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Nursing, Statistical Analysis, Multivariate Analysis, Prospective studies, Humans, and 21 moreEurope, Database Design, INTENSIVE CARE, Cluster Analysis, Netherlands, Workload, Cross Validation, External Validity, Clinical Sciences, Intensive Care Unit, Observer Variation, Random sampling, Public health systems and services research, Retrospective Studies, Multivariate Regression, Reproducibility of Results, Intensive Care Medicine, Intensive Care Units, Predictive value of tests, Severity of Illness Index, and Multicenter Studies as Topic
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... Michele Umbrello Paolo Formenti Andrea Galimberti Moreno Curti Matteo Zaniboni Gaetano Iapichino ... Anesthesiology 89:1313–1321 3. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL... more
... Michele Umbrello Paolo Formenti Andrea Galimberti Moreno Curti Matteo Zaniboni Gaetano Iapichino ... Anesthesiology 89:1313–1321 3. Michard F, Boussat S, Chemla D, Anguel N, Mercat A, Lecarpentier Y, Richard C, Pinsky MR, Teboul JL (2000) Relation between respiratory ...
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Decision Making, Mortality, Probability, Prospective studies, Humans, and 19 moreTriage, INTENSIVE CARE, Female, Male, Statistical Significance, Cohort Study, Propensity Score, Patient Admission, ROC Curve, Clinical Sciences, Intensive Care Unit, Aged, Middle Aged, Public health systems and services research, Intensive Care Medicine, Intensive Care Units, Confidence Interval, Medical Treatment, and Severity of Illness Index
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Hyponatremia is the most common electrolyte disturbance in hospitalized patients, and it represents a well-established risk factor for ICU/hospital mortality. The majority of hyponatremic states are associated with elevated arginine... more
Hyponatremia is the most common electrolyte disturbance in hospitalized patients, and it represents a well-established risk factor for ICU/hospital mortality. The majority of hyponatremic states are associated with elevated arginine vasopressin levels and a preserved sodium pool. Conventional treatment is either not pathophysiologically oriented or of limited effectiveness. The aim of the present study is to investigate the use of enteral Tolvaptan in critically ill hyponatremic patients. This is a retrospective observational study in a general ICU. Patients with preserved sodium pool hyponatremia refractory to conventional therapy were enrolled. The hemodynamic, renal, and hepatic functions, together with sodium and water balance as close as possible to the drug administration and up to 72 h thereafter, were analyzed. The main outcome was a serum sodium increase of ≥ 4 mmol/L in 24 h; secondary endpoints were the ability to maintain serum sodium at 24 and 72 h, a decrease in urine sodium concentration and an increase in sodium-free diuresis. 38 patients were enrolled. The average dose of enteral Tolvaptan was 7.5 mg. 31 patients (81.6 %) increased their serum sodium >4 mmol/l/24 h; the average increase was 6.7 ± 3.4 mmol/l during the first 24 h (p < 0.001 vs baseline), and this was sustained at 72 h. No adverse effects were reported. Plasma sodium (R = -0.622, p < 0.001), urine sodium (R = -0.345, p < 0.001), central venous oxygen saturation (R = 0.401, p = 0.013), and BUN (R = -0.416, p = 0.031) before Tolvaptan were all significantly correlated with the absolute increase in serum sodium after the administration. Enteral administration of Tolvaptan seems effective in the treatment of hyponatremia with preserved sodium pool in critically ill patients. Even if the study was underpowered to detect significant side effects or complications of unwarranted fast corrections of hyponatremia, we report no complications.
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It has been shown that apneic oxygenation can be safely performed for many days when metabolic carbon dioxide is removed by an extracorporeal membrane lung, and 100% oxygen is supplied directly into the trachea to keep the intrapulmonary... more
It has been shown that apneic oxygenation can be safely performed for many days when metabolic carbon dioxide is removed by an extracorporeal membrane lung, and 100% oxygen is supplied directly into the trachea to keep the intrapulmonary pressure at 5 cm. H2O. The study was designed to find "best intrapulmonary pressure (IP)", analogous to "best PEEP" during continuous positive pressure ventilation. In the present study we have shown that when IP was progressively raised from 5cm H2O to 20 cm H2O the PaO2 rose significantly due to progressive decrease in QVA/Q. A linear positive correlation was found between CO and QVA/Q. There was a negative correlation between QVA/Q and FRC. Total static lung compliance and FRC increased significantly at 15--20 cm H2O IP. There was no significant change in urinary flow, urea and creatinine clearances. We conclude that in apneic oxygenation a more "optimal IP" is attained at an IP pressure of 20 cm H2O than at 5 cm H2O.
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Results observed in 190 patients receiving parenteral nutrition (including 104 thus treated for periods of 3 to 28 days) are presented. The data point to the importance of both the quantity and quality of the calorie and nitrogen intake.... more
Results observed in 190 patients receiving parenteral nutrition (including 104 thus treated for periods of 3 to 28 days) are presented. The data point to the importance of both the quantity and quality of the calorie and nitrogen intake. The energy and plastic sources used in the treatment are discussed. The modalities most suited for employment in patients with unimpaired renal functional and in those with serious renal insufficiency are described in the light of personal experience.
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It has been shown that apneic oxygenation can be safely performed for many days when metabolic carbon dioxide is removed by an extracorporeal membrane lung, and 100% oxygen is supplied directly into the trachea to keep the intrapulmonary... more
It has been shown that apneic oxygenation can be safely performed for many days when metabolic carbon dioxide is removed by an extracorporeal membrane lung, and 100% oxygen is supplied directly into the trachea to keep the intrapulmonary pressure at 5 cm. H2O. The study was designed to find "best intrapulmonary pressure (IP)", analogous to "best PEEP" during continuous positive pressure ventilation. In the present study we have shown that when IP was progressively raised from 5cm H2O to 20 cm H2O the PaO2 rose significantly due to progressive decrease in QVA/Q. A linear positive correlation was found between CO and QVA/Q. There was a negative correlation between QVA/Q and FRC. Total static lung compliance and FRC increased significantly at 15--20 cm H2O IP. There was no significant change in urinary flow, urea and creatinine clearances. We conclude that in apneic oxygenation a more "optimal IP" is attained at an IP pressure of 20 cm H2O than at 5 cm H2O.
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A case of acute post-traumatic pulmonary failure was treated by extracorporeal respiratory assist, after conventional therapy had failed. Veno-venous bypass was established, with low extracorporeal blood flow (1.6-2 l min-1), and high... more
A case of acute post-traumatic pulmonary failure was treated by extracorporeal respiratory assist, after conventional therapy had failed. Veno-venous bypass was established, with low extracorporeal blood flow (1.6-2 l min-1), and high exchange surface area membrane lungs (7 m2), according to the technique of low-frequency positive-pressure ventilation with extracorporeal carbon-dioxide removal. After a first disconnection, the evolution of the lung disease necessitated a second surgical procedure, during which a chest tube perforated the patient's right lower, pulmonary lobe. A two-stage right thoracotomy was performed, with the patient connected to the extracorporeal system, and receiving full heparinization. Massive bleeding and severe hypoxia were encountered, but successfully overcome. The patient is now a long-term survivor.
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Variations in plasma levels of total carnitine (TC), free carnitine (FC), and acyl-carnitine (AC) were studied in 10 patients undergoing orthotopic liver transplantation. The postoperative values were higher than the preoperative ones and... more
Variations in plasma levels of total carnitine (TC), free carnitine (FC), and acyl-carnitine (AC) were studied in 10 patients undergoing orthotopic liver transplantation. The postoperative values were higher than the preoperative ones and positively related to time flow. As exogenous carnitine was not supplied during the study, these data suggested a better biosynthetic activity in the transplanted liver, in spite of standard blood tests results. No positive correlation between carnitine levels and variations in serum transaminases, bilirubin, cholestasis related enzymes, pre-albumin and albumin supply was found. Carnitine plasma levels were not influenced either by nutritional caloric input or by methionine and lysine inputs. Our results show that variations in carnitine plasma levels are a specific and responsive index of functional recovery in the transplanted liver.