catheters in femoral access and 52 catheters in central internal jugular access with tracheostomy.
T46604 413650-413964 Sentence denotes There were no signifi cant diff erences between patients with central jugular with tracheostomy and femoral access in age, sex, APACHE II score, diagnosis group, use of mechanical ventilation, use of antimicrobials, use of total parenteral nutrition, use of pulmonary artery catheter, and duration of the catheter.
T81309 413965-414152 Sentence denotes We diagnosed 16 CRB in 208 femoral catheters during 1,679 days of catheterization and 10 CRB in 52 central internal jugular catheters with tracheostomy during 462 days of catheterization.
T14095 414153-414370 Sentence denotes The incidence of CRB was higher in the central internal jugular with tracheostomy than in the femoral site (21.64 vs 9.52 per 1,000 catheter-days; risk ratio = 2.27; 95% confi dence interval = 1.04 to 4.97; P = 0.04).
T96699 414371-414538 Sentence denotes Conclusions The femoral site could be considered a more safe venous access than the central internal jugular in patients with tracheostomy to minimize the risk of CRB.
T59310 414539-414599 Sentence denotes The central venous catheter (CVC) is very useful in the ICU.
T35966 414600-414702 Sentence denotes A comparative study between antiseptic impregnated and standard catheters is therefore of great value.
T79666 414703-414913 Sentence denotes Methods Alternating the type of CVC used in each patient, we recorded for each patient: sex, age, APACHE II score, GCS, site of the puncture, reason for withdrawal of the catheter and the type of catheter used.
T10254 414914-414951 Sentence denotes The tip of the catheter was cultured.
T1942 414952-415102 Sentence denotes The groups were divided: group I (41 patients, 54 punctures) used the standard CVC, and group II (38 patients, 54 punctures) used the impregnated CVC.
T18187 415103-415158 Sentence denotes Results Sixty-two patients were included (48.38% male).
T37620 415159-415243 Sentence denotes We studied 108 periods, of which 54 were standard CVCs and 54 were impregnated CVCs.
T45063 415244-415356 Sentence denotes The average length of stay was higher for impregnated CVCs (14.11 days) compared with standard CVCs (10.7 days).
T15287 415357-415488 Sentence denotes Excluding death in both groups, the length of stay of the catheter in group I was 10.86 days, compared with 15.43 days in group II.
T96816 415489-415590 Sentence denotes Adding all periods of catheterization, group I have an amount of 578 days, and 762 days for group II.
T45571 415591-415658 Sentence denotes The total duration for group II was 31.84% higher than for group I.
T38627 415659-415824 Sentence denotes Regarding the reason for withdrawal of the CVC, predominant were suspected infection 77.8% of the time for standard CVCs, and 49.1% of the time for impregnated CVCs.
T10338 415825-415952 Sentence denotes The culture of the catheter's tip was positive in 10 (18.5%) standard CVs, against eight (15.1%) CVCs in the impregnated group.
T20343 415953-416059 Sentence denotes Most patients had GCS <9.The average APACHE II score was17.97 in group I, compared with 19.63 in group II.
T92831 416060-416126 Sentence denotes The predominant site of puncture was the subclavian vein (56.48%).
T48308 416127-416141 Sentence denotes See Figure 1 .
T96874 416142-416269 Sentence denotes Conclusions According to our study we observed that the length of stay with use of the impregnated CVC was higher (15.43 days).
T46690 416270-416326 Sentence denotes The rate of colonization was higher in the standard CVC.
T21419 416327-416575 Sentence denotes Patients who require a CVC for long periods have benefi ted with the use of impregnated CVCs, Introduction The chirurgical strategy for infection control in complicated intra-abdominal infections is responsible alone for 40% reduction in mortality.
T90500 416576-416677 Sentence denotes The second look strategy in tertiary peritonitis reduces the mortality and morbidity of the patients.
T65470 416678-416875 Sentence denotes Vacuum-assisted closure therapy can potentially decrease the concentration of proinfl ammatory cytokines, bacterial count, management of third-space fl uid and improved input and output monitoring.
T12433 416876-417012 Sentence denotes Methods The authors present a revision of 60 patients with tertiary peritonitis admitted to the ICU after chirurgical infection control.
T55315 417013-417057 Sentence denotes All patients have septic shock at admission.
T1139 417058-417161 Sentence denotes Twelve percent of them were admitted with an open abdomen and vacuum-assisted closure therapy was used.
T44118 417162-417270 Sentence denotes The parameters evaluated were hospital mortality, ICU stay (days) and time of mechanical ventilation (days).
T54522 417271-417582 Sentence denotes The patients submitted to vacuum-assisted closure therapy were similar to patients in whom the abdominal wall was closed, regarding the risk factors for peritoneal infection (corticotherapy, oncologic disease, renal insuffi ciency, hepatic insuffi ciency, desnutrition, hypoalbuminemia, a high APACHE II score).
T50902 417583-417727 Sentence denotes The patients submitted to vacuum-assisted closure therapy had a higher ICU stay and time of mechanical ventilation but lower hospital mortality.
T79358 417728-417856 Sentence denotes Conclusions Vacuum-assisted closure therapy is superior to primary abdominal wall closure in patients with tertiary peritonitis.
T57421 417858-418000 Sentence denotes The Sequential Organ Failure Assessment (SOFA) score is a widely used method to describe organ dysfunction/failure in critically ill patients.
T88689 418001-418198 Sentence denotes Although the majority of the studies use the SOFA score in outcome research, little is known about its correlation to left ventricular (LV) function in patients with severe sepsis and septic shock.
T91458 418199-418340 Sentence denotes The purpose of this study was to evaluate the correlation of SOFA score and LV function by tissue Doppler imaging in this patient population.
T54387 418341-418474 Sentence denotes Methods Sixty patients (ages 66 ± 15, men n = 28) admitted to the ICU with severe sepsis or septic shock were prospectively enrolled.
T56254 418475-418560 Sentence denotes Transthoracic echocardiography was performed within 24 hours of admission to the ICU.
T68222 418561-418879 Sentence denotes We measured the LV end diastolic volume index (LVEDVI), LV end systolic volume index (LVESVI), LV ejection fraction (LVEF), mitral deceleration time of E velocity (Dct) and myocardial tissue Doppler strain imaging profi les at the basal, mid and apical portions of the LV septal wall in the LV apical fourchamber view.
T91742 418880-418938 Sentence denotes On the ICU admission day, the SOFA scores were calculated.
T81426 418939-419021 Sentence denotes Signifi cantly correlated parameters were subjected to linear regression analysis.
T39157 419022-419058 Sentence denotes P <0.05 was considered signifi cant.
T46947 419059-419263 Sentence denotes The mean heart rate was 90 ± 17 bpm, mean LV volumes, mean LVEF and mean Dct were within normal limits (LVEDVI; 44.6 ± 15.4 ml/m 2 , LVESVI; 18.7 ± 11.5 ml/m 2 , LVEF; 58.9 ± 15.7%, Dct; 175.8 ± 50.2 ms).
T54461 419264-419388 Sentence denotes The mean peak systolic strain measurements were -16.0 ± 5.0% (basal; -18.1 ± 7.0%, mid; -15.7 ± 5.6%, apical; -14.1 ± 6.6%).
T71281 419389-419424 Sentence denotes The mean SOFA score was 10.8 ± 3.9.
T66494 419425-419684 Sentence denotes Linear regression analysis showed correlation between the SOFA score and LVEF (r = -0.40, P = 0.02), Dct (r = -0.34, P = 0.007), mean septal strain (r = 0.40, P = 0.002), mid-septal strain (r = 0.43, P = 0.0007) and apical septal strain (r = 0.36, P = 0.006).
T27157 419685-419870 Sentence denotes Conclusions These results suggest that the higher SOFA score had lower LVEF, lower LV systolic strain and higher LV fi lling pressure in the patients with severe sepsis or septic shock.
T98816 419871-420056 Sentence denotes An assessment of the left ventricular longitudinal contraction by tissue Doppler strain imaging may serve as a useful tool to evaluate multiple organ failure in this patient population.
T446 420057-420174 Sentence denotes Introduction Myocardial dysfunction is reportedly a common complication of sepsis that requires specifi c management.
T87798 420175-420313 Sentence denotes Although frequently reported in the literature, the clinical spectrum and frequency of this organ failure have not been fully appreciated.
T94137 420314-420500 Sentence denotes We sought to determine the frequency of myocardial dysfunction in severe sepsis and septic shock and to describe the clinical spectrum of this entity with transthoracic echocardiography.
T13461 420501-420649 Sentence denotes Methods Prospective single-center study capturing all patients admitted to the ICU with severe sepsis or septic shock from May 2007 to January 2009.
T41711 420650-420740 Sentence denotes All patients enrolled underwent comprehensive transthoracic echocardiography on admission.
T57058 420741-420860 Sentence denotes The exclusion criteria included <18 years of age, pregnancy, documented ischemic, valvular or congenital heart disease.
T84916 420861-421004 Sentence denotes All patients with LV systolic dysfunction defi ned as LVEF <50% received a repeat echocardiographic study at 5 days or upon dismissal from ICU.
T40987 421005-421094 Sentence denotes Results One hundred and six patients were enrolled, mean age was 65, and 50% were female.
T45784 421095-421122 Sentence denotes The mean SOFA score was 11.
T15326 421123-421193 Sentence denotes Central venous oxygen saturation was less than 70% in 37% of patients.
T51983 421194-421488 Sentence denotes Twenty-nine patients (27%) had global LV systolic dysfunction (14 = mild, nine = moderate, six = severe), 33 patients (31%) had RV dysfunction (18 = mild, nine = moderate, six = severe), 14 patients had biventricular involvement (13%) and 39 patients (37%) had diastolic fi lling abnormalities.
T78938 421489-421662 Sentence denotes Of the 29 patients with LV systolic dysfunction on initial examination, 28 received a follow-up echocardiogram and 96% of these patients (n = 27) improved in all parameters.
T4963 421663-421715 Sentence denotes Thirty-day mortality was 39%, 6-month mortality 52%.
T7687 421716-421765 Sentence denotes Myocardial dysfunction did not predict mortality.
T44448 421766-421899 Sentence denotes Conclusions These results confi rm that myocardial dysfunction is frequent and broad in patients with severe sepsis and septic shock.
T50259 421900-422027 Sentence denotes Right ventricular involvement and diastolic abnormalities should be considered as part of the clinical spectrum of this entity.
T95602 422028-422146 Sentence denotes There was poor correlation with myocardial dysfunction and mortality and it was reversible regardless of presentation.
T70764 422147-422338 Sentence denotes We should not focus only on left ventricular ejection fraction to diagnose myocardial dysfunction in sepsis, since only a small portion of these patients had isolated LV systolic dysfunction.
T58908 422339-422391 Sentence denotes In sepsis, microcirculatory blood fl ow is impaired.
T76496 422392-422684 Sentence denotes Intravenous nitroglycerin (NTG) seems to have no eff ect on sublingual microcirculation Introduction Elevated serum levels of cardiac-specifi c troponin I (cTnI) are claimed to be associated with the degree of sepsis-related cardiac dysfunction and with the disease outcome in critically ill.
T15646 422685-422776 Sentence denotes We tested this association in a specifi c group of ICU patients with post-traumatic sepsis.
T94995 422777-422920 Sentence denotes Methods A prospective observational study was conducted in an ICU of a level I-equivalent trauma center between September 2008 and August 2009.
T65148 422921-422956 Sentence denotes No exclusion criteria were adopted.
T63099 422957-423155 Sentence denotes Serum cTnI concentrations were collected at peak sepsis-related cardiovascular dysfunction (defi ned by the highest pressure adjusted heart rate (PAR) in MODS score and by the dose of the inotrope).
T59809 423156-423394 Sentence denotes Data were gathered on demographics, severity of infl ammatory response (SIRS criteria) and organ dysfunction (MODS score), presence of superimposed acute coronary events, other potential reasons for cTnI elevation and the disease outcome.
T6624 423395-423477 Sentence denotes Intergroup comparisons were made with Student's t test/nonparametric alternatives.
T68631 423478-423631 Sentence denotes The prognostic utility of cTnI was examined by the construction of ROC curves and its levels were categorized on the basis of the defi ned cut-off value.
T75912 423632-423778 Sentence denotes Probable associations between these categories and the organ dysfunction severity, as well as the outcome, were examined with Fisher's exact test.
T55009 423779-423835 Sentence denotes Results A total of 92 polytrauma patients were enrolled.
T578 423836-423945 Sentence denotes The confi dence intervals of PAR, MODS and SIRS were 21.26 ± 2.72, 6.99 ± 2.94 and 3.75 ± 1.10, respectively.
T17703 423946-424022 Sentence denotes Blunt cardiac injury had been diagnosed in 20 patients (21.7%) on admission.
T11835 424023-424170 Sentence denotes Three patients (3.3%) developed acute coronary events during their ICU stay and 12 patients (13.2%) had other potential reasons for cTnI elevation.
T16368 424171-424303 Sentence denotes Signifi cantly higher cTnI concentrations were found in the critically ill with myocardial contusion and with acute coronary events.
T63666 424304-424384 Sentence denotes However, the presence of blunt cardiac injury had no measurable outcome eff ect.
T4533 424385-424555 Sentence denotes Troponin I levels were signifi cantly higher in nonsurvivors (P = 0.00) and very good prognostic performance of cTnI was found (AUROC = 0.82; cut-off value = 0.05 ng/ml).
T21394 424556-424674 Sentence denotes The subsequent comparison between its categorized values and those of PAR and MODS showed strong positive association.
T34276 424675-424808 Sentence denotes Elevated cTnI concentrations (>0.05 ng/ml) signifi cantly increased the risk of death (RR = 5.58; 95% CI = 1.67 to 20.79; P = 0.002).
T51773 424809-424980 Sentence denotes Conclusions In a group of patients with post-traumatic sepsis elevated serum cTnI levels proved to be a good marker of severe organ (including cardiovascular) dysfunction.
T58748 424981-425221 Sentence denotes They also showed reasonable prognostic value regarding the disease outcome. was measured using Simpson's rule, and early peak diastolic relaxation velocity of septal mitral annulus (E' , cm/second) was measured using tissue Doppler imaging.
T52150 425222-425266 Sentence denotes APACHE II score was calculated at admission.
T45677 425267-425414 Sentence denotes By APACHE II score, two groups were formed: low APACHE II score (LAS) was defi ned as 0 to 14 patients and high APACHE II score (HAS) ≥15 patients.
T95572 425415-425484 Sentence denotes In 65 of 208 patients an echocardiographic examination was performed.
T55766 425485-425747 Sentence denotes Age (61.0 ± 18.4 vs 63.5 ± 16.9 years, P = NS), male sex (64.5% vs 58.8%, P = NS) and mean artery pressure (86.2 ± 15.7 vs 85.7 ± 21.2 mmHg, P = NS) were comparable, whereas patients with HAS had a higher heart rate (96.5 ± 24.5 vs 108.2 ± 17.1/minute, P <0.05).
T42443 425748-425870 Sentence denotes At admission, patients with HAS had a signifi cantly lower EF than patients with LAS (55.1 ± 7.0 vs 50.5 ± 10.1, P <0.05).
T33735 425871-426018 Sentence denotes Diff erence could not be observed after 24 hours (53.6 ± 7.2 vs 52.4 ± 7.%, P = NS) and 72 hours (53.8 ± 7.3 vs 54.3 ± 7.3, P = NS); see Figure 1 .
T1152 426019-426173 Sentence denotes Patients with HAS showed a lower initial E' than patients with LAS (6.2 ± 2.1 vs 5.1 ± 2.1, P <0.05) and after 24 hours (6.1 ± 2.2 vs 5.1 ± 1.3, P <0.05).
T50317 426174-426290 Sentence denotes Three days after admission, E' values in patients with LAS and HAS were comparable (5.6 ± 2.0 vs 5.7 ± 2.1, P = NS).
T80028 426291-426464 Sentence denotes Conclusions In patients with community-acquired sepsis and APACHE II score ≥15 points, a signifi cantly depression of both systolic and diastolic function could be observed.
T66366 426465-426604 Sentence denotes After 24 hours systolic function and after 72 hours diastolic function of patients with an APACHE II score <15 and ≥15 points were similar.
T3951 426605-426660 Sentence denotes This could be possibly due to alterations in afterload.
T23870 426661-426853 Sentence denotes Following a 10 mmHg drop in mean arterial pressure (MAP) from baseline, sheep were randomly assigned to receive intravenous infusions of either POV, AVP or the vehicle (0.9% NaCl; n = 6 each).
T82478 426854-426916 Sentence denotes POV and AVP were titrated to keep MAP above baseline -10 mmHg.
T61698 426917-427026 Sentence denotes All sheep were awake, mechanically ventilated and fl uid resuscitated to maintain hematocrit at baseline ±3%.
T63636 427027-427072 Sentence denotes Data are expressed as mean ± SEM at 24 hours.
T68364 427073-427162 Sentence denotes Fluids are represented as the average over time to account for individual survival times.
T14255 427163-427238 Sentence denotes Results Both treatment strategies signifi cantly reduced fl uid input (AVP:
T86416 427239-427265 Sentence denotes 7.7 ± 0.6 ml/kg/hour; POV:
T24447 427266-427322 Sentence denotes 5.8 ± 0.8 ml/kg/hour), positive net fl uid balance (AVP:
T4873 427323-427349 Sentence denotes 4.9 ± 0.5 ml/kg/hour; POV:
T82992 427350-427387 Sentence denotes 0.4 ± 0.6 ml/kg/hour), thoracic (AVP:
T78543 427388-427414 Sentence denotes 0.8 ± 0.2 ml/kg/hour; POV:
T6472 427415-427463 Sentence denotes 0.3 ± 0.1 ml/kg/hour) and abdominal fl uid (AVP:
T64084 427464-427492 Sentence denotes 0.10 ± 0.04 ml/kg/hour; POV:
T13984 427493-427558 Sentence denotes 0.01 ± 0.01 ml/kg/hour) as well as extravascular lung water (AVP:
T67295 427559-427581 Sentence denotes 22.6 ± 1.4 ml/kg; POV:
T208 427582-427645 Sentence denotes 15.8 ± 1.9 ml/ kg) and increased plasma oncotic pressures (AVP:
T87997 427646-427667 Sentence denotes 12.5 ± 0.9 mmHg; POV:
T35455 427668-427844 Sentence denotes 15.9 ± 1.1 mmHg) vs control animals (9.6 ± 0.4 ml/kg/hour; 7.7 ± 0.4 ml/kg/ hour; 2.2 ± 0.4 ml/kg/hour; 0.29 ± 0.13 ml/kg/hour; 22.9 ± 2.8 ml/kg; 8.9 ± 0.1 mmHg, respectively).
T71059 427845-427916 Sentence denotes Notably, POV was superior to AVP in all these variables (P <0.05 each).
T91998 427917-428173 Sentence denotes Myocardial contractility was higher in the POV group vs AVP and control animals as suggested by higher left ventricular stroke work indexes (66 ± 3 vs 48 ± 7 and 43 ± 3 g/m/m 2 , respectively; P <0.05 each) at lower or similar global end-diastolic volumes.
T80319 428174-428358 Sentence denotes Pulmonary dysfunction (decrease in PaO 2 /FiO 2 ratio) was attenuated in POV (364 ± 47 mmHg) as compared with AVP (195 ± 66 mmHg; P <0.05) and control animals (213 ± 76 mmHg; P <0.05).
T68836 428359-428494 Sentence denotes Whereas one AVP and three control animals had to be sacrifi ced prematurely, all POV-treated animals survived the 24-hour study period.
T1397 428495-428757 Sentence denotes Conclusions In MRSA pneumonia-induced ovine septic shock, the selective V 1a -receptor agonist POV is superior to the mixed V 1a /V 2receptor agonist AVP in reducing vascular leakage and cardiopulmonary dysfunction when administered as a fi rst-line vasopressor.
T86502 428758-429052 Sentence denotes Introduction Improvements in survival for acute myocardial infarction, trauma, and stroke have been realized through continuous quality improvement (CQI) initiatives that include early identifi cation and implementation of time-sensitive therapies at the earliest stage of disease presentation.
T70773 429053-429248 Sentence denotes In addition, challenges in the management of severe sepsis and septic shock remain in regards to implementation of an early sepsis resuscitation bundle (RB) in order to maximize outcome benefi t.
T38545 429249-429423 Sentence denotes We examined the impact of a hospital-wide CQI initiative on septic RB compliance and outcome and investigated the mortality benefi ts beyond the 6-hour recommendation period.
T98766 429424-429550 Sentence denotes Methods Prospective cohort study of patients who met the defi nition of severe sepsis or septic shock over an 18-month period.
T90607 429551-429662 Sentence denotes Current sepsis RB being MAP ≥65, CVP ≥8 and SvO 2 ≥70% goals met within 6 hours and 18 hours upon presentation.
T28634 429663-429791 Sentence denotes The 498 severe sepsis and septic shock patients were enrolled and examined at what time period would the RB still be eff ective.
T6188 429792-429889 Sentence denotes Using a time cut-off , the Compliers at 18 hours and NonCompliers at 18 hours were then compared.
T52811 429890-429997 Sentence denotes There were 202 patients who had the RB completed in less than or equal to 18 hours (Compliers at 18 hours).
T56468 429998-430092 Sentence denotes There were 296 patients who never completed the RB within 18 hours (NonCompliers at 18 hours).
T86671 430093-430284 Sentence denotes The Compliers at 18 hours had a signifi cant 10.2% lower hospital mortality at 37.1% (22% relative reduction) compared with the NonCompliers at 18 hours hospital mortality of 47.3% (P <0.03).
T1536 430285-430441 Sentence denotes Adjusting for diff erences in baseline illness severity, the Compliers at 18 hours had a greater reduction in predicted mortality of 26.8% vs 9.4%, P <0.01.
T84708 430442-430491 Sentence denotes Compliance started at 30.4% and fi nished at 63%.
T61958 430492-430666 Sentence denotes Conclusions A CQI initiative for severe sepsis and septic shock with particular emphasis on the RB signifi cantly improved bundle compliance and decreased hospital mortality.
T63400 430667-430871 Sentence denotes It has been previously shown that compliance to the RB within 6 hours improves outcome; however, when the time of bundle completion is extended to 18 hours, the mortality benefi ts are still signifi cant.
T38926 430872-431027 Sentence denotes Introduction To investigate the eff ect of myocardial preservation of early goal-directed therapy (EGDT) on severe sepsis/septic shock patients in the ICU.
T80504 431028-431249 Sentence denotes Methods This is a prospective and randomized controlled study, in which the total 158 severe sepsis/septic shock patients from the ICU were randomly assigned into two groups (EGDT group, n = 81 and control group, n = 77).
T78237 431250-431468 Sentence denotes Then the concentration of serum cardiac troponin I (cTnI), high sensitivity C-reactive protein (hs-CRP) and APACHE II score of patients were obtained on the 0, 3rd, 7th, and 14th day after fl uid resuscitation therapy.
T64397 431469-431957 Sentence denotes The levels of cTnI were the same between the EGDT and control groups on day 0 (exceeded normal cTnI patients in two groups 0.41 vs 0.42, normal cTnI patients in two groups 0.05 vs 0.04, P >0.05), there was a dramatic decrease in exceeded normal cTnI patients of the EGDT group, in which cTnI returned to normal after EGDT (14th day: exceeded normal cTnI patients in two groups 0.08 vs 0.16, P <0.05); however, only a little diff erence in normal cTnI patients of the two groups (P >0.05).
T97972 431958-432154 Sentence denotes The level of hs-CRP changed like cTnI (P <0.05), and there was positive correlation between cTnI and hs-CRP on each time (P <0.05); APACHE II scores obviously decrease in the EGDT group (P <0.05).
T60389 432155-432323 Sentence denotes Meanwhile, the EGDT group have an obviously higher 28-day survival rate and longer survival time than that of the control group (74.1% vs 55.8%; 23.5 vs 19.6, P <0.05).
T56310 432324-432465 Sentence denotes Conclusions EGDT has an eff ect of myocardial preservation and improves the survival rate for severe sepsis/septic shock patients in the ICU.
T10842 432466-432529 Sentence denotes Introduction Sepsis mortality rates in Brazil are high [1, 2] .
T72754 432530-432713 Sentence denotes Many studies have already shown that implementation of education programs based on Surviving Sepsis Campaign 6-hour (6h SSC) and 24-hour bundles successfully reduces sepsis mortality.
T46024 432714-432823 Sentence denotes The objective of this study was to evaluate the impact of the SSC-based program on patient outcome in Brazil.
T42824 432824-432964 Sentence denotes Methods Severe sepsis and septic shock patients were included in voluntary participating hospitals that have sent data for at least 2 years.
T79800 432965-433053 Sentence denotes The intervention was based on strategies aimed at improving compliance with the bundles.
T35411 433054-433189 Sentence denotes Regular reports containing compliance and mortality data were sent to the hospital in order to base local strategies of improving care.
T20323 433190-433355 Sentence denotes Results are presented by the semester of hospital inclusion in the campaign through 2 years, regardless of when those months occurred in the time frame of the study.
T76798 433356-433454 Sentence denotes Results Compliance to 6h SSC increased from the fi rst to the fourth semester as follows: lactate:
T86769 433455-433495 Sentence denotes 65.0% to 71.5%, P = 0.01, blood culture:
T44988 433496-433534 Sentence denotes 42.5% to 50.3%, P = 0.08, antibiotics:
T94537 433535-433603 Sentence denotes 38.9% to 45.3%, P = 0.02, achieving mean arterial pressure >65 mmHg:
T74921 433604-433646 Sentence denotes 43.7% to 75.4%, P <0.000, CVP achievement:
T20098 433647-433691 Sentence denotes 14.6% to 36.6%, P <0.000, SvO 2 achievement:
T65504 433692-433751 Sentence denotes 10.4 to 22.7, P = 0.000 and completion of the whole bundle:
T48760 433752-433773 Sentence denotes 8.3 to 9.0, P = 0.34.
T74242 433774-433933 Sentence denotes A 7% absolute reduction (relative reduction of 11.6%) in hospital mortality was found in the third semester of the campaign (OR 1.33 (1.04 to 1.69), P = 0.01).
T36206 433934-434005 Sentence denotes However, in the fourth semester mortality has increased again to 60.6%.
T46568 434006-434106 Sentence denotes Conclusions Implementation of the SSC in Brazil has been associated with increased bundle adherence.
T77365 434107-434253 Sentence denotes However, the impact on the mortality rate seems not to be sustained, probably due to the diffi culty associated with keeping an education program.
T52424 434254-434345 Sentence denotes It is important to develop strategies aiming to increase motivation in Brazilian hospitals.
T43833 434346-434457 Sentence denotes Introduction Noradrenaline and dopamine were the standard catecholamines used in the treatment of septic shock.
T29812 434458-434625 Sentence denotes Loss of response was the common problem that led to patient loss after large continuous doses of noradrenaline, which was termed catecholamine refractory septic shock.
T39484 434626-434744 Sentence denotes Recently vasopressin and its analog, namely terlipressin, were used in the treatment of such a catastrophic condition.
T58860 434745-434933 Sentence denotes Methods In a prospective controlled study we included 40 patients with catecholamine-resistant septic shock (that is, noradrenaline dose exceeded 0.6 μg/kg/minute) divided into two groups:
T62184 434934-435273 Sentence denotes 20 patients were treated conventionally according to the Surviving Sepsis Campaign 2008, who served as a control group; and the other 20 patients were treated conventionally and when the noradrenaline dose exceeded 0.6 μg/kg/ minute, terlipressin in a dose of 1 mg intravenous bolus every 12 hours for a study time of 48 hours was started.
T40080 435274-435533 Sentence denotes Results Terlipressin therapy was associated with increased systemic vascular resistance from 546 ± 260 dyne·sec/cm -5 to 986 ± 390 dyne·sec/ cm -5 after 48 hours, which represents normalized arterilor tone that is expected to allow better organ bed perfusion.
T68066 435534-435920 Sentence denotes There was a reduction of both stroke volume and cardiac output (from 63 ± 16 ml/beat to 51 ml/ beat and from 78 l/minute to 5.3 l/minute, respectively) yet this was not associated with abnormal organ perfusion marked by improved urine output from 49 ml/hour to 133 ml/hour and improved global perfusion as marked by decrease lactic acidosis from 9.3± 3 mEq/l to 5.7 ± 3 mEq/l, P <0.002.
T2081 435921-436045 Sentence denotes There was signifi cant reduction of oxygen delivery (DO 2 from 848 ml/minute to 610 ± 47 ml/minute after 48 hours, P >0.02).
T35686 436046-436186 Sentence denotes There was no eff ect on length of ICU stay in both groups (16 ± 6 days in the terlipressin group and 12 ± 6 days in control group, P <0.06).
T26511 436187-436278 Sentence denotes Terlipressin support showed nonsignifi cantly less mortality (60% vs 70% in control group).
T27423 436279-436383 Sentence denotes Regarding organ function, terlipressin could improve the SOFA score from 11 ± 3.2 to 8 ± 5 with P <0.02.
T43126 436384-436504 Sentence denotes Conclusions Terlipressin is a rather safe, inexpensive, easy to administer alternative in the treatment of septic shock.
T43108 436505-436640 Sentence denotes Further studies are needed to decide the ideal timing for initiation of this therapy early vs late adjuvant or as an initial treatment.
T59397 436641-436723 Sentence denotes Reference in patients with specifi c co-morbidities such as chronic liver disease.
T67369 436724-436889 Sentence denotes In this study we evaluated whether the adherence to the resuscitation sepsis bundle improved the outcome of cirrhotic patients with septic shock admitted to the ICU.
T65932 436890-437097 Sentence denotes Methods The prospective observational cohort study included 38 patients with documented cirrhosis and septic shock admitted to a multidisciplinary ICU at a university hospital from January 2005 to June 2009.
T76883 437098-437263 Sentence denotes In each patient the compliance to four resuscitation interventions recommended by the SSC guidelines (that is, 6-hour bundle) and the 30-day mortality were measured.
T25113 437264-437327 Sentence denotes Results The 6-hour bundle was completed in 50% of the patients.
T70850 437328-437510 Sentence denotes In these patients the MELD and SOFA scores (39 ± 11 and 18 ± 2) were higher (P <0.05) than those observed in patients without compliance to the 6-hour bundle (31 ± 12 and vs 15 ± 3).
T6136 437511-437630 Sentence denotes The 30-day mortality was 94.7% and 68.4% (P <0.05) in patients with and without 6-hour bundle compliance, respectively.
T10145 437631-437835 Sentence denotes A Cox regression analysis, after adjustment for MELD and SOFA scores, indicated that none of the single sepsis interventions as well as the 6-hour bundle was independently associated with 30-day survival.
T82215 437836-438040 Sentence denotes Conclusions The adherence to the resuscitation interventions recommended by the SSC evidence-based guidelines did not improve the survival rate of cirrhotic patients with septic shock admitted to our ICU.
T60558 438041-438270 Sentence denotes Recently, there has been further interest in the complications of DAA following a review by Gentry and colleagues suggesting a signifi cantly increased incidence of SBEs and death in those with baseline bleeding precautions [1] .
T81487 438271-438377 Sentence denotes We are one of the largest single-centre users of DAA worldwide and thus are keen to report our experience.
T84776 438378-438542 Sentence denotes Methods In 2002 a scoring system, reporting tool, and supporting database were developed to track the outcome of DAA-treated severe sepsis patients in our hospital.
T16634 438543-438674 Sentence denotes This is maintained by the clinical pharmacists and captures data on relative contraindications, adverse events and patient outcome.
T67452 438675-438746 Sentence denotes Classifi cation of data is obtained from the electronic patient record.
T66292 438747-438921 Sentence denotes Any DAA administration outside agreed criteria is recorded and bleeding incidents are reviewed with a consultant intensivist to confi rm categorisation into serious or minor.
T90875 438922-439004 Sentence denotes Conclusions Our results are similar to those of a UK-wide audit of APC usage [1] .
T49824 439005-439137 Sentence denotes The mortality of our patients was higher (56% vs 45%), but our patients were probably sicker (median fi ve organ failures vs three).
T15472 439138-439226 Sentence denotes Based on APACHE, actual outcome appears worse than predicted for patients receiving APC.
T43265 439227-439373 Sentence denotes Using the ICNARC method score, however, outcomes were hemoperfusion) we used LPS adsorber (Alteco® LPS Adsorber; Alteco Medical AB, Lund, Sweden).
T61158 439374-439482 Sentence denotes The patient's blood was taken before and after adsorption, then the serum was separated and stored at -70°C.
T35407 439483-439807 Sentence denotes We determined the LPS concentration by LAL test, lipopolysaccharide-binding protein (LBP), sIL-1 RII and sCD14 by ELISA kits (Hycult Biotechnology, the Netherlands), and proinfl ammatory and anti-infl ammatory cytokines IL-6, TNFβ, IL-8, IL-2, INFγ, IL-12, TNFα, IL-4, IL-5, IL-1β and IL-10 by ELISA kit (Bender MedSystems).
T77288 439808-439898 Sentence denotes Results In all cases we saw reliable reduction of the LPS level in serum (1.8 to 2 times).
T58113 439899-440061 Sentence denotes After the investigation of some cytokine levels we obtained similar results: IL-6, TNFβ and IL-8 levels had been reduced 30 to 40%, 87% and 62 to 76% accordingly.
T11195 440062-440163 Sentence denotes At the same time, IL-2, INFγ, IL-12, TNFα, IL-4 and IL-5 levels in serum had not changed practically.
T67834 440164-440289 Sentence denotes However, in approximately 1/3 cases an IL-1β and IL-10 concentration increase in serum was observed (33 and 40% accordingly).
T35627 440290-440579 Sentence denotes Also our research has shown that, in the most of the cases after application of this sorbent, LBP decreased insignifi cantly (10 to 32%), but the sIL-1 RII level slightly increased (10 to 18%) in the majority of patients and considerably decreased (two times) in 1/3 investigated patients.
T82886 440580-440672 Sentence denotes The CD14 concentration in patient serum reliably did not change before and after adsorption.
T86370 440673-440740 Sentence denotes The somatic status of patients was stabilized after LPS adsorption.
T43869 440741-441004 Sentence denotes Introduction It was assumed that pathologic activation of neutrophils and monocytes is associated with sepsis, acute lung injury/ARDS, and multiple organ failure, and that removal of these cells from the circulation could reduce leukocyte-dependent tissue injury.
T24602 441005-441289 Sentence denotes Cartridges containing polymyxin B (PMX) immobilized to fi bers (Toraymyxin; Toray Industries, Tokyo, Japan) have been developed for selective adsorption of circulating endotoxin in patients with Gram-negative bacterial infection, and this treatment has proven to be highly eff ective.
T40759 441290-441494 Sentence denotes This study examined the eff ect of direct hemoperfusion through fi lters with immobilized PMX direct-hemoperfusion (DHP) on leukocyte function and plasma levels of cytokines in patients with septic shock.
T68538 441495-441688 Sentence denotes Methods We evaluated the eff ect of PMX-DHP on circulating leukocytes in patients with septic shock by assessing the changes of neutrophil and monocyte surface antigen expression after PMX-DHP.
T83415 441689-441921 Sentence denotes In another experiment, heparinized blood from patients with sepsis was passed through PMX fi lters in a laboratory circuit and then changes of the cell count and surface antigen expression by neutrophils and monocytes were assessed.
T18604 441922-442059 Sentence denotes After perfusion, neutrophils were isolated and the capacity of these cells to damage cultured endothelial monolayers was also determined.
T87783 442060-442228 Sentence denotes We found that PMX-DHP led to an increased CXCR1 and CXCR2 expression along with a decrease of CD64 and CD11b expression by circulating neutrophils from septic patients.
T10529 442229-442441 Sentence denotes Plasma levels of cytokines, including IL-6, IL-8, IL-10, and high-mobility group box-1, were elevated in patients with septic shock compared with healthy controls, but cytokine levels were not altered by PMX-DHP.
T92305 442442-442621 Sentence denotes Ex vivo perfusion of heparinized blood from patients with sepsis through PMX fi lters in a laboratory circuit caused a signifi cant decrease of the neutrophil and monocyte counts.
T76279 442622-442752 Sentence denotes Activated neutrophils with high CD11b/CD64 expression and low CXCR1/CXCR2 expression showed preferential adhesion to PMX fi lters.
T46160 442753-442905 Sentence denotes Neutrophils isolated from the blood after ex vivo PMX perfusion caused less damage on the endothelial cell monolayer than cells from sham-treated blood.
T73232 442906-443039 Sentence denotes Introduction Direct and rapid removal of pathogens or noxious metabolites from a patient is the most straightforward cure imaginable.
T56110 443040-443194 Sentence denotes Dialysis and plasma fi ltration/exchange are the current broadly applicable methods to perform a direct removal of disease-causing factors from a patient.
T29804 443195-443343 Sentence denotes We describe the use of stable nanomagnets to rapidly and selectively remove heavy metal ions, overdosed steroid drugs and proteins from human blood.
T85004 443344-443510 Sentence denotes This nanomagnet-based purifi cation method avoids fouling of fi lter membranes and benefi ts from a high external surface area, and a correspondingly fast diff usion.
T79435 443511-443670 Sentence denotes Methods Nanomagnets equipped with heavy metal complexants, digoxin antibody fragments and entire human IL-6 antibodies were added to a series of blood samples.
T76755 443671-443742 Sentence denotes The nanomagnets scan blood by Brownian motion and capture their target.
T45191 443743-443876 Sentence denotes Afterwards, a small magnet was placed at the sample tube wall accumulating the nanomagnets in the pole region of the external magnet.
T67771 443877-443931 Sentence denotes The purifi ed supernatant can then easily be decanted.
T11635 443932-444039 Sentence denotes The concentrations of lead, digoxin and IL-6 in blood samples were determined by standard clinical methods.
T25021 444040-444192 Sentence denotes Blood integrity was observed by rotation thromboelastography and monitoring of serum potassium, lactate dehydrogenase, bilirubin and haptoglobin levels.
T72390 444193-444338 Sentence denotes To measure the biological relevance of the IL-6 removal, the eff ect on caspase-3 activation was assessed in camptothecin-stimulated neutrophils.
T51850 444339-444457 Sentence denotes Results A signifi cant decrease of lead, digoxin and IL-6 levels was measured after the blood purifi cation procedure.
T94919 444458-444561 Sentence denotes The extraction using nanomagnets was in clear dose-eff ect dependence and could be accurately titrated.
T52957 444562-444694 Sentence denotes Treatment with nanomagnets did not signifi cantly aff ect the integrity of blood and all levels remained in the clinical norm range.
T54808 444695-444845 Sentence denotes Caspase-3 assays showed a reduced anti-apoptotic eff ect after IL-6 removal, underlining the biological relevance of the achieved removal effi ciency.
T81464 444846-445036 Sentence denotes Conclusions We demonstrate the extraction of lead, digoxin and IL-6 from whole blood as an example for the rapid treatment of heavy metal poisoning, drug overdosing and severe infl ammation.
T49754 445037-445325 Sentence denotes The presented direct blood extraction could be combined with existing therapeutic strategies and may have major implications on the treatment of severe intoxications, sepsis (specifi c fi ltering of cytokines or toxins) [1] , metabolic disorders (thyreotoxicosis) and autoimmune diseases.
T70825 445326-445336 Sentence denotes References
T90782 445337-445401 Sentence denotes Methods Fifty-fi ve septic patients were enrolled in this study.
T92990 445402-445574 Sentence denotes Every patient had four CPFA treatments (LINDA; Bellco-Mirandola, Italy) for 8 hours with Q b = 200 ml/minute, Q ultrafi ltration = 30 ml/kg/hour and Q plasma = 20% of Q b .
T27127 445575-445809 Sentence denotes At T0 (basal), T1 (after fi rst cycle), T2 (after second cycle), T3 (after third cycle) and T4 (after fourth cycle) we evaluated haemodynamic parameters, norepinephrine dosage, PaO 2 /FiO 2 ratio, plasma IL-6, and procalcitonin (PCT).
T76035 445810-445872 Sentence denotes The ANOVA test was used to compare changes during times study.
T32327 445873-445923 Sentence denotes P <0.05 was considered statistically signifi cant.
T58186 445924-446022 Sentence denotes Results Patients enrolled in the study have been submitted to 256 CPFA treatments for 2,650 hours.
T82334 446023-446070 Sentence denotes Table 1 presents the main results of the study.
T79884 446071-446147 Sentence denotes IV quartile of IL-6 is shown in Table 1 . was not diff erent between groups.
T19966 446148-446273 Sentence denotes Group 1 patients had a trend towards higher number of organ dysfunction (P = 0.07) and more septic shock episodes (P = 0.09).
T39685 446274-446390 Sentence denotes Regarding treatment adequacy, compliance with any indicator or the entire SSC-6h bundle was not related to survival.
T29256 446391-446484 Sentence denotes However, achievement of the CPV target was associated with a higher early mortality (Group 1:
T90067 446485-446500 Sentence denotes 69.6%, Group 2:
T37087 446501-446545 Sentence denotes 40.6%, P = 0.013; OR -3.3.4 (1.33 to 8.40)).
T44344 446546-446745 Sentence denotes Conclusions In this observational study, factors related to disease severity rather than to the evidence-based treatment compliance were associated with short-term death among severe septic patients.
T68628 446747-446856 Sentence denotes The sepsis mortality rate is higher in Brazilian public hospitals with no clear diff erences in risk factors.
T79467 446857-446977 Sentence denotes We aim to identify risk factors that could explain why the mortality rate is diff erent in public and private hospitals.
T4129 446978-447144 Sentence denotes Methods All severe sepsis and septic shock patients over 18 years old admitted to two private ICUs (Group 1) and one public ICU (Group 2) were prospectively included.
T75154 447145-447303 Sentence denotes Demographic, clinical and outcome features, including compliance to the 6-hour Surviving Sepsis Campaign bundle (SSC-6h), were collected in an electronic CRF.
T56804 447304-447456 Sentence denotes Duration of organ dysfunction was defi ned as the time elapsed between the installation of the dysfunction and its diagnosis by the healthcare provider.
T25878 447457-447569 Sentence denotes Results were expressed as a percentage or as median and interquartiles, and P <0.05 was considered signifi cant.
T51494 447570-447768 Sentence denotes Introduction Critically ill cancer patients are at increased risk for acute kidney injury (AKI), but studies on these patients are scarce and were all single centered, conducted in specialized ICUs.
T75966 447769-447896 Sentence denotes The aim of this study was to evaluate the characteristics and outcomes in a prospective cohort of ICU cancer patients with AKI.
T50103 447897-448010 Sentence denotes Methods Prospective multicenter cohort study conducted in ICUs from 28 hospitals in Brazil over a 2-month period.
T70660 448011-448124 Sentence denotes Univariate and multivariate logistic regression were used to identify factors associated with hospital mortality.
T98055 448125-448215 Sentence denotes Results Out of all 717 ICU admissions, 87 (12%) had AKI and 36% of them received dialysis.
T49112 448216-448359 Sentence denotes Kidney injury developed more frequently in patients with hematological malignancies than in patients with solid tumors (26% vs 11%, P = 0.003).
T36937 448360-448494 Sentence denotes Ischemia/shock (76%) and sepsis (67%) were the main contributing factors, and kidney injury was multifactorial in 79% of the patients.
T64219 448495-448568 Sentence denotes The ICU mortality was 61% (53/87) and hospital mortality was 71% (62/87).
T39022 448569-448837 Sentence denotes Despite the lack of statistical signifi cance, hospital mortality was higher in patients who received RRT later on during the ICU stay (92%) in comparison with those who received RRT on the fi rst day in the ICU (78%) and those who were not dialyzed (64%) (P = 0.105).
T41213 448838-448932 Sentence denotes End-of-life decisions (to withhold or to withstand therapies) were taken in 18 (23%) patients.
T19922 448933-449046 Sentence denotes General and renal-specifi c severity-of-illness scores were inaccurate in predicting outcomes for these patients.
T90463 449047-449242 Sentence denotes In a multivariate analysis, length of hospital stay prior to ICU, acute organ dysfunctions, need for mechanical ventilation and a poor performance status were associated with increased mortality.
T73349 449243-449318 Sentence denotes Moreover, cancer-related characteristics were not associated with outcomes.
T31524 449319-449503 Sentence denotes Conclusions The present multicenter study confi rmed that AKI in critically ill patients with cancer is frequent, usually multifactorial and still associated with high mortality rates.
T65600 449504-449624 Sentence denotes On the other hand, the current study also suggests that ICU admission and RRT should be considered in selected patients.
T7387 449625-449776 Sentence denotes Mortality in these patients is mostly dependent on the severity of acute illness and the performance status, rather than cancerrelated characteristics.
T5347 449777-450043 Sentence denotes Conclusions These results suggest signifi cant increased ICU mortality in the following groups: over 50 years old, smokers, patients with poor exercise tolerance, patients with IHD or PV, patients with COPD and patients who drink alcohol to excess or those with ALD.
T18422 450044-450238 Sentence denotes While these results should not be used as a basis upon which to permit or refuse intensive care admission, they should be used to inform staff and patients of likely outcome from intensive care.
T47404 450239-450433 Sentence denotes Introduction C-reactive protein (CRP) is an acute-phase protein, the blood levels of which increase rapidly in response to infection, trauma, ischemia, burns, and other infl ammatory conditions.
T13025 450434-450509 Sentence denotes Serum albumin decreases in critically ill patients with similar conditions.
T78731 450510-450701 Sentence denotes The use of these blood tests as risk markers or as predictors of organ failure and death has been studied previously [1, 2] and we wished to investigate their applicability to our population.
T72224 450702-450920 Sentence denotes Admission CRP correlated positively with length of stay (r = 0.14, P = 0.017) and APACHE II score (r = 0.13, P = 0.03) but did not signifi cantly correlate with duration of mechanical ventilation (r = 0.10, P = 0.103).
T97045 450921-451105 Sentence denotes Admission albumin correlated negatively with length of stay (r = -0.15, P = 0.01), duration of mechanical ventilation (r = -0.15, P = 0.014) and APACHE II score (r = -0.17, P = 0.004).
T58628 451106-451201 Sentence denotes Conclusions CRP and serum albumin on admission are both predictors of intensive care mortality.
T3775 451202-451369 Sentence denotes CRP and serum albumin also correlate signifi cantly with other severity markers such as length of stay and duration of mechanical ventilation and also APACHE II score.
T892 451370-451431 Sentence denotes that statins may reduce mortality in critically ill patients.
T35657 451432-451551 Sentence denotes We aimed to investigate the association between statin therapy on admission and outcome from intensive care in our ICU.
T22384 451552-451692 Sentence denotes Methods A prospective case-note review of 504 consecutive admissions to Glasgow Royal Infi rmary ICU was undertaken over an 18-month period.
T28308 451693-451997 Sentence denotes Details of statin prescription, cardiovascular co-morbidity and smoking status was sought from the patients' case notes by hand using details of current and previous admissions, clinical letters, results of investigations and correspondence from the patient's general practitioner, using agreed criteria.
T79593 451998-452151 Sentence denotes Demographic, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and outcome data were retrieved from the Ward Watcher system in the ICU.
T42985 452152-452206 Sentence denotes Results Complete data were available for 444 patients.
T58984 452207-452299 Sentence denotes One hundred and eleven (25%) of these were on statin therapy on admission to intensive care.
T67357 452300-452394 Sentence denotes All data are expressed as mean ± 95% confi dence interval or median (interquartile range [1] .
T74385 452395-452490 Sentence denotes The aim of this study was to establish children's own views as to their outcome in this regard.
T82160 452491-452756 Sentence denotes Methods A cohort of 102 children aged over 7 years, with no preexisting learning diffi culties, completed the PedsQL 4.0 Pediatric Quality of Life Inventory [2] and a post-traumatic stress screener in face-to-face interviews, 3 months after discharge from the PICU.
T14266 452757-452841 Sentence denotes Of this group, 76 also completed questionnaires, by post or telephone, at 12 months.
T77834 452842-453038 Sentence denotes Results Children's total PedsQL scores were signifi cantly lower than those of healthy children at 3 months (PICU mean = 79.3; healthy mean = 83.9, P <0.01), but at 12 months they were comparable.
T74560 453039-453258 Sentence denotes By 12 months, the mean score for the PICU group on the physical functioning subscale had improved signifi cantly (from 73.1 to 81.5, P <0.001) but was still below normal population levels (healthy mean = 88.5, P <0.01).
T8262 453259-453451 Sentence denotes The total PedsQL score at 12 months was not associated with PIM score or length of stay, but was signifi cantly negatively associated with post-traumatic stress symptoms (r = -0.40, P <0.001).
T31645 453452-453649 Sentence denotes Within-group analyses revealed that electively admitted children reported higher emotional functioning than healthy children at 3 months (PICU elective mean = 91.0 vs healthy mean = 78.5, P <0.01).
T43011 453650-453796 Sentence denotes Conclusions The self-report version of the PedsQL proved to be a feasible and responsive tool for assessing HRQoL in this group of PICU survivors.
T30910 453797-454046 Sentence denotes However, in order to assess this aspect of outcome for the majority of children admitted to the PICU, who are younger and/or have signifi cant cognitive impairment, administration of the parent-proxy version of this questionnaire would be necessary.
T72913 454047-454164 Sentence denotes Health Methods Potential participants were patients admitted for more than 48 hours to a 12-bed medical-surgical ICU.
T13877 454165-454250 Sentence denotes Patients or their proxies were asked to give informed consent and complete the SF-36.
T9827 454251-454320 Sentence denotes The SF-36 is a questionnaire measuring HRQOL on eight subscales [1] .
T35968 454321-454380 Sentence denotes The use of the SF-36 in proxies has been validated [2, 3] .
T91950 454381-454479 Sentence denotes Participants were asked to complete the SF-36 based on the situation 4 weeks before ICU admission.
T64934 454480-454568 Sentence denotes SF-36 scores were compared with normative data (n = 1,742) [1] , by independent t tests.
T99160 454569-454664 Sentence denotes Results Fifty-one questionnaires were completed, of which 28 (51.9%) were completed by a proxy.
T81656 454665-454800 Sentence denotes HRQOL before ICU admission was signifi cantly lower on all SF-36 domains compared with the general population (P <0.0001) ( Figure 1 ).
T67810 454801-454863 Sentence denotes This is in line with fi ndings in one other Dutch survey [4] .
T38717 454864-454973 Sentence denotes Conclusions HRQOL before admittance to the ICU is lower compared with HRQOL in the normal healthy population.
T55759 454974-455047 Sentence denotes This is likely to contribute to the diminished HRQOL after ICU discharge.
T20559 455048-455189 Sentence denotes To measure the infl uence of critical illness and ICU stay on HRQOL after an ICU stay, it is important to measure HRQOL before ICU admission.
T14973 455190-455362 Sentence denotes Introduction Creation of innovative retention strategies is a major focus for nursing administration as a shortage of nurses recurs and turnover of staff becomes a problem.
T91759 455363-455484 Sentence denotes Retention strategies, to be eff ective, need to be targeted specifi cally to particular conditions of the nursing staff .
T83620 455485-455592 Sentence denotes Introduction Thiopental (TP) is used in severe brain trauma to control high intracranial pressure episodes.
T92919 455593-455712 Sentence denotes Deleterious side eff ects were described that questioned its ability to reach its objectives securely and effi ciently.
T7848 455713-455867 Sentence denotes We analyzed the impact of TP use on cerebral hemodynamics and caregivers' behavior towards recommendations using a high-rate recording information system.
T90108 455868-455937 Sentence denotes Methods A set of 813 hours of data were recorded at a rate of 0.5 Hz.
T88659 455938-455966 Sentence denotes The study was observational.
T6849 455967-456065 Sentence denotes Deleterious episodes were detected using the Information System (IS) and validated by two experts.
T27293 456066-456192 Sentence denotes We detected low cerebral perfusion pressure (CPP), high intracranial (HICP) and/or low mean arterial pressure (lMAP) episodes.
T45031 456193-456273 Sentence denotes We used commonly admitted threshold for the ICP (20 mmHg) and the CPP (60 mmHg).
T32720 456274-456348 Sentence denotes Medical orders intended to reach the recommended objectives were analyzed.
T86124 456349-456439 Sentence denotes Results Forty-eight periods stratifi ed according to TP dose were analyzed on 16 patients.
T43731 456440-456517 Sentence denotes Cumulative duration with TP was 20,520 minutes and 26,294 minutes without TP.
T33020 456518-456597 Sentence denotes The mean dose of TP administration was 250 ± 20 mg/hour (3.4 ± 1.4 mg/kg/hour).
T27467 456598-456678 Sentence denotes The HICP incidence was 85 ± 16 per 100 hours with TP vs 95 ± 29 without TP (NS).
T91549 456679-456749 Sentence denotes HICP duration was longer with TP (27 ± 2 vs 19 ± 2 minutes, P <0.005).
T13961 456750-456849 Sentence denotes The lMAP incidence was the same with or without TP (56 ± 19 vs 34 + 8 per 100 hours of monitoring).
T59541 456850-456939 Sentence denotes Duration of lMAP episodes was the same with or without TP (22 ± 2 vs 20 ± 2 minutes, NS).
T81759 456940-457093 Sentence denotes The incidence of orders intended to restore cerebral hemodynamics was equivalent in both situations (TP vs no TP, 79 ± 24 vs 104 ± 29 per 100 hours, NS).
T43771 457094-457152 Sentence denotes One hundred and eighty-eight medical orders were analyzed.
T25879 457153-457242 Sentence denotes Use of catecholamine was more frequent with TP (57% (n = 44) vs 43% (n = 33), P = 0.034).
T70760 457243-457320 Sentence denotes Conclusions The use of TP complies with the recommendations (prolonged HICP).
T10553 457321-457401 Sentence denotes It did not result in a signifi cant increase in cerebral hypoperfusion episodes.
T47472 457402-457461 Sentence denotes We showed evidence of adaptations to its use by physicians.
T77047 457462-457599 Sentence denotes The doses are lower than the doses prescribed earlier in the literature and the use of catecholamine is more frequent during TP infusion.
T40261 457600-457718 Sentence denotes This could result in a better control of deleterious side eff ects of TP and a better compliance with recommendations.
T28818 457719-457773 Sentence denotes Our IS was effi cient in physicians' orders' analysis.
T28294 457774-457947 Sentence denotes Introduction Mistakes and errors may occur during the care process, particularly in the ICU as characterized by its large number of drugs administered to the single patient.
T66807 457948-458130 Sentence denotes One of the most important infl uencing factors on intramural morbidity and mortality is indeed a harmful or unpredicted reaction to a drug, a so-called adverse drug event (ADE) [1] .
T18681 458131-458202 Sentence denotes By far the largest proportion (70%) of these ADEs is dose related [1] .
T86932 458203-458389 Sentence denotes The objectives of this study are to measure the frequency and severity of ADEs in the ICU and to determine the infl uence of severity of illness and nursing workload on their prevalence.
T11033 458390-458504 Sentence denotes Methods A cross-sectional study in the ICU of a tertiary referral hospital, based on a retrospective chart review.
T96374 458505-458654 Sentence denotes A tool was developed for measuring the incidence and characteristics of ADEs based on the Global Trigger Tool for Measuring Adverse Drug Events [2] .
T3977 458655-458871 Sentence denotes If an ADE was identifi ed the severity was evaluated using the categories based on the system for classifying medication errors by the National Coordination Council for Medication Error Reporting and Prevention [3] .
T50166 458872-459061 Sentence denotes The severity of illness was calculated using the Sepsis-related Organ Failure Assessment score [4] and the nursing workload by the classical Therapeutic Intervention Scoring System-28 [5] .
T65691 459062-459175 Sentence denotes The review of 1,009 nursing days in 79 patients revealed 230 ADEs, which occurred in a total of 175 nursing days.
T47564 459176-459285 Sentence denotes The most commonly identifi ed ADE was a hypoglycemia of <50 mg/dl (n = 75), followed by hypokalemia (n = 67).
T46603 459286-459404 Sentence denotes Ninety-six percent of the ADEs were classifi ed as category E, whereas only 4% of ADEs were classifi ed as category F.
T43124 459405-459563 Sentence denotes The mean severity of illness and nursing workload scores were signifi cant higher on nursing days when an ADE occurred (P <0.001 and P = 0.002, respectively).
T21025 459564-459603 Sentence denotes Conclusions ADEs are common in the ICU.
T28129 459604-459761 Sentence denotes The lack of a golden standard for reporting and collecting ADEs makes it diffi cult to compare with other studies and to assess the real value of this study.
T66505 459762-459897 Sentence denotes However, these date strongly and clearly indicate the infl uence of severity of illness and nursing workload on the prevalence of ADEs.
T62606 459898-459957 Sentence denotes Introduction Appropriate use of ICU resources is mandatory.
T28487 459958-460105 Sentence denotes When a patient is admitted to a unit able to provide a higher (lower) level of care than required, a waste (overuse) of resources can be advocated.
T87760 460106-460305 Sentence denotes StART is an approach to identify possible mismatches between the level of care actually delivered, assumed to correspond to what is clinically required, and the level of care deliverable by the unit.
T61855 460306-460477 Sentence denotes Methods ICU beds are classifi ed by levels of care deliverable as High (ventilator, monitor, and 720 minutes nurse time) and Low (monitor and 360 minutes nurse time) [1] .
T4127 460478-460793 Sentence denotes The level of care actually delivered is classifi ed as High (invasive or non-invasive ventilation, or two vasoactive drugs, or at least two of the following: one vasoactive drug, dialysis, respiratory support), Low (single vasoactive drug, or dialysis, or respiratory support) and Ordinary (none of the above) [2] .
T26965 460794-460956 Sentence denotes Mismatches between the level of beds available and the level of care delivered were evaluated both on admission and for each ICU-day of 4,237 patients in 28 ICUs.
T12752 460957-461061 Sentence denotes An ICU-day was judged as inappropriate, even without mismatch, if an Ordinary patient was present. [1] .
T16994 461062-461127 Sentence denotes Patients in critical care typically receive highrisk medications.
T40290 461128-461215 Sentence denotes Error reporting is integral to identifying common errors and medication risk reduction.
T78249 461216-461344 Sentence denotes Methods A medication reporting form was developed to run alongside the offi cial hospital incident reporting system for 2 weeks.
T53782 461345-461406 Sentence denotes Forms were distributed throughout the critical care facility.
T36537 461407-461545 Sentence denotes All members of the multidisciplinary team were asked to anonymously complete a form every time a medication error, or near miss, occurred.
T79501 461546-461615 Sentence denotes After 2 weeks, the submitted forms were analysed by the project team.
T33340 461616-461652 Sentence denotes In total 112 reports were submitted.
T21453 461653-462025 Sentence denotes The largest numbers of incidents reported were due to prescribing (67%) errors followed by administration (15%), documentation (7%), electronic prescribing problems (6%), storage (3%) and monitoring (2% Introduction Communication between healthcare professionals is a key step for patient safety, its failure accounting for over 60% of root causes in sentinel events [1] .
T43146 462026-462225 Sentence denotes Bedside rounds are important for teamwork communication and can be improved by an explicit approach [2] and by process-oriented information tools to organize and direct interprofessional rounds [3] .
T51603 462226-462537 Sentence denotes Methods As part of a quality improvement project, we conducted an observation of the documentation of daily goals (DG) and best practices (BP) in a step-down unit (both tools have been previously added to patient fl owsheets), before and after the introduction of a structured rounds process and team education.
T86121 462538-462645 Sentence denotes Our hypothesis was that these important tools were used before rounds, without input from all team members.
T62948 462646-462824 Sentence denotes Rounds were observed on two separate periods and the observer would take notes of whether DG and BP were documented or not and whether discussion took place before documentation.
T96591 462825-462916 Sentence denotes Diff erences in proportions between the two periods were analyzed with Fisher's exact test.
T23244 462917-462953 Sentence denotes P <0.05 was considered signifi cant.
T46039 462954-463006 Sentence denotes We observed 100 bedside interactions on each period.
T80984 463007-463255 Sentence denotes Documentation remained unchanged for DG (pre 55% vs post 53%, P >0.05) and BP (pre 57% vs post 48%); however, the second period had an improved documentation after team discussion (DG: pre 2% vs post 31%, P <0.001; BP pre 0% vs post 33%, P <0.001).
T82019 463256-463406 Sentence denotes Conclusions The intervention aided in increasing documentation after discussion, implying an increased communication among the interprofessional team.
T49212 463407-463484 Sentence denotes About 50% of patients still will not have documentation after bedside rounds.
T68207 463485-463601 Sentence denotes Patient information was not collected, therefore our study is limited in providing information on clinical outcomes.
T26767 463602-463782 Sentence denotes Further research should focus on how to best implement these tools, how to qualitatively assess the content of daily goals and to demonstrate eff ects on patient-centered outcomes.
T85766 463783-463928 Sentence denotes Introduction The use of a high-fi delity simulator can lead to very realistic clinical situations sometimes diffi cult to manage psychologically.
T7412 463929-464084 Sentence denotes The aim of this study was to evaluate the psychological stress induced by simulationbased training and the associated skills in anesthesiologist residents.
T32280 464085-464130 Sentence denotes Methods A cohort of 27 residents was studied.
T29698 464131-464303 Sentence denotes The psychological stress just before and after the simulation session was quantifi ed by autoevaluation scale (numeric scale 0 to 10) and by salivary amylase sampling [1] .
T79388 464304-464419 Sentence denotes Nontechnical skills were quantifi ed by analysing videotapes and scoring the Anaesthetist NonTechnical Skills [2] .
T84150 464420-464557 Sentence denotes The median stress numeric scale before the simulation session was 5 (ranging 2 to 8), and after was 7 (2 to 10) (P = 0.0004) (Figure 1 ).
T75522 464558-464691 Sentence denotes The stress scale before the session was signifi cantly lower in residents who already underwent simulation-based training (P = 0.04).
T49161 464692-464772 Sentence denotes In 48% of residents, stress scales after the simulation session were above 8/10.
T28632 464773-464896 Sentence denotes Salivary amylase after the session was signifi cantly higher than before (P = 0.008), corresponding to a 2.2-fold increase.
T45796 464897-465001 Sentence denotes They were no signifi cant relationships between psychological stress parameters and nontechnical skills.
T82913 465002-465230 Sentence denotes Conclusions Psychological stress before the simulation session, but especially after simulation, appears to be high in anesthesiologist residents, and particularly in those who performed a simulation session for the fi rst time.
T3470 465231-465309 Sentence denotes This fact should be considered when organising such simulation-based teaching.
T94677 465310-465320 Sentence denotes References
T25731 465321-465411 Sentence denotes The respiratory therapist has a central role in the management of critically ill patients.
T23540 465412-465548 Sentence denotes The objective of this study was to evaluate the impact of an education program aiming to improve quality of care of respiratory therapy.
T97580 465549-465820 Sentence denotes Methods A before-after study was designed to assess compliance to 15 respiratory therapy indicators, chosen due to their relevance in patient care and availability for objective measurement, in all patients admitted to the ICU regardless of mechanical ventilation or not.
T89042 465821-465907 Sentence denotes Compliance was assessed during 1 month before implementation of the education program.
T41401 465908-466040 Sentence denotes The educational process comprised of meetings, group training, written manuals and individual feedback for noncompliance situations.
T59059 466041-466129 Sentence denotes After 6 months of the implementation process, compliance assessment was again performed.
T69659 466130-466143 Sentence denotes Results [1] .
T36976 466144-466252 Sentence denotes We decided to study the level of adherence of Mexican physicians to the measures proposed in this checklist.
T49174 466253-466380 Sentence denotes Methods We conducted a 3-month prospective observational study in the adult ICU of an academic hospital in northeastern Mexico.
T61662 466381-466564 Sentence denotes Patients were sorted into one of the two study groups: group 1 had a critical care physician on charge of the ICU management, while group 2 had a noncritical care physician on charge.
T34334 466565-466641 Sentence denotes We measured the adherence of the physicians to the FAST HUG checklist items.
T77763 466642-466712 Sentence denotes We arbitrarily defi ned good compliance as having fulfi lled >4 items.
T43176 466713-466858 Sentence denotes Results One hundred and forty-seven patients were admitted to the ICU during the study period, but only 129 had complete data and were evaluated.
T37289 466859-466924 Sentence denotes There were 86 patients in group 1, while group 2 had 43 patients.
T17361 466925-466993 Sentence denotes Group 1 patients had higher age, SOFA and APACHE score on admission.
T30523 466994-467158 Sentence denotes We analyzed the subgroup of patients who had an initial APACHE score between 11 and 25, as they are usually the ones most likely to benefi t from FAST HUG measures.
T75999 467159-467200 Sentence denotes These results are described in Table 1 .
T24314 467201-467417 Sentence denotes We noticed that most of the group 1 patients had severe sepsis, while most of the group 2 patients had ischemic heart disease, which clearly explains the diff erences in mechanical ventilation and length of ICU stay.
T53987 467418-467497 Sentence denotes Results The cohorts examined resulted in similar demographic and clinical data.
T11908 467498-467594 Sentence denotes As shown in Figure 1 , microorganisms isolated did not change signifi cantly in the two periods.
T18455 467595-467699 Sentence denotes Figure 2 summarizes the diff erences in tracheal aspirate/blood culture isolation among the two periods.
T26694 467700-467807 Sentence denotes Conclusions We cannot confi rm that a single-bed room location can prevent nosocomial infection diff usion.
T23893 467808-467845 Sentence denotes A limit of this study, as in previous
T52855 467846-468057 Sentence denotes The sniffi ng position is widely promoted for teaching airway positioning prior to intubation attempts, but whether this analogy results in novices placing the head and neck appropriately has not been evaluated.
T26397 468058-468150 Sentence denotes An alternate analogy -win with the chin -or simple anatomic instructions may perform better.
T4246 468151-468303 Sentence denotes Methods Randomized controlled study comparing diff erent instructions for enabling novices to adequately position a simulator mannequin's head and neck.
T32131 468304-468399 Sentence denotes Study volunteers included medical students and PGY1 residents in surgery and internal medicine.
T84498 468400-468637 Sentence denotes Subjects independently positioned a mannequin based upon their understanding of four randomly-assigned written instructions for: the sniffi ng position; the win with the chin analogy; anatomic instructions; and no instructions (control).
T27693 468638-468809 Sentence denotes Digital photographs following each instruction were analyzed by two airway experts for adequacy of overall positioning, and for the three components of airway positioning.
T98586 468810-468843 Sentence denotes Results There were 81 volunteers.
T11070 468844-469051 Sentence denotes The positioning was adequate most often (43.2%) following the win with the chin analogy as compared with the other instructions (37.0% anatomic instructions; 19.8% control; 14.8% sniffi ng position analogy).
T1245 469052-469160 Sentence denotes Positioning following the sniffi ng position instructions was not diff erent from no instruction (P = 0.53).
T97068 469161-469282 Sentence denotes The win with the chin and anatomic instructions were better than no instructions (P = 0.002 and P = 0.023, respectively).
T22670 469283-469513 Sentence denotes The win with the chin analogy resulted in adequate airway positioning signifi cantly more often than the sniffi ng position or control, and maintained atlanto-occipital extension when compared with providing anatomic instructions.
T71605 469514-469689 Sentence denotes Overall, win with the chin was a superior teaching analogy and could replace the sniffi ng position analogy. with an average APACHE II score of 13 and average SOFA score of 5.
T95451 469690-469808 Sentence denotes Four admissions (17%) were elective, due to severe co-morbidities, extreme weight or anticipated airway diffi culties.
T5169 469809-469933 Sentence denotes Seven patients needed to go back to theatre one or more times for re-exploratory surgery due to postoperative complications.
T68351 469934-470025 Sentence denotes Three patients remained intubated for 19 days or more, two of whom required a tracheostomy.
T74393 470026-470104 Sentence denotes Three patients died; two from intra-abdominal haemorrhage and one from sepsis.
T51824 470105-470194 Sentence denotes Conclusions This is a high-risk cohort of patients, with 4.8% requiring an ICU admission.
T78346 470195-470329 Sentence denotes The need for patients to return to theatre for re-exploratory surgery was associated with longer ICU stays and multiple complications.
T36903 470330-470509 Sentence denotes This demand on critical care services is likely to increase as bariatric surgery continues to grow as a specialty and the NHS will need to increase investment in ICUs accordingly.
T95821 470510-470636 Sentence denotes Five Results Over the 5-year period, both quantities and costs of drugs increased, following a nonsteady, nonparallel pattern.
T61877 470637-470969 Sentence denotes Four ATC codes accounted for 80% of both quantities and costs, with ATC code B (blood and haematopoietic organs) amounting to 63% in quantities and 41% in costs, followed by ATC code J (systemic anti-infective, 20% of the costs), ATC code N (nervous system, 11% of the costs) and ATC code C (cardiovascular system, 8% of the costs).
T3368 470970-471046 Sentence denotes Prescription by SC amounted to 1% in drug quantities, but 19% in drug costs.
T89978 471047-471156 Sentence denotes The rate of increase in quantities and costs was seven times larger for ICP than for SC (Figure 1 overleaf ).
T76930 471157-471248 Sentence denotes Some peak values in costs and quantities were related to a very limited number of patients.
T52831 471249-471357 Sentence denotes Conclusions A 5-year increase in quantities and costs of drug prescription in an ICU is a matter of concern.
T67469 471358-471439 Sentence denotes Rather unexpectedly, total costs and cost increases were generated mainly by ICP.
T58366 471440-471604 Sentence denotes A careful follow-up is necessary to try infl uencing this evolution through an institutional policy co-opted by all professional categories involved in the process.
T28068 471605-471747 Sentence denotes Introduction One consequence of pressure on inpatient hospital bed numbers is a delay in the discharge of critically ill patients to the ward.
T66706 471748-471908 Sentence denotes Although this delay in discharge has been reported in a number of countries, the clinical and economic consequences of this delay have not been studied [1, 2] .
T73014 471909-472087 Sentence denotes Methods We examined data from a mixed London ICU (32 beds) using the medtrack software tool (MASH Ltd) in addition to real-time mapping of ICU bed utilisation and patient fl ows.
T32559 472088-472194 Sentence denotes We defi ned delayed discharge as beginning 3 hours after the actual medical/nursing decision to discharge.
T76619 472195-472340 Sentence denotes We described a set of criteria a priori, to assess the eff ect of delayed patient discharge, searching for both benefi cial and harmful eff ects.
T96203 472341-472490 Sentence denotes We also analysed the economic consequences of discharge delay using the medtrack capture of the critical care minimum dataset and available tariff s.
T6457 472491-472568 Sentence denotes In the 6-month analysis period, there were 15,320 hours of delayed discharge.
T43166 472569-472737 Sentence denotes This resulted in the postponement/delay of 45 operations for patients requiring level 3 intensive care and 177 operations for patients requiring level 2 intensive care.
T62928 472738-472819 Sentence denotes One hundred and fourteen tertiary referrals were refused because of bed blockage.
T4048 472820-472894 Sentence denotes Seventy-two patients were discharged between the hours of 22:00 and 06:00.
T63790 472895-473060 Sentence denotes There was a mean delay of 5.3 hours between identifying a patient requiring unplanned admission to critical care and their actual admission due to delayed discharge.
T94544 473061-473160 Sentence denotes Only 21 patients acquired a hospital-acquired organism while awaiting discharge (seven infections).
T57400 473161-473391 Sentence denotes Family/patient interviews suggested that the negative eff ects of noise and exposure to the resuscitation and/or death of ICU patients were off set by a perceived benefi t of receiving critical care nursing for a prolonged period.
T40722 473392-473513 Sentence denotes This potential benefi t was refl ected by a 72% reduction in the readmission of critically ill patients to critical care.
T84386 473514-473567 Sentence denotes The estimated cost of delayed discharge was £342,000.
T99676 473568-473698 Sentence denotes Conclusions Delayed discharge of patients to the ward following an episode of critical illness is a common and increasing problem.
T42380 473699-473802 Sentence denotes This delay is not benign and should be considered when prioritising bed utilisation in acute hospitals.
T6585 473803-474023 Sentence denotes Introduction Pain is the most relevant factor for prolonged hospital stay after thoracic surgery and is associated with stress known to alter the Th1/Th2 ratio (Th = T helper cells) in the immediate postoperative period.
T98115 474024-474255 Sentence denotes Thoracic epidural block (TEB), central α 2 -receptor stimulation via intravenous clonidine application and stimulation of opioid receptors can decrease either pain and/or stress and might therefore infl uence this immune imbalance.
T88865 474256-474352 Sentence denotes The primary endpoint of the current study was the perioperative Th1/Th2 balance in lung surgery.
T91885 474353-474422 Sentence denotes The secondary endpoints aimed to the incidence of pain and pneumonia.
T96194 474423-474659 Sentence denotes Methods After approval by the ethics committee and informed consent a total of 60 patients was randomized to receive double-blinded either remifentanil intravenously, or remifentanil + clonidine intravenously, or ropivacaine epidurally.
T84803 474660-474722 Sentence denotes Pain intensity was assessed by the numeric rating scale (NRS).
T83326 474723-474784 Sentence denotes The Th1/Th2 ratio was measured using a cytometric bead array.
T9859 474785-474896 Sentence denotes Pneumonia was diagnosed according to the hospital-acquired pneumonia criteria of the American Thoracic Society.
T9310 474897-474984 Sentence denotes The Th1/Th2 ratio adjusted for baseline diff ered between groups over time (P = 0.012).
T4721 474985-475275 Sentence denotes At the end of surgery there was no signifi cant diff erence between the remifentanil and the remifentanil + clonidine groups (P = 0.679) but a signifi cantly lower ratio in the ropivacaine group compared with the remifentanil (P = 0.004) and the remifentanil + clonidine groups (P = 0.019).
T54578 475276-475480 Sentence denotes NRS scores immediately after surgery were lower in the ropivacaine group compared with the remifentanil group and the remifentanil + clonidine group but achieved only borderline statistical signifi cance.
T68268 475481-475522 Sentence denotes None of the patients developed pneumonia.
T40896 475523-475641 Sentence denotes Conclusions Intraoperative TEB decreases the Th1/Th2 ratio and provides better pain therapy immediately after surgery.
T56353 475642-475753 Sentence denotes Introduction Protocol for perioperative usage of beta blockers was used in only 9% of major clinics in the USA.
T26244 475754-475879 Sentence denotes It is a very common practice to discontinue beta blockers during the perioperative period or to maximally reduce their doses.
T84404 475880-476052 Sentence denotes The main purpose of this paper is to investigate the incidence of adverse eff ects of beta blockers during large-scale trauma and orthopedic surgeries in spinal anesthesia.
T93111 476053-476295 Sentence denotes Methods In this open prospective study we evaluated the adverse eff ects of beta blockers in ASA II and III research subjects who received beta blockers 1 to 12 hours preoperatively, n = 37, mean age 67 ± 12, with adjacent metabolic syndrome.
T4017 476296-476420 Sentence denotes Results were compared with the same number of patients and ASA group, mean age 57 ± 18, who have not received beta blockers.
T83552 476421-476573 Sentence denotes Patients from both groups received midazolam premedication 30 minutes before arriving in the operating room and spinal anesthesia with 0.5% bupivacaine.
T25938 476574-476689 Sentence denotes Patient surveillance was conducted by continued EKG, blood pressure, pulse (all non-invasive) and SpO 2 monitoring.
T97029 476690-476763 Sentence denotes Systolic and diastolic pressure and pulse were recorded every 10 minutes.
T65645 476764-476815 Sentence denotes Results were statistically tested (M ± SD, t test).
T37877 476816-476851 Sentence denotes The results are shown in Figure 1 .
T3469 476852-477036 Sentence denotes The group receiving beta blockers shows a higher percentage of patients with hypertension on arrival in the operating room for 11% and hypotension after the start of spinal anesthesia.
T74112 477037-477182 Sentence denotes Occurrence of bradycardia (HR <60/minute) was increased with statistical signifi cance for 24% (P <0.05), with use of atropine for 27% (P <0.05).
T69225 477183-477316 Sentence denotes The occurrence of arrhythmias shows a statistical increase in the same group, for 27% (P <0.05), as well as nausea for 29% (P <0.05).
T93102 477317-477488 Sentence denotes Conclusions Due to their adverse eff ects, beta blockers should be discontinued before spinal anesthesia and surgical procedures with signifi cant circulating volume loss.
T87186 477489-477641 Sentence denotes Introduction Surgical-related neuroendocrine stress response extends over the postoperative period, inducing insulin resistance and hyperglycaemia [1] .
T84120 477642-477786 Sentence denotes Remifentanil continuous infusion, reducing pain and anxiety, may reduce postoperative insulin resistance and result in better glycaemic control.
T72141 477787-477942 Sentence denotes The aim of the study was to assess trends in glycaemia and HOMA scores in postoperative patients during remifentanil-driven, postoperative analgo-sedation.
T96133 477943-478093 Sentence denotes Methods Enrolled patients were those consecutively admitted to a surgical ICU after major abdominal interventions during a 1-month period (July 2009).
T7686 478094-478205 Sentence denotes Group R patients underwent analgo-sedation with continuous remifentanil infusion at the recommended doses [2] .
T84565 478206-478296 Sentence denotes Glycaemia and HOMA scores were evaluated at admission time (T0) and after 12 and 24 hours.
T35701 478297-478579 Sentence denotes Control patients were those who underwent morphine-based continuous analgo-sedation (M Group Conclusions Remifentanil-based analgo-sedation was associated with lower glycaemia and HOMA score in patients following major abdominal surgery, particularly at 24 hours from ICU admission.
T94345 478580-478678 Sentence denotes HOMA scores showed that morphine-treated patients were insulin resistant, although normoglycaemic.
T20211 478679-478807 Sentence denotes A better control of the neuroendocrine stress response in patients analgo-sedated with remifentanil might explain these results.
T48649 478808-478939 Sentence denotes Introduction Ultralow-dose opioid antagonists can enhance opioid analgesia and prevent tolerance in rodent nociceptive pain assays.
T7619 478940-479188 Sentence denotes Methods A randomized, double-blind controlled trial is designed to investigate whether the addition of 5 ml ultralow-dose naltrexone (1 μg in a liter of sterile water) to morphine (0.05 mg/kg) changes the total opioid requirement and side eff ects.
T64083 479189-479471 Sentence denotes Results Two hundred and sixty-seven patients (18 to 45 years old) with moderate extremities trauma entered the study, Pain control measurements were evaluated every 15 minutes for the fi rst hour, then every 30 minutes for the second and third hours and fi nally at the fourth hour.
T20117 479472-479539 Sentence denotes Effi cacy was measured by the 11-point numerical pain rating scale.
T26401 479540-479624 Sentence denotes The following side eff ects were evaluated: sedation, nausea, vomiting and pruritus.
T95668 479625-479705 Sentence denotes We found that opioid requirements did not diff er signifi cantly between groups.
T38323 479706-479823 Sentence denotes The morphine + naltrexone group on average required 0.04 mg more morphine during the 4 hours than the morphine group.
T69527 479824-479934 Sentence denotes Conclusions The morphine + naltrexone group had a lower incidence of nausea than the morphine + placebo group.
T55643 479935-480029 Sentence denotes However, the incidence of vomiting, pruritus and sedation between the two groups were similar.
T73717 480030-480240 Sentence denotes The combination of ultralow-dose naltrexone and morphine in moderate Introduction Pulmonary hypertension (PH) is a life-threatening disease commonly seen in ICU septic patients and associated with poor outcome.
T28025 480241-480432 Sentence denotes New and better therapies are required, since the response to various agents such as NO, prostaglandins and phosphodiesterase inhibitors is usually partial and the mortality rate remains high.
T13897 480433-480556 Sentence denotes Inhaled drugs seem to be an attractive treatment option, since they are delivered directly to pulmonary resistance vessels.
T4312 480557-480814 Sentence denotes A new device (anesthetic conserving device -AnaConDa (ACD)) permitting direct administration of volatile anaesthetics -such as sevofl urane -to the breathing circuit of a conventional ICU ventilator in a safe and eff ective way has recently been introduced.
T38107 480815-480973 Sentence denotes The aim of the present study was to evaluate the effi cacy and safety of sevofl urane administration via the ACD on a porcine model of acute PH during sepsis.
T28514 480974-481150 Sentence denotes Methods PH was induced in 16 anaesthetized, mechanically ventilated swine (25 kg) by intravenous infusion of 0.5 mg/kg LPS (Escherichia coli, 111:B4) in a period of 30 minutes.
T23179 481151-481202 Sentence denotes After LPS, animals were randomized into two groups.
T68830 481203-481422 Sentence denotes In group A sevofl urane was infused via the ACD, according to the manufacturer's recommendations in order to obtain an end-tidal concentration of 0.5%, whereas group B did not receive sevofl urane and served as control.
T31049 481423-481589 Sentence denotes Haemodynamic parameters (systemic and pulmonary) were recorded before (phase 0) and after the LPS (phase 1) and every 20 minutes for the next 2 hours (phases 2 to 7).
T48463 481590-481689 Sentence denotes Results LPS was found to produce PH (phase 1) and to reduce arterial blood pressure in both groups.
T21560 481690-481912 Sentence denotes After sevofl urane infusion, both systolic (PAPs) and diastolic (PAPd) pulmonary pressures exhibited step-by-step reduction, which became statistically signifi cant in phase 3 and thereafter, in relation to phase 1 values.
T101 481913-482048 Sentence denotes On the contrary, in group B animals, not sevofl urane-treated, pulmonary pressures remained at high levels throughout the study period.
T68651 482049-482195 Sentence denotes Systemic arterial pressure exhibited an endotoxin-related reduction in both groups, which was not found to be aff ected by sevofl urane treatment.
T73481 482196-482401 Sentence denotes Conclusions Sevofl urane administration via the ACD was found to reduce the pulmonary pressure in a porcine model of endotoxin-induced acute PH without any detrimental eff ects on the systemic circulation.
T55612 482402-482473 Sentence denotes This may represent a signifi cant advance in the treatment of acute PH.
T27067 482474-482553 Sentence denotes However, the potential clinical implications of the method merit further study.
T24386 482554-482793 Sentence denotes Introduction Methyl-naltrexone (Relistor®), a peripheral μ-opioid receptor antagonist shown to induce laxation in patients receiving opioids, is licenced for use in palliative care; a similar benefi t is proposed in critical care patients.
T28101 482794-482961 Sentence denotes Impaired gut motility and constipation are common issues in the critical care setting with contributing factors including trauma, surgery and use of opiate analgesics.
T63796 482962-483175 Sentence denotes The eff ects of methyl-naltrexone were studied on seven patients in whom conventional treatment for constipation with stimulant and osmotic laxatives, faecal softeners and suppositories failed to produce eff ects.
T15910 483176-483328 Sentence denotes Methods Over a 6-week period, 15 critically ill patients with opiateinduced constipation (OIC) of more than 4 days duration were pros pectively studied.
T49753 483329-483544 Sentence denotes All patients were treated with conventional methods from admission to critical care, which included regular senna and sodium docusate, supplemented with glycerin suppositories and picolax for resistant constipation.
T24768 483545-483669 Sentence denotes Methyl-naltrexone was administered to seven patients at 0.15 μg/kg subcutaneously on alternate days until laxation occurred.
T19688 483670-483745 Sentence denotes The remainder of patients in the study continued with conventional therapy.
T15828 483746-483859 Sentence denotes Results Six out of seven patients responded to methyl-naltrexone with laxation occurring between 12 and 24 hours.
T15021 483860-483976 Sentence denotes One patient did not respond due to faecal impaction but subsequently experienced laxation after manual disimpaction.
T16130 483977-484075 Sentence denotes Side eff ects were few (nausea 14%, vomiting 14%) and there was no increase in opiate requirement.
T63195 484076-484178 Sentence denotes Those patients treated by conventional means eventually produced laxation after a further 3 to 5 days.
T83600 484179-484382 Sentence denotes Conclusions Previous studies have shown the earlier return of gut motility improves patient progress, facilitates earlier respiratory weaning, prevents debilitation and results in reduced length of stay.
T55658 484383-484535 Sentence denotes Methyl-naltrexone is a safe and effi cacious drug for the treatment of OIC in critical care patients in whom conventional treatments prove unsuccessful.
T73959 484536-484599 Sentence denotes Side eff ects are few and opiate requirements remain unchanged.
T93735 484600-484734 Sentence denotes Further investigation to elucidate the cost-eff ectiveness of methyl-naltrexone use in OIC of the critically ill patient is warranted.
T2201 484735-484840 Sentence denotes Introduction Evidence suggests prolonged sedation is associated with prolonged ventilation and mortality.
T12425 484841-485049 Sentence denotes Further evidence suggests that some sedatives and analgesics are more prone to cause oversedation than others, possibly due to disturbances in pharmacokinetic properties in the context of acute organ failure.
T90471 485050-485204 Sentence denotes Our aim was to describe current sedation and analgesic practice in UK ICUs, and to determine whether recent evidence has changed practice in recent years.
T99598 485205-485359 Sentence denotes Methods We performed a web-based survey using a tool developed via a systematic, step-wise process following recognised practice for questionnaire design.
T33540 485360-485492 Sentence denotes These steps included question development and questionnaire formatting and testing before being published on the Zoomerang™ website.
T27844 485493-485754 Sentence denotes Conclusions Propofol has been proposed as an alternative to benzodiazepines in severe AWS, but it could increase the rate of complications (especially seizures and respiratory infections) that could lead to an increase in the intubation rate and length of stay.
T97657 485755-485838 Sentence denotes The APACHE score could be a predictor for the risk of complications and intubation.
T66079 485839-486015 Sentence denotes Introduction The objective of this study was to identify the proportion of patients who experienced agitation and/or pain during physiotherapy sessions in intensive care (ICU).
T40268 486016-486102 Sentence denotes The prevalence and causes of distress in critically ill patients are poorly described.
T11116 486103-486234 Sentence denotes Identifi ed stressors include physiotherapy [1, 2] , but no standards for sedation/analgesia management during physiotherapy exist.
T92732 486235-486430 Sentence denotes Recent evidence supporting routine ICU management at lighter levels of sedation potentially increases the importance of interventions to avoid distress during interventions such as physiotherapy.
T16005 486431-486488 Sentence denotes Methods A prospective observational study was undertaken.
T63544 486489-486609 Sentence denotes Fortynine patients admitted to the ICU requiring mechanical ventilation and physiotherapy were recruited into the study.
T90544 486610-486684 Sentence denotes A single session of physiotherapy was observed by an independent assessor.
T27860 486685-486807 Sentence denotes Agitation was measured using the Richmond Agitation Sedation Scale (RASS) and pain using the Behavioural Pain Scale (BPS).
T63876 486808-486959 Sentence denotes The RASS and BPS were collected immediately pre physiotherapy, after each intervention during physiotherapy and at 5 and 30 minutes post physiotherapy.
T65124 486960-487093 Sentence denotes Results Sixteen participants (33%) experienced agitation (RASS score ≥1) while 48 participants (98%) experienced pain (BPS score ≥4).
T39002 487094-487227 Sentence denotes Figure 1 shows the number of participants who experienced agitation and pain in relation to their RASS level prior to physiotherapy.
T95502 487228-487422 Sentence denotes Of interest, the independent assessor observed little communication, in regards to the management of sedation or pain at any stage during physiotherapy, between nursing and physiotherapy staff .
T33930 487423-487517 Sentence denotes Regardless of the RASS level pre physiotherapy, the majority of participants experienced pain.
T15956 487518-487647 Sentence denotes In contrast, only one-third of participants experienced agitation; this was more prevalent for those at a lighter sedation level.
T46927 487648-487840 Sentence denotes More routine use of RASS, BPS and communication with nursing staff should be undertaken during physiotherapy to ensure optimal levels of sedation and adequate levels of analgesia are achieved.
T29950 487841-488254 Sentence denotes Introduction Contrary to wards that manage usually chronic or acute pain (algology, gerontology, surgery, recovery room, and so forth), a comparison of the fi ve most popular self-report pain tools (vertical and horizontal Visual Analog Scale (VAS-V, VAS-H), 0 to 10 oral Numeric Rating Scale (NRS-O), 0 to 10 visual enlarged NRS (NRS-V), Verbal Descriptor Scale (VDS)) has never been evaluated in an ICU setting.
T75752 488255-488404 Sentence denotes Methods Consecutive patients admitted to a medical-surgical ICU during 1 year were included when alert (RASS >-2) and able to follow simple commands.
T87304 488405-488502 Sentence denotes Exclusion criteria: previous self-report pain assessment without the presence of an investigator.
T38462 488503-488695 Sentence denotes Pain assessment using the fi ve scales in random order either at baseline (T1) and after (T2) administration of an analgesic, or during a nociceptive procedure, in absence of pain at baseline.
T83471 488696-488807 Sentence denotes Evaluated parameters: psychometric properties of scales (feasibility, validity, responsiveness and preference).
T15041 488808-488878 Sentence denotes Nonparametric tests were used for statistical analysis (Statview 5.0).
T59755 488879-488923 Sentence denotes Data are expressed as median (25th to 75th).
T31680 488924-488980 Sentence denotes Results All basal levels were below the expected values.
T33392 488981-489130 Sentence denotes Following enteral administration, pharmacological levels were already reached in 5 minutes, with a serum peak after 16 minutes (half-absorption time:
T20687 489131-489153 Sentence denotes 3 minutes 17 seconds).
T73943 489154-489286 Sentence denotes The maximum serum level observed was 11,040 pg/ml and the disappearance rate indicated a half-elimination time of 1 hour 34 minutes.
T1054 489287-489430 Sentence denotes Serum melatonin levels decreased signifi cantly after midnight; pharmacological levels were maintained up to 10 hours following administration.
T81674 489431-489490 Sentence denotes No excessive sleepiness was reported in this patient group.
T23619 489491-489596 Sentence denotes Conclusions Critically ill patients exhibited reduced melatonin secretion, as reported in the literature.
T98028 489597-489845 Sentence denotes Despite the critical illness, the oral bioavailability was satisfactory: serum levels after oral administration showed basically unchanged intestinal absorption, while the disappearance rate was slower than reported elsewhere in healthy volunteers.
T81201 489846-490039 Sentence denotes Introduction The aim of our study is to describe clinical progress, need for mechanical ventilation (MV), complications and mortality of patients with delirium tremens (DT) admitted to our ICU.
T36571 490040-490178 Sentence denotes Methods Patients with a diagnosis of DT admitted to a medical ICU of a tertiary hospital from January 2001 to December 2008 were included.
T33225 490179-490399 Sentence denotes We recorded: admission diagnosis, pathologies associated with DT, APACHE II score, treatment, need for MV and duration, complications, length of stay in the ICU and total hospital stay, mortality and survival at 2 years.
T65192 490400-490434 Sentence denotes Results There were 50 cases of DT.
T13082 490435-490465 Sentence denotes Median age 45 years, 96% male.
T77543 490466-490557 Sentence denotes Reasons for hospital admission: DT (68%), seizures (36%), sepsis (16%), brain injury (10%).
T47646 490558-490690 Sentence denotes Reasons for admission to the ICU: DT (54%), DT and seizures (26%), DT and brain injury (10%), DT and sepsis (8%), DT and other (2%).
T64588 490691-490727 Sentence denotes Median APACHE II score was 9 (range:
T12461 490728-490737 Sentence denotes 8 to 13).
T6872 490738-490899 Sentence denotes Seventy-four percent of the patients were controlled with no need for MV with a midazolam infusion of 45 to 50 μg/kg/hour and haloperidol of 17 to 30 μg/kg/hour.
T33883 490900-491024 Sentence denotes Twenty-eight per cent (14 patients) required MV, of them 78% had DT and other associated pathology on admission (Figure 1 ).
T8184 491025-491119 Sentence denotes From a total of 28 patients admitted with DT and no associated pathology, only four needed MV.
T1151 491120-491160 Sentence denotes The median time on MV was 2 days (range:
T16839 491161-491169 Sentence denotes 1 to 9).
T96384 491170-491271 Sentence denotes Complications were present in 22%: ventilation-associated pneumonia, and other infectious conditions.
T86603 491272-491315 Sentence denotes Total hospital length of stay 14 days ((SD:
T856 491316-491345 Sentence denotes 11), 5.5 days in the ICU (SD:
T45450 491346-491349 Sentence denotes 9).
T71443 491350-491391 Sentence denotes The registered hospital mortality was 4%.
T48559 491392-491607 Sentence denotes Rate of survival at 2 years was 84%, from these 72% had continuous visits to emergency (≥5 consultations in 2 years) for episodes related to alcohol withdrawal or complications associated with chronic alcohol abuse.
T91216 491608-491816 Sentence denotes Conclusions Even though our patients with DT are frequently admitted to the ICU, this is a pathology that most of the time has a benign course with low hospital mortality and high rate of survival at 2 years.
T48796 491817-491871 Sentence denotes These patients are regular users of the health system.
T8704 491872-492007 Sentence denotes The occurrence of complications and the need for MV in our patients were low, and were present in the group of DT with other diagnoses.
T17093 492008-492185 Sentence denotes Introduction Delirium in ICU patients increases time on mechanical venti lation, is an independent risk factor for death and can cause cognitive impairment in survivors [1, 2] .
T9826 492186-492395 Sentence denotes The two most commonly used validated assessment methods for diagnosing delirium in intensive care are the Confusion Assessment Method for ICU (CAM) and the Intensive Care Delirium Checklist Score (ISDCS) [3] .
T55237 492396-492613 Sentence denotes We wished to determine the prevalence of delirium in our unit, whether there was a diff erence in results between these methods of assessment and whether good agreement could be achieved between two trained assessors.
T94399 492614-492691 Sentence denotes Methods We performed a prospective prevalence study in a single tertiary ICU.
T28901 492692-492831 Sentence denotes Patients were assessed between days 3 and 10 of their stay and tested provided their Richmond Agitation Sedation Score (RASS) was ≥-3 [1] .
T26787 492832-492994 Sentence denotes Each patient was independently assessed by the two trained assessors with the CAM and ISDCS, with randomisation of both the order of interview and the score used.
T89787 492995-493066 Sentence denotes Both sets of assessments were carried out within an hour of each other.
T63048 493067-493179 Sentence denotes Exclusions included readmissions, those who did not speak English, the deaf and registered psychiatric patients.
T14671 493180-493287 Sentence denotes The CAM was completed by the assessors and the ISDCS required observational answers from the bedside nurse.
T87198 493288-493344 Sentence denotes We performed 104 assessments (208 tests) on 52 patients.
T20084 493345-493466 Sentence denotes Mean (SD) age, APACHE II and total SOFA on the day of admission were 67.4 (14.0), 14.0 (5.3) and 5.7 (2.7), respectively.
T14760 493467-493549 Sentence denotes Delirium was found in 37.5% of patients using the CAM, but only 14.4% using ISDCS.
T73764 493550-493685 Sentence denotes Inter-rater agreement for CAM and ISDCS was 86.5% (κ 71.4%, SE 13.8%, P <0.001) and 94.2% (κ 76.7%, SE 13.8%, P <0.0001), respectively.
T21850 493686-493756 Sentence denotes There was signifi cant underscoring of the RASS by the bedside nurses.
T73484 493757-493872 Sentence denotes When the trained assessors found a diff erence, it was always lower than the score documented by the bedside nurse.
T23033 493873-494095 Sentence denotes Conclusions There was good inter-rater agreement in the diagnosis of delirium between the two trained assessors, but the prevalence found was lower than previously reported [1] and varied considerably with the method used.
T74507 494096-494247 Sentence denotes The diff erence in results between the two scores may be due to a lack of discernment on the part of the bedside nurse of the ISDCS assessment process.
T84314 494248-494322 Sentence denotes Introduction Delirium aff ects up to 33% of acutely hospitalized patients.
T27804 494323-494401 Sentence denotes In ICU patients it can prolong the length of stay and increase mortality [1] .
T70457 494402-494542 Sentence denotes The optimal management of delirium requires a calm environment, sleep hygiene and correction of underlying factors (for example, infection).
T94026 494543-494678 Sentence denotes This can be a challenge in the ICU, and drug therapy, commonly haloperidol, clonidine, benzodiazepines or propofol, is often used [1] .
T58327 494679-494771 Sentence denotes Quetiapine, an atypical antipsychotic, has been used in acute delirium outside the ICU [2] .
T5598 494772-494854 Sentence denotes It has few extrapyramidal side eff ects, a short half-life and is mildly sedating.
T74164 494855-494925 Sentence denotes Our impression was that it had potential in the treatment of delirium.
T14512 494926-495122 Sentence denotes Methods In a 30-bed tertiary ICU with more than 1,200 admissions annually we reviewed the notes of patients admitted from February 2008 to November 2009 who had a delirium treated with quetiapine.
T47257 495123-495196 Sentence denotes Patients were excluded if they were taking quetiapine prior to admission.
T52171 495197-495230 Sentence denotes The following data were recorded:
T58176 495231-495432 Sentence denotes Richmond Agitation and Sedation Score Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1 S166 (RASS), duration of delirium, agents used, patient demographics and adverse events.
T56225 495433-495493 Sentence denotes Results Five patients met the inclusion criteria (Table 1) .
T85795 495494-495530 Sentence denotes All were males, aged 37 to 85 years.
T61984 495531-495734 Sentence denotes All had a prolonged delirium prior to the commencement of quetiapine and all were on a combination of four drugs (clonidine, haloperidol, lorazepam and propofol) that were not controlling their delirium.
T80136 495735-495838 Sentence denotes At 3 to 7 days following commencement of quetiapine the RASS scores were 0 and other drugs were ceased.
T82622 495839-495870 Sentence denotes No adverse eff ects were noted.
T80609 495871-496006 Sentence denotes Conclusions Quetiapine was successful in controlling prolonged ICU delirium and allowed weaning of other medications in these patients.
T89120 496007-496043 Sentence denotes It may be a useful delirium therapy.
T25749 496044-496109 Sentence denotes Further studies are required to demonstrate effi cacy and safety.
T91519 496110-496145 Sentence denotes References vs 36.9%, respectively).
T66749 496146-496241 Sentence denotes The ICU length of stay tended to be longer in the SynColl-Group (14 versus 10 days, P = 0.055).
T18685 496242-496462 Sentence denotes Conclusions In patients with severe sepsis, fl uid therapy with synthetic colloids -gelatin or the third-generation 6% HES 130/0.4 -considerably increases the incidence of ARF and need for RRT compared with crystalloids.
T26918 496463-496596 Sentence denotes These results confi rm recent meta-analysis and RCTs, which demonstrated an increased incidence of ARF by synthetic colloids [2, 3] .
T54487 496597-496703 Sentence denotes Introduction Dehydration is an important problem among patients admitted to the emergency department (ED).
T89395 496704-496787 Sentence denotes However, there has not yet been a consensus on the ideal fl uid for these patients.
T80322 496788-496914 Sentence denotes This study was planned to evaluate the ideal crystalloid for the patients admitted to the ED who have symptoms of dehydration.
T43306 496915-497003 Sentence denotes Methods We conducted a randomized controlled trial that included 90 dehydrated patients.
T2463 497004-497151 Sentence denotes Three groups of patients each included 30 randomized for one of the solutions Lactated Ringer's, 0.9% NaCl or Isolyte® (Eczacıbaşı-Baxter, Turkey).
T21723 497152-497215 Sentence denotes Solutions were infused at a rate of 20 ml/kg/ hour for 2 hours.
T63932 497216-497312 Sentence denotes Venous blood sample pH, Na + , K + , Cl -, and HCO 3 levels were evaluated at 0, 1, and 2 hours.
T332 497313-497448 Sentence denotes Results We detected a decrease in serum pH (7.406 to 7.365) and HCO 3 -(23.1 to 21.5) levels at the second hour in the 0.9% NaCl group.
T27995 497449-497573 Sentence denotes However, in the Isolyte® group an increase in both serum pH (7.410 to 7.434) and HCO 3 -(23.4 to 24.4) levels were observed.
T54694 497574-497791 Sentence denotes In the Lactated Ringer's group, Introduction To evaluate early continuous venovenous hemodiafi ltration (CVVHDF) in patients with refractory septic shock and multiorgan failure upon mortality and morbidity in the ICU.
T42494 497792-498059 Sentence denotes Methods Forty patients were prospectively studied and randomly treated with either conventional treatment (20 patients; group II) or with early CVVHDF (less than 6 hours of maximal hemodynamic support) in addition to the conventional treatment (20 patients; group I).
T83043 498060-498200 Sentence denotes Metabolic acidosis, serum lactate and serum procalcitonin level (PCT) before and 5 days after CVVHDF were monitored to evaluate the outcome.
T69951 498201-498278 Sentence denotes APACHE II and ΔSOFA scoring systems were used before and 5 days after CVVHDF.
T72012 498279-498406 Sentence denotes Results Compared with group II, patients of group I had lower mortality (55% vs 70%) with an insignifi cant P value (P = 0.54).
T10291 498407-498849 Sentence denotes Group I patients showed a nonsignifi cant ΔSOFA (5.95 ± 4.39 vs 6.2 ± 3.3 in groups I and II, respectively, P = 0.66); regarding APACHE II scores, group I also showed statistically nonsignifi cant lower fi gures than group II (on admission APACHE II scores were 39.35 ± 10.65 vs 41.85 ± 10 in groups I and II, respectively, P = 0.45, while on day 5 APACHE II scores were 34.8 ± 10.6 vs 36.1 ± 10.9 in groups I and II, respectively, P = 0.41).
T73248 498850-499130 Sentence denotes Group I patients showed lower PCT on admission and day 5 than group II patients (on admission PCT level was 0.64 ± 0.18 vs 0.68 ± 0.17 in groups I and II, respectively, P = 0.5) while the day 5 PCT level was (0.51 ± 0.15 vs 0.52 ± 0.17 in groups I and II, respectively, P = 0.83).
T52587 499131-499603 Sentence denotes Indicators of improvement showed a statistically signifi cant diff erence between survivors and nonsurvivors in group I regarding serum lactate level at day 5 (P <0.001), while other indicators as fever, renal profi le, WBC count, metabolic acidosis, serum lactate level on admission and platelet count were statistically insignifi cant (on admission P = 0.2, 0.55, 0.45, 0.41, 0.65, 0.55, respectively, and on day 5 P = 0.37, 0.94, 0.71, 0.5, <0.001, 0.88, respectively).
T38528 499604-499850 Sentence denotes There was a signifi cant statistical diff erence between survivors and nonsurvivors in group I considering the number of organ failures as less than or equal to three organs involved in comparison with more than three organs involved (P = 0.008).
T1319 499851-500072 Sentence denotes Introduction Both inhaled hydrogen sulfi de (H 2 S) [1] and intravenous H 2 S donors protected against kidney ischemia/reperfusion (I/R) injury [2] [3] [4] , but all these data originate from unresuscitated rodent models.
T81838 500073-500222 Sentence denotes Therefore, we investigated the eff ect of the H 2 S donor Na 2 S in a clinically relevant porcine model of aortic occlusion-induced renal I/R injury.
T97378 500223-500414 Sentence denotes Methods Anesthetised and ventilated pigs received Na 2 S (n = 9) or vehicle (n = 10) for 2 hours before and 8 hours after 90 minutes of intra-aortic balloon occlusion-induced kidney ischemia.
T12724 500415-500503 Sentence denotes During reperfusion noradrenaline was titrated to keep blood pressure at baseline levels.
T87750 500504-500866 Sentence denotes Before Na 2 S, prior to aortic occlusion and at 1, 2, 4 and 8 hours of reperfusion, we measured renal blood fl ow and function (creatinine clearance and blood levels, fractional Na + excretion), blood cytokines (TNFα, IL-6, IL-1β) and nitrates, renal tissue DNA damage (comet assay), HO-1 and caspase-3 expression (western blotting), and NF-κB activation (EMSA).
T65292 500867-500957 Sentence denotes Histological damage (glomerular tubularisation [5] ) was assessed immediately post mortem.
T75250 500958-501141 Sentence denotes Results Na 2 S pretreatment was associated with a progressive fall in core temperature and signifi cantly lower noradrenaline infusion rates needed to achieve the hemodynamic targets.
T4290 501142-501399 Sentence denotes While renal blood fl ow and fractional Na + excretion were comparable, Na 2 S attenuated the fall in creatinine clearance and the rise in creatinine blood levels, respectively, which coincided with signifi cantly lower IL-6, IL-1β, and nitrate blood levels.
T90478 501400-501547 Sentence denotes Kidney glomerular and tissue DNA damage were markedly attenuated, whereas NF-κB activation was signifi cantly higher in the Na 2 S-treated animals.
T2158 501548-501779 Sentence denotes Conclusions In a clinically relevant porcine model mimicking aortic cross-clamping-induced kidney I/R injury, Na 2 S attenuated tissue injury and organ dysfunction as a result of reduced systemic infl ammation and oxidative stress.
T26348 501780-501984 Sentence denotes The higher NF-κB activation and the unchanged fractional Na + excretion were most probably due to the drop in temperature [6] and the direct eff ect of H 2 S on tubular Na + absorption [7] , respectively.
T99352 501985-502127 Sentence denotes Introduction Sepsis has been identifi ed as the most common cause of renal injury in ICUs although the pathophysiology is not well understood.
T2147 502128-502337 Sentence denotes No large clinical studies are available that show an improvement of renal function in patients with sepsis and this may be related to the lack of early diagnostic tests that indicate the onset of renal injury.
T22144 502338-502568 Sentence denotes The aim of the current study was to search for potential new early markers of renal injury during acute endotoxemia and to investigate whether renal injury can be ameliorated by the induction of lipopolysaccharide (LPS) tolerance.
T61483 502569-502693 Sentence denotes Methods Five healthy males received intravenous bolus injections of 2 ng/kg/day Escherichia coli LPS for 5 consecutive days.
T14957 502694-502795 Sentence denotes We used surfaceenhanced laser desorption/ionization time-of-fl ight mass spectrometry (Seldi-TOF MS).
T87484 502796-502924 Sentence denotes This approach allows for rapid high-throughput profi ling of multiple urine samples and detects low molecular weight biomarkers.
T30474 502925-503310 Sentence denotes Results Repeated LPS administrations induced a diminished glomerular fi ltration rate of 33 ± 7% (P = 0.02) on day 2 and an increase in serum creatinine of 11 ± 3% (P = 0.002) on day 3, which was associated with the appearance of 15 peak intensities in the urinary protein profi le including an increase in β-microglobulin levels (P = 0.04) 6 hours after the fi rst LPS administration.
T14094 503311-503482 Sentence denotes Four of the 15 peak intensities on day 1 correlated with serum creatinine levels on day 3; 3,950, 4,445, 6,723 and 7,735 m/z (P = 0.03; 0.01; 0.02 and 0.05, respectively).
T88585 503483-503797 Sentence denotes With the development of LPS tolerance, renal function was restored, refl ected by a decrease in serum creatinine and β-microglobulin levels to baseline (P = 0.2 and 0.4, respectively, between days 1 and 5), and by attenuated peak intensities in the urinary protein profi le (P <0.0001 for all 15 peak intensities).
T88415 503798-503929 Sentence denotes In conclusion, renal injury occurs during repeated endotoxemia and can be predicted by new urinary markers using proteome research.
T63996 503930-504084 Sentence denotes The four markers that correlated with the extent of renal injury may represent potential new biomarkers for renal injury and need further identifi cation.
T52288 504085-504210 Sentence denotes The infl ammation-induced renal injury subsided when LPS tolerance developed after 5 consecutive days of LPS administrations.
T19843 504212-504302 Sentence denotes We developed a technique for detection of MDZ and 1-hydroxymidazolam glucuronide (1-OHMG).
T7309 504303-504362 Sentence denotes No commercial source of 1-OHMG prevented assay development.
T32302 504363-504423 Sentence denotes 1-OHMG had pharmacological activity and is renally excreted.
T28902 504424-504488 Sentence denotes We postulated that ultrafi ltrate (UFR) would be rich in 1-OHMG.
T59512 504489-504536 Sentence denotes We describe a method to purify 1-OHMG from UFR.
T18277 504537-504573 Sentence denotes Methods Ethics approval was granted.
T91563 504574-504646 Sentence denotes To purify, UFR was extracted on a C-18 column, it was washed and eluted.
T94107 504647-504680 Sentence denotes HPLC-MS separation was performed.
T4606 504681-504779 Sentence denotes The 1-OHMG (mol. wt 517/ 518 in MS) was desiccated and re-dissolved four times to maximise purity.
T1743 504780-504843 Sentence denotes Electrospray (ESI) mass spectrometry (MS) characterised 1-OHMG.
T5250 504844-504880 Sentence denotes The purity was calculated using NMR.
T74634 504881-504969 Sentence denotes A calibration plot of 1-OHMG, MDZ and DZP (internal standard) for HPLC-MS was performed.
T99887 504970-505033 Sentence denotes Results 1-OHMG identity was confi rmed using MS/MS (Figure 1 ).
T99956 505034-505091 Sentence denotes Two milligrams of 1-OHMG was purifi ed from 5,000 ml UFR.
T9460 505092-505122 Sentence denotes The 1-OHMG was 98% pure (NMR).
T17017 505123-505172 Sentence denotes The extinction coeffi cient was identical to MDZ.
T72142 505173-505227 Sentence denotes The calibration plot resulted in correlation of 0.912.
T66685 505228-505304 Sentence denotes The assay was applied into clinical practice, to report sera and UFR levels.
T78109 505305-505396 Sentence denotes Introduction Complex care in the hemato-oncological ICU sometimes requires the use of CRRT.
T73286 505397-505646 Sentence denotes As the hemato-oncological patients have some specifi cations we retrospectively followed up the results of our eff ort in patients with acute renal failure due to veno-occlusive disease (VOD) after allogeneic hematopoietic stem cell transplantation.
T58638 505647-505748 Sentence denotes VOD is one of the most severe early complications in this type of patients and its mortality is high.
T66509 505749-505911 Sentence denotes Methods From 1 January 2007 to 30 October 2009 we performed 94 procedures (one procedure = 24 hours) in 15 patients with VOD and acute renal oligo-anuric failure.
T55563 505912-506010 Sentence denotes As a standard in our ICU we perform CVVH with post dilution on a Fresenius Multifi ltrate machine.
T31404 506011-506167 Sentence denotes The key drug for the treatment of VOD is defi brotide and the patients were severely thrombocytopenic, we have not used any anticoagulation in the CVVH set.
T65842 506168-506306 Sentence denotes The dose of defi brotide ranged from 10 to 20 mg/kg/day according to the severity of thrombocytopenia and eventually hemorrhagic symptoms.
T48769 506307-506391 Sentence denotes Blood count, acid-base balance and biochemistry were monitored at least twice daily.
T20852 506392-506504 Sentence denotes The thrombocytopenia was corrected with the donor platelets and the platelet level was sustained at 20 x 10 9 l.
T56150 506505-506719 Sentence denotes The introduction of CVVH in all 15 patients dramatically helped to overcome the severe part of VOD until the defi brotide helped to restore Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1
T7782 506720-506763 Sentence denotes the right function of vascular endothelium.
T74042 506764-506822 Sentence denotes None of the 15 patients died from VOD as a cause of death.
T27959 506823-506937 Sentence denotes Surprisingly, the median patency of the CVVH tubing set was 46 hours despite no anticoagulation in the tubing set.
T7108 506938-507009 Sentence denotes Defi brotide is effi cient in preventing coagulation in the tubing set.
T74846 507010-507054 Sentence denotes No serious hemorrhagic events were observed.
T93431 507055-507257 Sentence denotes The fl uent maintenance of fl uid balance, the removal of waste products of metabolism and the maintenance of acid-base balance were very important for the patient in the critical point of advanced VOD.
T65144 507258-507486 Sentence denotes Conclusions CVVH is an integral part of intensive care in hemato-oncology and the use of this therapeutic modality in patients with VOD with acute renal failure can signifi cantly improve the results of our therapeutic eff orts.
T38780 507487-507744 Sentence denotes Comparison of the effi cacy and safety of two regional citrate anticoagulation protocols using acid citrate dextrose A or Introduction Continuous renal replacement therapy (CRRT) is the treatment of choice for acute renal failure in critically ill patients.
T38905 507745-507904 Sentence denotes Our study compared the effi cacy and safety of regional citrate anticoagulation (RCA) with acid citrate dextrose A (ACD-A) against Prismocitrate 10/2 (Gambro).
T32816 507905-508044 Sentence denotes Use of Prismocitrate 10/2 eliminates the need for a separate infusion pump for ACD-A as it doubles as replacement fl uid and anticoagulant.
T41151 508045-508113 Sentence denotes This removes a source of error in the calculation of fl uid balance.
T82722 508114-508251 Sentence denotes The combination of tri-sodium citrate and citric acid in Prismocitrate 10/2 avoids the metabolic alkalosis associated with ACD-A [1, 2] .
T4822 508252-508307 Sentence denotes Methods This was a prospective sequential cohort study.
T93566 508308-508391 Sentence denotes All patients admitted to the surgical ICU who required CRRT for ARF were recruited.
T71603 508392-508473 Sentence denotes Group A, using ACD-A, was recruited from October 2007 to September 2008 (n = 23).
T1681 508474-508568 Sentence denotes Group B, using Prismocitrate 10/2, was recruited from October 2008 to September 2009 (n = 20).
T28966 508569-508703 Sentence denotes We evaluated the incidence of metabolic alkalosis and other biochemical changes, azotemia control, fi lter lifespan and complications.
T21198 508704-508819 Sentence denotes The incidence of metabolic alkalosis in Group B from treatment day 2 onwards was signifi cantly lower than Group A.
T77152 508820-508921 Sentence denotes The Group A median pH was 7.42 (6.81 to 7.62) compared with Group B pH 7.35 (7.2 to 7.49), P = 0.001.
T13504 508922-508997 Sentence denotes The control of electrolytes and azotemia was not signifi cantly diff erent.
T11442 508998-509134 Sentence denotes The mean fi lter duration was 58.8 hours (95% CI 38.0 to 79.6) for Group A and 61.8 hours (95% CI 45.8 to 77.8) for Group B (P = 0.678).
T9335 509135-509301 Sentence denotes Longitudinal analysis revealed a statistically signifi cant result for reduced metabolic alkalosis for Group B. (standard bicarbonate P <0.001, base excess P <0.001).
T62067 509302-509457 Sentence denotes Repeat treatment sessions also showed a statistically signifi cant reduction of metabolic alkalosis using Prismocitrate 10/2 rather than ACD-A (P = 0.029).
T38591 509458-509565 Sentence denotes Conclusions RCA with Prismocitrate 10/2 reduces the incidence of metabolic alkalosis associated with ACD-A.
T27317 509566-509664 Sentence denotes This regime is safe, feasible and improved patient safety, with no increase in complication rates.
T41658 509665-509722 Sentence denotes Our unit has now converted to Prismocitrate 10/2 for RCA.
T79738 509723-509746 Sentence denotes injury (TBI) is common.
T11813 509747-509871 Sentence denotes We hypothesised that the use of such therapies would signifi cantly augment creatinine clearances (CrCl) in this population.
T32438 509872-510065 Sentence denotes Methods Head-injured patients requiring hyperosmolar therapy using 3% or 20% saline solutions and/or norepinephrine infusion for the maintenance of a CPP >60 mmHg were recruited into the study.
T23172 510066-510184 Sentence denotes Additional management was consistent with local practice and in line with the Brain Trauma Foundation guidelines [1] .
T46137 510185-510310 Sentence denotes An 8-hour CrCl, physiological variables, fl uid balance, and medications were recorded daily during active management of CPP.
T93184 510311-510434 Sentence denotes A further CrCl was collected just prior to discharge (off CPP therapy), and if this was elevated, was repeated on the ward.
T97903 510435-510567 Sentence denotes Augmented renal clearance (ARC) was defi ned as a CrCl >160 ml/minute/1.73m 2 for males and >150 ml/minute/1.73m 2 for females [2] .
T19882 510568-510618 Sentence denotes Results Twenty consecutive patients were enrolled.
T46527 510619-510743 Sentence denotes The average ICU length of stay was 15 days (CI 95% 11 to 18), and time to study entry averaged 2.3 days (CI 95% 1.7 to 2.8).
T43492 510744-510891 Sentence denotes All patients received norepinephrine (n = 20), 85% (n = 17) received hypertonic saline, and therapy lasted on average 7.6 days (CI 95% 5.6 to 9.5).
T60845 510892-510979 Sentence denotes ARC was demonstrated in 17 (85%) patients at any point during active management of CPP.
T40414 510980-511177 Sentence denotes The mean maximum CrCl was 179 ml/ minute/1.73 m 2 while on CPP therapy (CI 95% 159 to 198) returning to a mean CrCl of 111 ml/minute/1.73 m 2 (CI 95% 91 to 131, P <0.001) when measured in the ward.
T66222 511178-511292 Sentence denotes The mean CrCl in the ICU while not receiving CPP therapy was 150 ml/minute/1.73 m 2 (CI 95% 134 to 167, P = 0.03).
T20012 511293-511385 Sentence denotes The mean time to reach peak CrCl while on active treatment was 4.7 days (CI 95% 3.0 to 6.4).
T95470 511386-511516 Sentence denotes Norepinephrine use, saline loading, mean arterial pressure, and central venous pressure, predicted CrCl on the day of measurement.
T59632 511517-511648 Sentence denotes Conclusions ARC is common in head-injured patients receiving active management of CPP and persists even after ceasing such therapy.
T30221 511649-511749 Sentence denotes This has signifi cant implications for appropriate dosing of renally excreted drugs in this setting.
T58420 511750-511857 Sentence denotes Introduction The kidney is the organ of the human body designed to sense and regulate intravascular volume.
T7337 511858-512106 Sentence denotes The KING (Kidney Instant Monitoring; Orvim, Paderno Dugnano, Italy) is a new device that allows continuous measurement of urinary electrolytes and real-time body response to changes in intrathoracic and intra-abdominal pressures and to lung injury.
T29211 512107-512224 Sentence denotes Methods Sixteen pigs (weight 20 ± 3 kg) were anaesthetized, tracheotomized, catheterized and mechanically ventilated.
T72997 512225-512342 Sentence denotes Pigs were ventilated for approximately 10 hours with a TV of 10 ml/kg, RR 15 breaths/minute, F I O 2 0.5 and no PEEP.
T1210 512343-512459 Sentence denotes After TV was increased, pigs were divided into two groups: eight pigs with a lower TV and eight pigs with higher TV.
T19524 512460-512516 Sentence denotes A variable dead space was added to maintain normocapnia.
T81350 512517-512582 Sentence denotes Pigs were mechanically ventilated with the new TV up to 48 hours.
T70904 512583-512683 Sentence denotes The KING measured urinary output and urinary concentration of sodium and potassium every 10 minutes.
T89290 512684-512718 Sentence denotes NaCl 0.9% was exclusively infused.
T77565 512719-512931 Sentence denotes The average urinary concentration of each electrolyte was expressed as the total concentration Introduction NGAL levels are dramatically increased in urine and plasma from patients with acute kidney injury (AKI).
T97444 512932-513062 Sentence denotes In this study we tested the clinical utility of NGAL in critically ill patients with many confounding conditions including sepsis.
T28872 513063-513180 Sentence denotes In addition, a new fully automated NGAL assay was validated with a selection of clinical samples from these patients.
T75447 513181-513308 Sentence denotes Methods Plasma and urinary NGAL was monitored (daily to alternate days) in 135 consecutive patients admitted to intensive care.
T54476 513309-513361 Sentence denotes AKI was classifi ed according to the RIFLE criteria.
T50897 513362-513418 Sentence denotes Three patients were excluded because of incomplete data.
T40000 513419-513480 Sentence denotes NGAL was determined with an ELISA kit (BioPorto Diagnostics).
T95538 513481-513596 Sentence denotes Diff erences between maximal NGAL levels in the patient were analyzed nonparametrically by the Kruskal-Wallis test.
T48706 513597-513656 Sentence denotes Data are reported as median (interquartile range) in ng/ml.
T55498 513657-513754 Sentence denotes A fully automated immunoturbidimetric NGAL test (The NGAL Test; BioPorto Diagnostics) was tested.
T4532 513755-514027 Sentence denotes The NGAL Test was validated by means of linearity studies with dilutions of calibrator material, determination of antigen excess zone and a method comparison with the ELISA kit on 40 urine and 40 plasma samples with NGAL levels from 25 to 2,995 ng/ml as measured by ELISA.
T46973 514028-514145 Sentence denotes Results Sixty-two patients did not have AKI; 15 were classifi ed as risk (R), 11 as injury (I) and 44 as failure (F).
T61785 514146-514338 Sentence denotes The urinary NGAL was signifi cantly (P <0.0001) higher in patients with AKI (R 377 (102 to 830), I 519 (321 to 1,845) and F 2,747 (559 to 7,621)) than in patients without AKI (51 (29 to 213)).
T40251 514339-514537 Sentence denotes Plasma NGAL levels were signifi cantly (P <0.0001) higher in patients with AKI (R 354 (259 to 511), I 546 (331 to 1,106) and F 1,062 (584 to 1,817)) than in patients without AKI (199 (128 to 308) ).
T62502 514538-514627 Sentence denotes Linearity studies of The NGAL Test demonstrated a measuring range from 25 to 5,000 ng/ml.
T83301 514628-514708 Sentence denotes No deleterious eff ect of antigen excess was seen up to a level of 40,000 ng/ml.
T58906 514709-514864 Sentence denotes There was good agreement between the ELISA and The NGAL Test results, the Pearson coeffi cient of correlation being 0.98 for both urine and plasma samples.
T58295 514865-515101 Sentence denotes Conclusions It is concluded that NGAL is dramatically increased in the urine and plasma of unselected critically ill patients with AKI and the degree of injury is refl ected by the observed levels despite several confounding conditions.
T67641 515102-515248 Sentence denotes NGAL determination may therefore be useful for the diagnosis of renal injury and monitoring the management of patients admitted to intensive care.
T43710 515249-515469 Sentence denotes Validation of The NGAL Test demonstrates a performance that complies with the expectations for a fully automated clinical laboratory assay, which can thus be a valuable tool for the management of critically ill patients.
T85690 515470-515592 Sentence denotes Introduction Intra-abdominal hypertension (IAH) is associated with signifi cant mortality in surgical and trauma patients.
T36757 515593-515644 Sentence denotes However, IAH can occur in medical patients as well.
T88168 515645-515810 Sentence denotes Thus, the main objective of this study was to assess whether the IAH during the fi rst 24-hour period of admission was an independent predictor for 28-day mortality.
T93419 515811-515866 Sentence denotes Methods We conducted a prospective observational study.
T54605 515867-516009 Sentence denotes All patients admitted to the medical ICU were enrolled in this study and underwent intra-abdominal pressure (IAP) measurement via the bladder.
T66783 516010-516088 Sentence denotes The primary outcome was the association between IAH and 28-day mortality rate.
T98268 516089-516157 Sentence denotes Results Seventy-seven eligible patients were enrolled to this study.
T39632 516158-516187 Sentence denotes The incidence of IAH was 44%.
T88626 516188-516225 Sentence denotes The mean age was 60.52 ± 18.34 years.
T70186 516226-516331 Sentence denotes In terms of 28-day mortality, there was no association between the presence of IAH and mortality outcome.
T6333 516332-516458 Sentence denotes However, regarding ICU mortality, nonsurvivors had signifi cantly higher mean IAP within 24 hours of admission than survivors:
T63523 516459-516513 Sentence denotes 11.55 (8.0 to 20.3) vs 9.95 (3.0 to 27.0) (P = 0.041).
T56815 516514-516661 Sentence denotes Conclusions Neither the mean IAP nor the presence of IAH within the fi rst 24 hours of admission was an independent predictor for 28-day mortality.
T62975 516662-516802 Sentence denotes Nonetheless, this study demonstrated the diff erence of IAP between survivors and nonsurvivors in terms of ICU mortality in the medical ICU.
T73029 516803-517021 Sentence denotes Introduction Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have become serious causes of morbidity and mortality in critical surgical and medical patients, especially in the past 10 years.
T86120 517022-517156 Sentence denotes Increased IAP levels became one of the routine physiologic parameter measurement elements in critical patients and indicate prognosis.
T59434 517157-517272 Sentence denotes In this study, our aim was to observe IAP increase, APB decrease and their clinical manifestations in ICU patients.
T19276 517273-517334 Sentence denotes Methods Eighty-nine ICU patients were included in this study.
T10617 517335-517410 Sentence denotes IAP levels were measured by infusing 25 ml saline into the urinary bladder.
T25933 517411-517467 Sentence denotes The symphisis pubis plane affi liated as the zero point.
T45338 517468-517534 Sentence denotes Patients were divided into groups according to IAP and APB levels.
T14825 517535-517608 Sentence denotes Clinical follow-up, required medical care and survival were investigated.
T8959 517609-517705 Sentence denotes Results Within the 89 patients, 36 of them diagnosed as IAH and 34 of them diagnosed as low APB.
T76171 517706-517759 Sentence denotes There were 25 patients that had both IAH and low APB.
T54685 517760-517902 Sentence denotes In these patients, during the fi rst 2 days of the study, statistically signifi cant SGOT, SGPT, PO 2 , urea and creatinine levels were found.
T31304 517903-518065 Sentence denotes We also determined increased positive inotropic support and ventilatory support need with increased sepsis and multiple organ failure incidence in these patients.
T72815 518066-518130 Sentence denotes Mortality rates were strongly related to IAH and low APB levels.
T62404 518131-518241 Sentence denotes Conclusions In critically ill patients, IAP measurement, a very simple and valuable method, must be performed.
T65923 518242-518318 Sentence denotes IAH and low APB levels are indicators of high morbidity and mortality rates.
T59509 518319-518450 Sentence denotes Therefore, IAP measurement may become a routine element in follow-ups and survival rate determinations, in critically ill patients.
T92291 518451-518654 Sentence denotes Introduction Acute liver failure (ALF) is a rare disease with a spectrum of presentations from mild coagulopathy and altered conscious level to multiple organ failure and intracranial hypertension (ICH).
T4814 518655-518829 Sentence denotes A new group, Acute Liver Failure studies in Europe (ALSiE), has and wishes to further initiate collaboration between centres with clinical expertise in the management of ALF.
T42553 518830-518945 Sentence denotes It aims to establish a pan-European database of clinical and demographic data in ALF and initiate clinical studies.
T62312 518946-519053 Sentence denotes Methods We describe the experience of 13 centres in seven countries over a 3-month period to 31 March 2009.
T72277 519054-519145 Sentence denotes ALF was defi ned as an INR >1.5 and encephalopathy in the absence of chronic liver disease.
T70858 519146-519191 Sentence denotes Results are presented as median and IQ range.
T52864 519192-519330 Sentence denotes Results Eighty-fi ve patients were treated, acetaminophen was the dominant aetiology in the UK, 60%, and represented 34% in other centres.
T31549 519331-519457 Sentence denotes At presentation INR was 3.8 (2.1 to 6.5), hepatic encephalopathy (HE) grade I (0 to 2) was observed and 20% required pressors.
T53637 519458-519543 Sentence denotes Grade III/IV coma was seen in 64% during their course and of these 25% developed ICH.
T80649 519544-519636 Sentence denotes Seventyone per cent required ventilation, 58% renal replacement therapy and pressors in 65%.
T27823 519637-519704 Sentence denotes Ninety per cent required management in a critical care environment.
T63886 519705-519854 Sentence denotes Overall survival was 75% -42 cases fulfi lled poor prognostic criteria (PPC), of whom 31 were transplanted, 28 (90%) surviving to hospital discharge.
T16377 519855-519905 Sentence denotes Of the 11 remaining, four survived and seven died.
T37786 519906-519961 Sentence denotes Thirty-two out of 43 who did not fulfi ll PPC survived.
T57026 519962-520044 Sentence denotes Patients who died were older and had a predominant aetiology of hypoxic hepatitis.
T57994 520045-520134 Sentence denotes One organ support or less was associated with 70% survival with medical management alone.
T1948 520135-520279 Sentence denotes Two organ support or more was required in 55 patients and 27% survived with medical management, the remainder requiring transplantation or died.
T149 520280-520476 Sentence denotes Conclusions ALF has a high prevalence of progression to multiple organ failure requiring a multidisciplinary approach (critical care, transplant surgery and hepatology) to achieve optimal outcome.
T9761 520477-520526 Sentence denotes The development of ICH is 25% in grade III/IV HE.
T28389 520527-520559 Sentence denotes Despite this, outcomes are good.
T69979 520560-520737 Sentence denotes Introduction Following liver transplantation, hepatic artery stenosis and portal vein obstruction occur in 3 to 12% of the patients, and more frequently in children than adults.
T7299 520738-520822 Sentence denotes Today, the standard of care is Doppler ultrasound and liver enzyme assessment daily.
T87134 520823-520885 Sentence denotes Accordingly, detection of severe hypoperfusion may be delayed.
T98266 520886-521125 Sentence denotes The aim of the present study was to explore whether microdialysis catheters implanted in the left and right liver lobe, by measurement of glucose, lactate, pyruvate and glycerol every 2 hours, detected vascular complications and rejection.
T74580 521126-521208 Sentence denotes Methods Seventy-three patients undergoing 82 liver transplantations were included.
T15403 521209-521244 Sentence denotes Nine of the patients were children.
T18785 521245-521359 Sentence denotes Two microdialysis catheters were inserted in the liver and one in subcutaneous tissue by a split needle technique.
T14153 521360-521438 Sentence denotes They were kept for as long as the catheters functioned, and maximally 4 weeks.
T98541 521439-521552 Sentence denotes Metabolic parameters (glucose, pyruvate, glycerol and lactate) were collected every 2 hours and measured bedside.
T53440 521553-521624 Sentence denotes Results Median age of the patients was 52 years (6 months to 70 years).
T12653 521625-521724 Sentence denotes The median time for catheters inserted in the liver was 9.5 days, with a range from 0.5 to 26 days.
T39711 521725-521946 Sentence denotes Six patients had hepatic artery stenosis/ occlusion, and in fi ve of them lactate increased to values >10 mM with a lactate/pyruvate ratio of several hundred and a concomitant decrease in glucose and increase in glycerol.
T83168 521947-522038 Sentence denotes In one patient (a 6-month-old child) lactate only increased to 2 mM and the LP ratio to 20.
T84368 522039-522194 Sentence denotes On the background of pathological metabolic values, all patients underwent immediate reoperation and blood clots were removed and the artery reanastomosed.
T9737 522195-522327 Sentence denotes In the child with low lactate values, the fl ow of the artery was less than 10% of total hepatic blood fl ow, despite reanastomosis.
T78251 522328-522457 Sentence denotes Thus, the exceptionally high portal fl ow delivered enough oxygen to prevent major ischemia despite very low fl ow in the artery.
T60174 522458-522617 Sentence denotes Thirteen patients had rejection verifi ed by biopsy, and in six patients anti-rejection therapy was given based on liver function tests and clinical judgement.
T64037 522618-522748 Sentence denotes All patients had some increase in lactate during the period of rejection, but the increase was in all but four patients only 1 mM.
T98755 522749-522798 Sentence denotes In the remaining four the increase was 3 to 4 mM.
T73003 522799-522931 Sentence denotes Conclusions By using microdialysis catheters measuring metabolic parameters, hepatic artery occlusions can be detected very rapidly.
T56729 522932-523008 Sentence denotes Patients with rejection show a small, but signifi cant, increase in lactate.
T78644 523009-523094 Sentence denotes Introduction Liver dysfunction in critically ill patients represents a major concern.
T42903 523095-523163 Sentence denotes Many drugs used in the ICU have been associated with hepatotoxicity.
T25470 523164-523406 Sentence denotes Hepatotoxicity presents in three distinct patterns: cholestatic (alkaline phosphatase (AP) ≥2 x ULN and ratio (ALT/ULN)/(AP/ ULN) ≤2), hepatocellular (ALT ≥3 x ULN and ratio ≥5) and mixed (AP ≥2 x ULN, ALT ≥3 x ULN and ratio between 2 and 5).
T52649 523407-523509 Sentence denotes No published studies have assessed the drug-induced cholestastic pattern of hepatotoxicity in the ICU.
T42525 523510-523702 Sentence denotes The aim of this study was to assess whether use of pharmacological classes previously associated with cholestasis are associated with an increased risk of pure or mixed cholestasis in the ICU.
T37220 523703-523840 Sentence denotes Methods A nested case-control study assessed the potential association between use of specifi ed pharmacological classes and cholestasis.
T51229 523841-524006 Sentence denotes Cases were identifi ed from a cohort of patients admitted ≥24 hours in whom at least one value of AP <240 IU/l had been obtained in the 72 hours following admission.
T17372 524007-524129 Sentence denotes We excluded patients with an identifi ed cause of cholestasis as well as patients with bone metastasis and pregnant women.
T73903 524130-524249 Sentence denotes Each case the subject was matched to a control subject based on age, gender, and length of ICU stay and admission year.
T77809 524250-524476 Sentence denotes Exposure to antiepileptics, penicillins, cephalosporins, carbapenems, macrolid antibiotics and parenteral nutrition was collected and included in a multivariate conditional logistic regression analysis with known risk factors.
T16649 524477-524610 Sentence denotes Introduction Energy requirements of critically ill septic shock patients treated in the ICU are particularly diffi cult to determine.
T84096 524611-524727 Sentence denotes Recent research shows that energy expenditure (EE) in those patients may be smaller than it was previously believed.
T30389 524728-524918 Sentence denotes EE values in this group are aff ected by the severity of the disease process as well as by administered treatment (sedation, inactivity of skeletal and respiratory muscles, fi ghting fever).
T94233 524919-525066 Sentence denotes The purpose of this study was to establish the infl uence of septic shock on EE in sedated and mechanically ventilated patients treated in the ICU.
T41656 525067-525302 Sentence denotes Using indirect calorimetry, we assessed EE in those patients and compared results with basal energy expenditure calculated according to the Harris-Benedict equation (BEE), and with EE values in patients subjected to general anesthesia.
T57297 525303-525407 Sentence denotes Methods Two groups of patients were studied with regard to EE measured by means of indirect calorimetry.
T34011 525408-525492 Sentence denotes Group I consisted of 50 critically ill patients treated in the ICU for septic shock.
T76453 525493-525591 Sentence denotes They were evaluated using the APACHE II and SOFA scores, taking into account the 28-day mortality.
T72483 525592-525716 Sentence denotes EE was measured continuously over the fi rst 24 hours of treatment by means of the Datex-Ohmeda M-COVX indirect calorimeter.
T96642 525717-525868 Sentence denotes Group II comprised 50 patients (ASA I and II), whose energy expenditure was measured under general anesthesia in surgical treatment of disc herniation.
T66967 525869-526037 Sentence denotes Energy expenditure measurements were taken with the use of the Datex-Ohmeda E-CAiOVX indirect calorimeter, adapted to work in an atmosphere containing anesthetic gases.
T86302 526038-526268 Sentence denotes Conclusions A decrease in the total metabolic rate of patients with severe sepsis and septic shock can constitute a prognostic indicator of heightened death risk in this group of ICU-treated patients. were excluded from the study.
T29091 526269-526417 Sentence denotes Onset time and occurrence of pneumonia were extracted from the hospital's database; patients who died during the fi rst 48 hours were then excluded.
T17435 526418-526542 Sentence denotes Patients staying for 2 days or longer in the ICU were divided into two groups (with or without NGT) and analyzed separately.
T63966 526543-526601 Sentence denotes Results One hundred and fi fty-six patients were analyzed.
T64967 526602-526680 Sentence denotes CT scan showed a NGT in 30 patients (one malposition in the medium esophagus).
T5018 526681-526790 Sentence denotes Gastric gas, liquid/solid and total volume were not diff erent in patients with and without NGT (Z test; gas:
T54007 526791-526840 Sentence denotes 54 ± 147 vs 95 ± 168 ml, P = 0.179; liquid/solid:
T9203 526841-526882 Sentence denotes 226 ± 282 vs 199 ± 237, P = 0.626; Total:
T98666 526883-526918 Sentence denotes 280 ± 311 vs 295 ± 320, P = 0.824).
T90053 526919-527054 Sentence denotes Twenty out of 153 patients developed a pneumonia in the fi rst 7 days, fi ve of which with NGT and 15 without (chi-squared, P = 0.459).
T87105 527055-527176 Sentence denotes There was no diff erence in gastric residuals between these patients and the 133 others (Mann-Whitney; Q1-median-Q3; Gas:
T24668 527177-527223 Sentence denotes 11-25-126 vs 14-43-90 ml, P = 1; liquid/solid:
T52939 527224-527269 Sentence denotes 16-63-432 vs 22-115-290 ml, P = 0.799; Total:
T3485 527270-527310 Sentence denotes 29-252-661 vs 68-186-371 ml, P = 0.873).
T78408 527311-527409 Sentence denotes Seventy-three patients were admitted to the ICU, of which 23 had a NGT and 20 developed pneumonia.
T72505 527410-527503 Sentence denotes There was no diff erence between gastric residuals of the 23 who had a NGT and the 50 others.
T36906 527504-527718 Sentence denotes A pneumonia developed in the fi rst 3 days in 1/23 patients with NGT vs 9/50 without NGT (chi-squared-Yates, P = 0.226); in the fi rst 7 days in 5/23 patients with NGT vs 15/50 without NGT (chi-squared, P = 0.462).
T80882 527719-527859 Sentence denotes There was no diff erence in gastric residuals between patients who developed early pneumonia (at 3 and 7 fi rst days) and those who did not.
T63524 527860-527995 Sentence denotes There was no diff erence in ICU length of stay (10.8 vs 12.7 days, P = 0.825) and onset time of pneumonia (4.2 vs 3.3 days, P = 0.234).
T44680 527996-528118 Sentence denotes Conclusions Our results suggest that gastric volume is high at admission of trauma patients, irrespective of NGT presence.
T46972 528119-528219 Sentence denotes In this study, pneumonia incidence was related neither with high gastric volume, nor with NGT usage.
T73211 528221-528329 Sentence denotes McWhirter and Pennington stated in 1994 that 40% of patients are malnourished on admission to hospital [1] .
T51198 528330-528388 Sentence denotes Malnutrition increases morbidity and mortality in the ICU.
T3885 528389-528461 Sentence denotes Early feeding improves outcome, length of stay and septic complications.
T84605 528462-528637 Sentence denotes Methods We aimed to assess the standard of nutritional practice, and measure caloric achievement and caloric debt in the fi rst 7 days of admission of critically ill patients.
T70537 528638-528756 Sentence denotes The European Society of Parenteral and Enteral Nutrition guidelines on enteral nutrition are set as the standard [2] .
T54025 528757-528874 Sentence denotes Between April and August 2009, all adult patients not fed orally within 3 days of admission to the ICU were included.
T69159 528875-528913 Sentence denotes The caloric target was 25 kcal/kg/day.
T75454 528914-528978 Sentence denotes All impediments to achievement of feeding targets were recorded.
T91266 528979-529138 Sentence denotes Results Among 30 patients (16 surgical and 14 medical), 11 patients were fed early within 24 hours of admission, 19 patients were fed 24 hours after admission.
T1989 529139-529235 Sentence denotes Twenty-three patients were fed by nasogastric tube, three patients received small bowel feeding.
T71710 529236-529354 Sentence denotes Parenteral nutrition (PN) was used alone in two patients and as a supplement to enteral nutrition (EN) in one patient.
T46713 529355-529447 Sentence denotes Conclusions Mean caloric achievement by day 7 was only 58.4% (Figure 1) , well below target.
T48385 529448-529533 Sentence denotes The following recommendations have now been made to improve the nutritional practice.
T13212 529534-529853 Sentence denotes A higher threshold for residual gastric volumes has been adopted, an earlier aggressive use of prokinetic agents is recommended, strategies to access small bowel feeding earlier and PN is now considered within 24 hours if EN is contraindicated or as supplement to EN if the caloric target is not reached after 48 hours.
T30040 529854-530044 Sentence denotes Introduction Nutritional screening and nutritional support have an important role to prevent malnutrition, which aff ects the prognosis and increases the morbidity and mortality of patients.
T7364 530045-530179 Sentence denotes We aimed to assess the patients who are consulted and followed by the nutritional support team during a 2-year period retrospectively.
T36508 530180-530349 Sentence denotes Methods Demographic characteristics, subjective global assessment scores (SGA) of patients' type, route, duration of nutritional support and complications were assessed.
T50410 530350-530422 Sentence denotes Results A total of 379 patients were consulted during the 2-year period.
T91760 530423-530582 Sentence denotes Two hundred and two of them (53.3%) were male and 177 (46.7%) were female and the mean value of ages was 63.5 ± 17.9 years (7 to 96 years, minimum to maximum).
T60294 530583-530668 Sentence denotes SGA scores were A in 35.1% (n = 133), B in 26.6% (n = 101), and C in 38.3% (n = 145).
T30028 530669-530869 Sentence denotes In 31.9% (n = 121) of the patients combined parenteral and enteral, in 29.6% (n = 112) only parenteral, in 25.6% (n = 97) only enteral and in 12.9% (n = 49) oral nutritional support were administered.
T90568 530870-531254 Sentence denotes Combined parenteral and enteral nutritional support was applied via nasogastric tube and peripheral parenteral in 54.5% (n = 66), nasogastric tube and santral parenteral in 29.8% (n = 36), oral and santral in 5.8% (n = 7), oral and peripheral parenteral in 6.6% (n = 8), nasojejunal and peripheral parenteral in 1.7% (n = 2) and gastrostomy and peripheral parenteral in 21.7% (n = 2).
T70857 531255-531373 Sentence denotes Parenteral nutritional support was applied via peripheral route in 62.5% (n = 70) and santral route in 37.5% (n = 42).
T77460 531374-531490 Sentence denotes Enteral nutrition was commonly applied by nasogastric tube in 87.6% (n = 85) and gastrostomy tube in 10.3% (n = 10).
T92156 531491-531563 Sentence denotes Nutritional support was applied during 18.2 ± 23.7 days (1 to 306 days).
T38092 531564-531758 Sentence denotes The most common complications were constipation (7.4%), nasogastric tube displacement or obstruction (5.2%), diarrhea (2.6%), thrombophlebitis (3.4%), aspiration (1.8%) and hyperglycemia (1.6%).
T58779 531759-531867 Sentence denotes Conclusions Nutritional screening should be a component of physical examination in hospital and outpatients.
T64865 531868-531925 Sentence denotes Are we feeding our critically ill patients appropriately?
T45489 531926-532033 Sentence denotes Introduction Nutrition plays a signifi cant part in the overall treatment plan for critically ill patients.
T55868 532034-532169 Sentence denotes In India, there are varying practices including use of kitchen feeds and/or commercial formula and also predominant use of bolus feeds.
T16630 532170-532530 Sentence denotes The multidisciplinary team in our critical care unit (CCU) includes a senior dietician and we wanted to review whether our standardized practice of routine screening for malnutrition using subjective global assessment, early use of nutrition (preferably within 24 hours) and continuous enteral feeding using commercial formula helped achieve nutritional goals.
T93653 532531-532673 Sentence denotes Methods A retrospective chart review was conducted on 508 patients who received continuous enteral feeding on day 1 and day 5 of the ICU stay.
T90220 532674-532793 Sentence denotes Information on calories prescribed (using the Harris-Benedict equation) and delivered on day 1 and day 5 was collected.
T9550 532794-533075 Sentence denotes Achieving the nutritional goal was defi ned as successful delivery of 90% of prescribed Introduction Early enteral nutrition (EN) is the preferred strategy for feeding the critically ill; however, it is not always possible to achieve suffi cient calories and protein with EN alone.
T33248 533076-533255 Sentence denotes The use of supplemental parenteral nutrition (PN) has been advocated as a strategy to avoid complications associated with protein/calorie defi cit from inadequate enteral feeding.
T24303 533256-533364 Sentence denotes The purpose of this study was to evaluate the eff ect of this practice on nutritional and clinical outcomes.
T57408 533365-533484 Sentence denotes Methods An international, observational study conducted in 2007 and again in 2008 examined nutrition practices in ICUs.
T85799 533485-533627 Sentence denotes Eligible patients were the mechanically ventilated who remained in the ICU for >72 hours and received early EN within 48 hours from admission.
T62769 533628-533723 Sentence denotes Data were collected on patient characteristics and daily nutrition practices for up to 12 days.
T5794 533724-533769 Sentence denotes Patient outcomes were recorded after 60 days.
T50432 533770-533910 Sentence denotes We compared the outcomes of patients who received early EN alone, early EN + early PN, and early EN + late PN (after 48 hours of admission).
T97422 533911-534194 Sentence denotes Regression analyses were conducted to determine the eff ect of increasing age, APACHE score, days in hospital prior to ICU admission, gastrointestinal dysfunction, nutritional strategy, and other baseline variables and their relationship to being alive and discharged within 60 days.
T9074 534195-534281 Sentence denotes Introduction Liver function disturbances have been of concern in parenteral nutrition.
T85366 534282-534436 Sentence denotes The aim of the post hoc analyses of two pooled studies was to compare liver function parameters using fi sh-oil-containing vs soybean oil lipid emulsions.
T38241 534437-534753 Sentence denotes Methods Two prospective, controlled, randomized, parallel-group, double-blind, multicenter studies compared SMOFlipid 20%, a fi shoil-containing lipid emulsion (SMOF: soybean oil 60 g, medium-chain triglycerides 60 g, olive oil 50 g, fi sh oil 30 g per l), vs standard soybean oil emulsion (SO, 200 g soybean oil/l).
T49225 534754-534782 Sentence denotes The studies were as follows:
T63075 534783-534967 Sentence denotes A: postsurgical adult patients, 5 days total parenteral nutrition, 100 SMOF vs 103 SO patients; B: adult patients receiving parenteral nutrition for 28 days, 22 SMOF vs 32 SO patients.
T68843 534968-535027 Sentence denotes Patients with data at baseline and study end were selected.
T72314 535028-535155 Sentence denotes The data were pooled and diff erences of laboratory data at 1 week minus baseline and study end minus baseline were calculated.
T15730 535156-535360 Sentence denotes Analyses of variance were applied using diff erences between 1 week/study end values and baseline values of bilirubin (BIL), AST and ALT as dependent variables and treatment group as independent variable.
T91182 535361-535458 Sentence denotes Covariates used: baseline values for BIL, AST, ALT and mean daily dose of fat per kg body weight.
T1677 535459-535551 Sentence denotes Results Baseline values were not signifi cantly diff erent between the two treatment groups.
T79658 535552-535657 Sentence denotes The mean daily intake of fat/kg bw after 1 week and study end was the same between both treatment groups.
T70759 535658-535890 Sentence denotes One-weekbaseline values of liver parameters (mean; SMOF group: BIL -5.1* μmol/l, AST -5.4** U/l, ALT 0.6*** U/l; SO group: BIL -2.0* μmol/l, AST 0.6** U/l, ALT 11.1*** U/l) were signifi cantly diff erent between treatment groups (P:
T33294 535891-535918 Sentence denotes 0.035*, 0.001**, 0.001***).
T68742 535919-535982 Sentence denotes Extending the analysis until 28 days did not alter the results.
T6762 535983-536133 Sentence denotes Conclusions Infusion of SMOFlipid 20% compared with a soybean oil standard lipid emulsion exerts a signifi cant decrease in the values of BIL and AST.
T17766 536134-536189 Sentence denotes It also signifi cantly attenuates the rise seen in ALT.
T25687 536190-536307 Sentence denotes These results indicate that SMOFlipid 20% is promising in preventing parenteral nutrition-induced liver disturbances.
T88763 536309-536503 Sentence denotes We supposed the diagnostic signifi cance of the ratio between proinfl ammatory and anti-infl ammatory cytokines in the peritoneal cavity and system blood fl ow in patients with abdominal sepsis.
T41294 536504-536598 Sentence denotes So we tried to correct such disbalance with glutamine intravenous and enteral supplementation.
T80970 536599-536718 Sentence denotes Methods Prospective controlled randomized investigation of the patients with abdominal sepsis (excluding pancreatitis).
T93755 536719-536754 Sentence denotes Group 1 (n = 16): standard therapy.
T62350 536755-536850 Sentence denotes Group 2 (n = 11): with intravenous infusion of glutamine (Dipeptiven; Fresenius Kabi, Germany).
T87230 536851-536979 Sentence denotes Group 3 (n = 11): with intravenous infusion of glutamine and enteral supplementation of glutamine (Intestamine; Fresenius Kabi).
T17922 536980-537127 Sentence denotes The patients in groups were identical according to the severity of disease (APACHE II), the standard of intensive care, the volume of surgery care.
T33069 537128-537477 Sentence denotes We investigated the proinfl ammatory cytokines: TNFα, IL-1, IL-6, IL-8; and anti-infl ammatory cytokines: soluble sTNF-RI and sTNF-RII, antagonist receptor IL-1, IL-10 in blood serum and in the peritoneal cavity during the initial 3 days of intensive care (ELISA; BD Biosciences Pharmingen, San Diego, CA, USA; EASIAs; Biosource, Nivelles, Belgium).
T274 537478-537658 Sentence denotes The probability of survival on day 28 was 73% in the standard therapy group, in the group with glutamine intravenous -78%, in the group with glutamine intravenous and enteral -84%.
T30447 537659-537748 Sentence denotes We did not fi x the decrease of the duration of respiratory support in all of the groups.
T53488 537749-537983 Sentence denotes The duration of acute intestinal injury was signifi cantly diff erent (standard group 49 hours vs 38 hours in group with glutamine intravenous supplementation -35 hours in group with intravenous and enteral glutamine supplementation).
T3626 537984-538167 Sentence denotes We investigated the prevalence of the concentration of proinfl ammatory cytokines in the peritoneal cavity and in blood serum according to the molar coeffi cient in the control group.
T80366 538168-538238 Sentence denotes The molar coeffi cient had a positive correlation with the SOFA scale.
T46123 538239-538407 Sentence denotes In group 2 (glutamine intravenous) the molar coeffi cients were decreased to the prevalence of anti-infl ammatory cytokines (in serum on day 3, in peritoneal on day 2).
T85946 538408-538581 Sentence denotes In group 3 (glutamine intravenous and enteral) we investigated the signifi cance diff erence and decrease of all cytokine levels in blood serum and in the peritoneal cavity.
T85261 538582-538717 Sentence denotes Conclusions Intravenous and enteral supplementation of glutamine improved the cytokine balance in blood and the peritoneal compartment.
T82115 538718-538868 Sentence denotes Introduction Glycemic control is mandatory in the critically ill, because hypoglycemia and hyperglycemia are associated with increased mortality [1] .
T17366 538869-539056 Sentence denotes We compared in a prospective observational study three new pointof-care devices with the hexokinase reference method and we evaluated whether their results would modify insulin titration.
T51532 539057-539280 Sentence denotes Methods Arterial blood glucose was simultaneously measured by the blood gas analyser RapidLab 1265, by three glucose meters (Accu-Chek performa, Precision XceedPro, Nova StatStrip), and with the hexokinase reference method.
T46052 539281-539351 Sentence denotes All values were duplicated and the average value of each was computed.
T37557 539352-539438 Sentence denotes Bland-Altman, Passing Bablok, Kanji [2] and modifi ed Kanji approaches were performed.
T32279 539439-539538 Sentence denotes Biases were expressed as the glucose result of the point-of-care method minus the reference method.
T69569 539539-539735 Sentence denotes We evaluated the theoretical impact on insulin titration by comparing glucose meter results with the hexokinase reference method on a dynamic sliding scale targeting a glycemia of 80 to 130 mg/dl.
T89406 539736-539801 Sentence denotes Results A total of 156 matched analyses were done in 80 patients.
T36139 539802-539837 Sentence denotes The mean fl ash SOFA score was 4.5.
T89273 539838-539893 Sentence denotes The range of the reference glucose was 25 to 327 mg/dl.
T19222 539894-540031 Sentence denotes The numbers of discrepancies of dosing insulin were respectively 8-5-6-14 at 0.1 U/hour, 0-6-3-6 at 0.2 U/hour and 2-3-0-0 at 0.3 U/hour.
T89922 540032-540065 Sentence denotes None was greater than 0.3 U/hour.
T90060 540066-540252 Sentence denotes Regarding the point-of-care results, total theoretical insulin dose changes were respectively: -11.7 U, -19.2 U, -22.2 U, +4.9 U for all these measurements (devices order as in Methods).
T89748 540253-540295 Sentence denotes Table 1 presents the standard comparisons.
T77832 540296-540549 Sentence denotes Introduction Chronic critical illness is characterized by a severe metabolic disorder, caused by the loss of the physiologic hypothalamic and pituitary functions and the onset of the so-called wasting syndrome, as many studies have just confi rmed [1] .
T4977 540550-540665 Sentence denotes In this study we assessed the correlation between the neuroendocrine pattern in chronic ICU patients and mortality.
T15546 540666-540789 Sentence denotes Methods The patients enrolled were 25 (18 male and fi ve female) with a mean age of 67 years and APACHE II score of 12 ± 5.
T68783 540790-540944 Sentence denotes We excluded females in a premenopausal state, patients with previous endocrine problems or in therapy with dopamine, high dose of cortisone or amiodarone.
T55101 540945-541261 Sentence denotes In these patients, we evaluate, on the seventh day of stay in the ICU (considered the chronic phase of critical illness), the mean value of four nocturnal hormonal measurements (LH, FSH, estrogen, testosterone, DHEAS, androstenedione, androstenediol, progesterone, TSH, FT3, FT4, RT3, GH, IGF1, prolactin, cortisol).
T70744 541262-541335 Sentence denotes Furthermore, we observed hormonal patterns in people who died in the ICU.
T52435 541336-541488 Sentence denotes We found statistical evidence in the correlation of high levels of estrogens, related to aromatase increased function [2] , and the percentage of death.
T88733 541489-541629 Sentence denotes In the group of patients with estrogens more than 50 pg/ml, six of them died, while if estrogens were normal or low, none died ( Figure 1 ).
T71270 541630-541727 Sentence denotes Survivors and nonsurvivors did not diff er by mechanism of injury or APACHE score (11.6 vs 11.8).
T58543 541728-541822 Sentence denotes Medium serum estradiol levels were 44.96 pg/ ml in survivors and 115.08 pg/ml in nonsurvivors.
T41880 541823-541963 Sentence denotes Conclusions To date, the role of these hormones in critical illness pathophysiology and the increase of estrogen levels are still uncertain.
T71085 541964-541993 Sentence denotes Further studies are required.
T658 541994-542187 Sentence denotes Introduction Patients with severe burn injury experience a rapid elevation in multiple circulating proinfl ammatory cytokines, with the levels correlating with both injury severity and outcome.
T63184 542188-542425 Sentence denotes Accumulations of these cytokines in animal models have been observed in remote organs, however data are lacking regarding early serial heart cytokine levels following burn injury, and the therapeutic eff ects of estrogen on these levels.
T29509 542426-542566 Sentence denotes Using an animal model, we studied the acute eff ects of a fullthickness third-degree burn on cardiac levels of IL-1β, IL-6, IL-10, and TNFα.
T67688 542567-542711 Sentence denotes In addition, we analyzed the eff ect of estrogen on levels of cytochrome C, signifying apoptosis, and levels of NF-κB, signifying infl ammation.
T22430 542712-542839 Sentence denotes Here, we hypothesized that acute estrogen treatment decreases infl ammation in the heart and blocks the induction of apoptosis.
T11854 542840-542933 Sentence denotes Methods In this study, 144 male rats received third-degree 40% total body surface area burns.
T90418 542934-543066 Sentence denotes Fifteen minutes following burn injury, the animals received a subcutaneous injection of either placebo or 17β-estradiol (0.5 mg/kg).
T38936 543067-543245 Sentence denotes The hearts were harvested at 0.5, 1, 2, 4, 6, 8, 12, 18, and 24 hours after injury, and the heart cytokine (IL-1β, IL-6, IL-10, TNFα) levels were measured using the ELISA method.
T64589 543246-543372 Sentence denotes In addition, we assessed the cytosolic levels of cytochrome C and NF-κB at the 24-hour time point using western blot analysis.
T17794 543373-543549 Sentence denotes In the burned rats, 17β-estradiol signifi cantly decreased the cardiac levels of TNFα (~95%), IL-6 (~50%), IL-1β (~25%), and IL-10 (~20%), when compared with the placebo group.
T92474 543550-543678 Sentence denotes In addition, we determined that estradiol treatment restored cytosolic levels of NF-κB (65% increase) at the 24-hour time point.
T62997 543679-543785 Sentence denotes Also, estrogen decreased cytosolic accumulation of cytochrome C (50% reduction) at the 24-hour time point.
T3958 543786-543914 Sentence denotes Conclusions Following severe burn injury, estrogens decrease cardiac infl ammation and levels of the pro-apoptotic cytochrome C.
T72194 543915-544015 Sentence denotes In addition, estrogen signaling promotes cell survival, as indicated by an increase in NF-κB levels.
T66669 544016-544190 Sentence denotes Importantly, estrogen treatment following burn injury nearly ablated the deleterious burn-induced increase of TNFα in the heart to levels similar to unburned control animals.
T88340 544191-544269 Sentence denotes Elevated cardiac levels of TNFα have previously been linked to a poor outcome.
T80116 544270-544408 Sentence denotes Introduction Glucocorticoids are known to have an anti-insulin action on glucose metabolism, leading to increased lactate production [1] .
T81119 544409-544533 Sentence denotes Alternatively, glucocorticoid-induced apoptosis is a well-recognized phenomenon initiated by mitochondrial dysfunction [2] .
T66627 544534-544629 Sentence denotes Increased lactate production follows loss of mitochondrial membrane potential during apoptosis.
T4832 544630-544790 Sentence denotes Both mechanisms may lead to clinically relevant hyperlactatemia following glucocorticoid administration during cardiac surgery requiring cardiopulmonary bypass.
T99150 544791-545008 Sentence denotes Methods All adult patients undergoing cardiac surgery and cardiopulmonary bypass from 5 October through 21 November 2005 in a large academic teaching hospital in Rotterdam, the Netherlands were included in this study.
T79901 545009-545100 Sentence denotes Dexamethasone (60 to 80 mg) was given perioperatively at the discretion of the anesthetist.
T35630 545101-545160 Sentence denotes Lactate levels were measured within 1 hour postoperatively.
T59947 545161-545304 Sentence denotes The association between dexamethasone treatment, serum lactate levels and possible confounders was evaluated using ANOVA and linear regression.
T80485 545305-545438 Sentence denotes Results A total of 82 patients 18 years and older underwent cardiopulmonary bypass for cardiac surgery in the above-mentioned period.
T915 545439-545642 Sentence denotes Three patients undergoing heart or lung transplantation, who thus received methylprednisolone, were excluded; a further two patients who received hydrocortisone for allergic reactions were also excluded.
T44174 545643-545725 Sentence denotes Data were incomplete for one patient, leaving a total of 76 patients for analysis.
T74661 545726-545896 Sentence denotes The mean lactate level was 1.2 mmol/l in the 47 patients who did not receive steroids and 2.6 mmol/l in the 29 patients who received dexamethasone (P <0.0001, Figure 1 ).
T9922 545897-546105 Sentence denotes When adjusting for potential confounders such as age, glucose level, duration of cardiopulmonary bypass and preoperative NYHA heart failure classifi cation, this diff erence remained signifi cant (P <0.0001).
T44716 546106-546256 Sentence denotes Conclusions Administration of dexamethasone during cardiac surgery requiring cardiopulmonary bypass is associated with a signifi cant hyperlactatemia.
T83628 546257-546342 Sentence denotes Introduction We previously observed that critically ill patients are vitD defi cient.
T39464 546343-546435 Sentence denotes This status cannot be restored by increasing the normally recommended intravenous vitD dose.
T32548 546436-546656 Sentence denotes The antimicrobial peptide LL-37 is expressed in macrophages upon stimulation by 25OHD 3 . sCD163 is a soluble pattern-recognition receptor, which is a marker of macrophage activation and a predictor of mortality in SIRS.
T85540 546657-546819 Sentence denotes The aim of this study is to unravel the impact of 25OHD 3 defi ciency and normalization on innate immunity parameters -CRP, LL-37 and sCD163 -in critical illness.
T24718 546820-547064 Sentence denotes Methods We randomly allocated patients upon ICU admission to receive either placebo (n = 13) or a 10-day treatment of 15 μg/day 25OHD 3 intravenously after a loading dose of 200 μg intravenously (n = 11) on top of the normal vitD dose (200 IU).
T14797 547065-547238 Sentence denotes Patients with chronic bone or kidney disease, glucocorticoid treatment, age younger than 18 years, or with an anticipated ICU length of stay less than 10 days were excluded.
T40793 547239-547350 Sentence denotes On admission, patients were compared with healthy age-matched, gendermatched and BMI-matched controls (n = 24).
T33511 547351-547485 Sentence denotes Results Administration of the 25OHD 3 regimen resulted in a rapid and sustained increase of serum 25OHD 3 levels (P <0.05 vs placebo).
T4745 547486-547580 Sentence denotes 1,25(OH) 2 D 3 levels rose only transiently (P = 0.07 on day 1, P = 0.08 on day 2 vs placebo).
T32190 547581-547681 Sentence denotes 25OHD 3 and 1,25(OH) 2 D 3 levels were lower than those of healthy controls (sampled during summer).
T36782 547682-547735 Sentence denotes 25OHD 3 treatment had no signifi cant eff ect on CRP.
T10208 547736-547838 Sentence denotes On admission, LL-37 levels (26 ± 6 μg/l) were comparable with those of healthy controls (22 ± 2 μg/l).
T57991 547839-547919 Sentence denotes The treatment tended to transiently increase LL-37 levels (change from baseline:
T74028 547920-547949 Sentence denotes P = 0.1 on day 6 vs placebo).
T84066 547950-548231 Sentence denotes Serum sCD163 levels tended to be higher at baseline Critical Care 2010, Volume 14 Suppl 1 http://ccforum.com/supplements/14/S1 S198 (P = 0.06 vs healthy controls) and rose signifi cantly over time (P <0.05 on day 5 and on day 10 vs day 0) but were not infl uenced by the treatment.
T93867 548232-548518 Sentence denotes The preliminary results of this randomized placebocontrolled pilot study indicate that, in contrast to a high intravenous 500 IU vitD supplement, intravenous 25OHD 3 treatment resulted in an immediate and persistent increase in serum 25OHD 3 , but did not aff ect 1,25(OH) 2 D 3 levels.
T22183 548519-548676 Sentence denotes Plasma LL-37 alterations in the studied prolonged critically ill patients hints at ameliorated LL-37 production provided that the 25OHD 3 status is restored.
T47213 548677-548797 Sentence denotes Serum sCD163 and CRP levels evolved during the ICU stay, but were not signifi cantly altered by 25OHD 3 supplementation.
T73797 548798-548945 Sentence denotes The results of this pilot study warrant further research into the potential modulation of innate immune processes by 25OHD 3 in the critically ill.
T2309 548946-549052 Sentence denotes Introduction Critical illness is characterized by lean tissue wasting whereas adipose tissue is preserved.
T9073 549053-549279 Sentence denotes Obese critically ill patients may have a lower risk of death than nonobese patients, a recent observation that may suggest a protective role for adipose tissue during illness, a role which has not been previously investigated.
T38378 549280-549422 Sentence denotes We hypothesized that adipose tissue could function as a waste bin for potentially toxic metabolites, such as glucose, during critical illness.
T28116 549423-549642 Sentence denotes Methods We studied adipose tissue biopsies from 61 of critically ill patients, more specifi cally morphology and the potential to take up and metabolize glucose, and compared this with biopsies from 20 matched controls.
T88402 549643-549850 Sentence denotes Results Adipose tissue biopsies from critically ill patients revealed a higher number and a smaller size of adipocytes as compared with matched controls, coinciding with increased preadipocyte marker levels.
T95164 549851-549950 Sentence denotes Also, >95% of adipose biopsies from critically ill patients displayed positive macrophage staining.
T82065 549951-550050 Sentence denotes Gene and protein expression of insulin-independent GLUTs, and tissue glucose content was increased.
T2738 550051-550147 Sentence denotes Glucokinase expression was upregulated whereas glycogen and glucose-6-phosphate levels were low.
T76329 550148-550236 Sentence denotes Acetyl-CoA-carboxylase protein level and activity of fatty-acid synthase were increased.
T5194 550237-550304 Sentence denotes A substantially increased activity of AMPK may play a crucial role.
T91076 550305-550475 Sentence denotes Conclusions The larger number of small adipocytes in response to critical illness appears to have an increased ability to take up and metabolize glucose into fatty acids.
T9314 550476-550643 Sentence denotes Such changes may render adipose tissue biologically active as a functional waste bin for toxic metabolites during critical illness, which could contribute to survival.
T64089 550644-550746 Sentence denotes Good communication with patients' relatives has humanitarian, professional and medico-legal benefi ts.
T5012 550747-550863 Sentence denotes The NHS Litigation Authority requires clear information documentation and monitoring that this is satisfactory [1] .
T40464 550864-551000 Sentence denotes This review was performed to ascertain relatives' opinions regarding the current standard of communication received from medical staff .
T46550 551001-551116 Sentence denotes Methods A paper questionnaire was made available to relatives after discussion with a member of the medical staff .
T55427 551117-551204 Sentence denotes Data for the fi rst month are discussed below, based on an average 50 admissions/month.
T80244 551205-551329 Sentence denotes The questionnaire was at the main reception desk, and staff also off ered them to relatives after each professional contact.
T3110 551330-551469 Sentence denotes Closed questions with single answers chosen from fi ve options (including one neutral option) were asked along with space for free comment.
T27897 551470-551567 Sentence denotes Results Eighteen questionnaires were completed: to our knowledge no relatives refused completion.
T61606 551568-551712 Sentence denotes Thirteen out of 18 discussions took place between 8 am and 6 pm, Monday to Friday, three between 8 pm and 6 am weekdays, and two at the weekend.
T61261 551713-551784 Sentence denotes All 18/18 respondents felt the doctor had explained their role in care.
T68113 551785-551901 Sentence denotes Thirteen out of 18 discussions took place in the dedicated interview room, four at the bedside and one by telephone.
T15983 551902-552092 Sentence denotes Seventeen out of 18 rated the service as very good for information given, clarity and the eff ect of the exchange on overall impressions of care; one questionnaire rated the service as good.
T70572 552093-552222 Sentence denotes Conclusions Relative communication is highly subjective but is known to infl uence impressions formed of overall quality of care.
T4787 552223-552347 Sentence denotes National audit frameworks emphasise objective quantifi able standards, which do not capture the quality of interaction [2] .
T99099 552348-552505 Sentence denotes We have monitored service quality based on subjective relative impressions, however the response rate (<40%) has potential for a positive bias in our favour.
T13040 552506-552622 Sentence denotes Many discussions are complex and there is a possibility that questionnaires were not off ered in certain situations.
T30660 552623-552770 Sentence denotes Additionally, despite full anonymity of the form, relatives may have been concerned about what was written impacting on their family member's care.
T77650 552771-552960 Sentence denotes It is known that benefi ts in the processes of clinical care leading to improvements in quality can arise purely from measurement; that is, performing service reviews such as this one [3] .
T79360 552961-553197 Sentence denotes If targets are to be used to benchmark quality of care in this area, there is a need for more consideration of the appropriate targets or alternatively an acceptance that there is the potential to have lower data capture in these areas.
T24003 553198-553298 Sentence denotes Introduction Patient satisfaction data collation is a priority for the UK's Care Quality Commission.
T79450 553299-553389 Sentence denotes In the adult intensive care unit (AICU), patients are often sedated for prolonged periods.
T29445 553390-553466 Sentence denotes Family satisfaction data may be useful to gauge quality of service delivery.
T6203 553467-553565 Sentence denotes The Family Satisfaction-ICU (FS-ICU 34) questionnaire was developed and validated in the USA [1] .
T52391 553566-553628 Sentence denotes To our knowledge, we are the fi rst group to use it in the UK.
T49355 553629-553682 Sentence denotes Methods The FS-ICU 34 is an anonymised questionnaire.
T67044 553683-553737 Sentence denotes We adapted the American terminology for use in the UK.
T71972 553738-553821 Sentence denotes Inclusion criteria were: AICU admission of 5 days or more; presence of next-of-kin.
T28877 553822-553854 Sentence denotes Patients who died were excluded.
T17070 553855-553930 Sentence denotes It was handed personally to AICU patients' next-of-kin following discharge.
T53693 553931-554029 Sentence denotes Nursing staff from both the AICU and general wards assisted in returning completed questionnaires.
T13250 554030-554292 Sentence denotes Key areas of questioning using the FS-ICU were: perception of treatment of patient discomfort; coordination of AICU services; skill and competencies of AICU staff ; consistency and frequency of communication; standard of family facilities; and emotional support.
T18293 554293-554380 Sentence denotes Relatives were asked to grade their answers on a fi ve-point scale (excellent to poor).
T44417 554381-554457 Sentence denotes Results Data from the fi rst 4 months of this survey have now been analysed.
T23940 554458-554565 Sentence denotes One hundred per cent of patients' relatives who fulfi lled the inclusion criteria received a questionnaire.
T26586 554566-554592 Sentence denotes The response rate was 68%.
T42496 554593-554675 Sentence denotes The majority of respondents were satisfi ed with overall care and decision-making.
T63485 554676-554904 Sentence denotes Similarly to published data [2] , families were most satisfi ed with nursing skill and competence (94.7% satisfi ed), and least satisfi ed with waiting room atmosphere (42.4%) and frequency of communication with doctors (71.2%).
T90816 554905-555015 Sentence denotes Conclusions The FS-ICU has enabled us to identify and target resources at key aspects of our service delivery.
T87 555016-555144 Sentence denotes It has presented an opportunity for us to address misunderstandings and misconceptions regarding the ICU within our client base.
T85598 555145-555280 Sentence denotes This survey is unique in examining the links the ICU has with the community and informs the process of understanding that relationship.
T46743 555281-555404 Sentence denotes Methods A 16-item questionnaire around various issues on consciousness was presented to attendees at conferences in Europe.
T16388 555405-555543 Sentence denotes Data were obtained from 3,672 respondents (M age 36 ± 16 years, range 14 to 88; 55% women; 34 EU countries) and were analyzed with SPSS v.
T22638 555544-555549 Sentence denotes 16.0.
T81179 555550-555682 Sentence denotes Results Sixty-seven percent (n = 2,454) agreed with ANH withdrawal in chronic VS (31%, n = 1,138 disagreed; 2%, n = 80 no response).
T61331 555683-555848 Sentence denotes A signifi cant agreement was expressed by nonreligious respondents (vs religious; B = 0.70, P <0.001) and nonmedical professionals (vs doctors; B = 0.34, P = 0.001).
T50854 555849-556078 Sentence denotes Signifi cant disagreement was expressed by women (vs men; B = -0.25, P = 0.004), central and south Europeans (vs northern; B = -0.85, P <0.001 and B = -1.23, P <0.001, respectively) and those of higher age (B = -0.008, P = 0.01).
T79638 556079-556230 Sentence denotes Eighty percent (n = 2,956) did not wish to stay alive if themselves were in a permanent VS (18%, n = 625 wished to stay alive; 2%, n = 64 no response).
T69471 556231-556397 Sentence denotes Seventy-eight percent considered that being in permanent VS is worse than death for the patient's family (55% considered it worse than death for patients themselves).
T71822 556398-556522 Sentence denotes Sixty-nine percent (n = 2,523) disagreed with ANH withdrawal in chronic MCS (29%, n = 1,073 agreed; 2%, n = 76 no response).
T25857 556523-556826 Sentence denotes A signifi cant disagreement was expressed by central and south Europeans (vs northern; B = -0.58, P <0.001 and B = -1.3, P <0.001, respectively) and respondents of higher age (B = -0.007, P = 0.019); a signifi cant agreement was expressed by non-religious respondents (vs religious; B = 0.65, P <0.001).
T48992 556827-556988 Sentence denotes Sixty-four percent (n = 2,355) did not wish to be kept alive if themselves were in a permanent MCS (34%, n = 1,248 wished to stay alive; 2%, n = 69 no response).
T74380 556989-557134 Sentence denotes Forty percent considered that being in a MCS is worse than VS for the patient's family (50% considered it worse than VS for patients themselves).
T34104 557135-557267 Sentence denotes Conclusions These fi ndings raise important ethical issues concerning our care for patients with chronic disorders of consciousness.
T76178 557268-557392 Sentence denotes In light of high rates of diagnostic error in these patients [2] , the necessity for adapted standards of care is warranted.
T19421 557393-557520 Sentence denotes Introduction The aim of this study was to demonstrate improvements in both staff and patient experiences with end-of-life care.
T30298 557521-557638 Sentence denotes The ICU is a setting where death is common; it has been suggested that 20% of patients in the US die on the ICU [1] .
T81328 557639-557779 Sentence denotes Given that the majority of ICU deaths involve the withholding or withdrawing of treatment [2] , the importance of end-of-life care is clear.
T36207 557780-557898 Sentence denotes Despite this frequency, studies suggest that the current quality of end-of-life care is suboptimal on the ICU [3, 4] .
T68107 557899-557963 Sentence denotes As a result, we developed a new framework to address this issue.
T33486 557964-558139 Sentence denotes Methods We introduced our new framework over a 1-year period; we circulated questionnaires to the staff pre and post study to demonstrate any improvements in end-of-life care.
T86967 558140-558298 Sentence denotes Results Our framework was found to be helpful by 97% of respondents and was associated with an improvement in communication and knowledge of end-of-life care.
T22494 558299-558504 Sentence denotes We discovered an increase in the number of staff who felt that patients, along with having their analgesia/sedation needs met, were now experiencing care that was more conducive to a good quality of dying.
T84907 558505-558619 Sentence denotes The number of staff who now felt confi dent in managing withdrawal of care trended towards a signifi cant P value.
T24685 558620-558645 Sentence denotes See Figure 1 for details.
T26990 558646-558891 Sentence denotes Conclusions Quality of end-of-life care was improved with our new framework; however, further research is vital to ensure our patients receive the same kind of evidence-based medicine in their fi nal hours as they did during their acute illness.
T17441 558892-559070 Sentence denotes The acknowledgement of local practice with respect to endof-life decisions in accordance with laws and ethical principles is inevitable for intensive physicians in all countries.
T17955 559071-559257 Sentence denotes The fi rst step for the required social dialogue is to search for local customs for harmonisation with ethical and legal regulations, as well as the interests of physicians and patients.
T26228 559258-559396 Sentence denotes Methods In 2007 we performed the fi rst Hungarian survey with the purpose to learn more about the local practice of end-of-life decisions.
T1761 559397-559530 Sentence denotes Questionnaires were sent out electronically to 743 registered members of the Hungarian Society of Anaesthesiology and Intensive Care.
T39656 559531-559675 Sentence denotes Respecting anonymity we have statistically evaluated 103 replies (response rate was 13.8%) and compared with data from other European countries.
T53627 559676-559874 Sentence denotes Results As expected, it turned out from the replies that the practice of domestic intensive care physicians is very paternal and this is promoted by legal regulations that share a similar character.
T95751 559875-560090 Sentence denotes Intensive care physicians generally make their decisions alone (3.75/5 points) without respecting the opinion of the patient (2.57/5 points), the relatives (2.14/5 points) or other medical personnel (2.37/5 points).
T21789 560091-560180 Sentence denotes Furthermore they prefer not to start a therapy rather than withdraw an ongoing treatment.
T67031 560181-560299 Sentence denotes Nevertheless, the frequency of end-of-life decisions (3 to 9% of ICU patients) is similar to other European countries.
T47362 560300-560383 Sentence denotes Conclusions Hungarian intensive care physicians make end-of-life actions routinely.
T46325 560384-560519 Sentence denotes They usually decide based on their own opinion, slightly considering the opinion of nursing personnel, the patients or their relatives.
T10528 560520-560603 Sentence denotes They are not supported by the Hungarian legal regulation in making these decisions.
T3671 560604-560718 Sentence denotes Although the living will and the advanced directive are both acknowledged, they are not as widespread as required.
T67678 560719-560853 Sentence denotes Our study is the fi rst step to commence a social dialogue, which is taken in the evolution of end-of-life decision-making procedures.