Abstract
In early acute respiratory distress syndrome (ARDS), alteration in the pulmonary capillary permeability is associated with outcome [1]. Alteration in the relation of extravascular lung water to intrathoracic blood volume (EVLW/ITBV) derived from thermal-dye dilution curves indicates changes in the pulmonary vascular permeability. Prone positioning improves gas exchange in most patients with ARDS, however whether this improvement is related to effects on pulmonary vascular permeability has not been evaluated. This prospective pilot study was designed to investigate whether prone positioning would alter EVLW/ITBV as a measure of pulmonary vascular permeability. Patients with ARDS on inverse ratio pressure-controlled ventilation with PEEP > 10 cmH2O for at least 24 hours were recruited. Patients were turned prone for 18 hours. Except for FiO2, ventilatory settings remained unchanged during the study period. Values of EVLW and ITBV were obtained using a single transpulmonary arterial thermodilution technique with a 5F-fibreoptic thermistor femoral artery catheter. Measurements of EVLW and ITBV were taken at pre-prone, 1, 2, 6, 12 and 18 hours after proning and 1 hour after supine. EVLW/ITBV while prone was normalised to pre-prone values as a baseline to illustrate differences during prone and supine. Data were expressed as mean (SEM). Repeated measures ANOVA was used for statistical analysis. Twelve episodes of proning in 11 patients were studied. Although mean PaO2/FiO2 improved within 1 hour, it continued to improve during the period studied and only reached significance 12 hours after proning (17.9 ± 2.9 v 35.1 ± 4.2, P < 0.05). Mean EVLW/ITBV did not change significantly. At least 12 hours may be needed for maximal benefit with prone positioning. Changes in pulmonary vascular permeability in ARDS do not appear to be an important mechanism to account for the improvement in gas exchange seen following prone positioning. Table 1 Changes in EVLW/ITBV after prone positioning in ARDS
Highlights
In our experience, very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient
The difference between both attributable mortality rates (22.1%) was statistically significant
P109 How we reduce allogenic blood transfusions in the patients undergoing surgery of ascending aorta D Radojevic, Z Jankovic, B Calija, M Jovic, B Djukanovic
Summary
Very often, even with a nonrebreathing mask (NRM), high oxygen delivery to patient with the existent materials is insufficient. There is evidence that increasing the dose of continuous renal replacement therapy (CRRT) is associated with improved survival in critically ill patients with acute renal failure (ARF) [1]. The aim of this study is to investigate if there is any difference in patients’ characteristics in ICU between COPD and nonCOPD diseases caused chronic respiratory failure and require mechanical ventilation during acute exacerbations. Noninvasive positive pressure ventilation (NPPV) has been reported to be beneficial in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD), and to facilitate weaning In this trial we assessed the possible benefit of early NPPV in patients with blunt chest trauma and acute respiratory failure. The aim of this study was to compare the pharmacokinetic and pharmacodynamic parameters and the clinical efficacy of a continuous infusion of cefepime versus an intermittent regimen in critically ill adults patients with gram negative bacilli infection. The purpose of the study is to identify the factors associated with DNR status in our institution
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
