Abstract
In a pilot study the 'open lung' concept was applied 22 times in 13 patients of a university medical intensive care unit with ARDS (lung injury score 3.7 ± 0.7) due to sepsis of various origin (APACHE II score 27.4 ± 6.3). Starting with the actual respirator adjustment, peak inspiratory pressure was increased by 10 cmH2O every 3 min up to a mean pressure of 61 ± 9 cmH2O, depending on the hemodynamic state and blood gas results of the patient. PEEP was increased to 15 to 25 cmH2O. After achieving maximal elevation of arterial PaO2, the peak pressure was then lowered to 30, maximal 40, cmH2O and PEEP adjusted just above the alveolar occlusion pressure which guaranteed a tidal volume of about 6 ml/kg body weight. Under this regimen, FiO2 could be significantly lowered from 0.9 to 0.55 with marked rise in oxygenation index from 100 ± 36 to 177 ± 63 mmHg in responders (15 maneuvers in 11 patients). Plain chest X-ray and CT scan showed marked reduction of signs of pulmonary infiltration in a very short time. The 'open lung' approach, though short-lived, might provoke pneumothorax and mediastinal emphysema. However, it enables rapid recruitment of previously atelectatic alveoli, thus resulting in better oxygenation on the one hand, and help avoid oxygen toxicity and protracted volu- and barotrauma on the other hand which are the usual sequel of prolonged ventilation using conventional mode in ARDS. Depending on our experience, the advantages of the concept are far more obvious than its possible risks. Continuous blood gas monitoring systems may help shorten the period of high inspiratory peak pressure. Multicentre studies are required to validate long-term results and possible complications.
Highlights
Brain swelling (BS) is a kind of response observed in 15%– 20% of severe head injury
Conclusions: (i) The oxygen free radical (OFR) and LA have some important effect in postischemic-anoxic encephalopathy. (ii) Mild hypothermia induced immediately with reperfusion after Cardiac arrest (CA) may improve cerebral outcome. (iii) The mechanism of this beneficial effect may be to reduce the generation of OFR and to mitigate the lipid peroxidation induced by OFR
Being a potent vasoactive peptide produced in sepsis, ET may be involved in the pathophysiology of the markedly deteriorated splanchnic circulation seen in septic shock
Summary
Brain swelling (BS) is a kind of response observed in 15%– 20% of severe head injury. Mean arterial blood pressure in fair prognosis patients increased significantly compared with control values, while slight decreases occurred in leukocyte and platelet counts after 30 min of this treatment. Methods: After approval of the ethics committee and written informed consent, 12 patients (6 male and 6 female, mean age 59 ± 10 years) undergoing elective liver resection randomly received either 0.4 g/kg HBOC-201 (Biopure MA, group 1) or 3 ml/kg of hydroxyethylstarch 70,000/0.5 (B Braun, FRG, group 2) after autologous blood donation of 1 l. Subjects and methods: A prospective study evaluating the efficacy of increasing peri-operative oxygen delivery in high risk surgical patients, to greater than 600 ml/min/m2 with dopexamine hydrochloride, in routine clinical practice Results: Expressed as medians with 25%, 75% centiles.
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