Abstract
Inhalation of nitric oxide (NO) and prone position ventilation (PPV) have been showed to improve the PaO2/FiO2 ratio in patients with acute respiratory distress syndrome (ARDS). The aim of this study was to identify which of the following treatments (PPV, NO or PPV + NO) improved the PaO2/FiO2 ratio most in a patient. Ten consecutive patients presenting with severe acute respiratory failure (PaO2/FiO2 <150 mmHg) unrelated to congestive heart failure were studied. The time course of the treatment was as follow: supine position (SPV) (H0 control value), PPV (H0 to H2), SPV (H2 to H3), PPV + NO (H3 to H5) and SPV + NO (H5 to H6). Oxymetric parameters were measured at the end of each cycle of treatment. During the protocol, ventilator settings were unchanged. A patient was considered as responder to a treatment when the PaO2/FiO2 ratio increased by a value of 20 mmHg compared to the control value. After the protocol time course, each patient received the treatment according to the best oxymetric results. Two patients were no responders to PPV and 8 patients responded to PPV with an increase of PaO2/FiO2 of 122.8 ± 104.5 mmHg (mean ± sd). Five patients were responders to NO with an increase of PaO2/FiO2 of 51.8 ± 20.2 mmHg. Only one patient was not responsive to NO and to PPV, but responded to PPV + NO combination (+ 65 mmHg). According to the results, the treatments selected were: 1) PPV + NO in 6 patients: increase of PaO2/FiO2 by a mean of 149.7 ± 89.6 mmHg; 2) PPV in 3 patients: increase of PaO2/FiO2 by a mean of 131.3 ± 124 mmHg; 3) NO alone in one patient: increase of PaO2/FiO2 by 75 mmHg. Although the aim of the study was not to compare the 2 methods, it seems nevertheless that PPV was more effective than NO. An additive effect of PPV and NO was found in 6 out of 10 patients and especially in one patient not responding to PPV or NO alone.
Highlights
Lipopolysaccharides (LPS) are known to be involved in the pathogenesis of septic shock and multiorgan failure
Prospective, longitudinal, descriptive cohort study with no therapeutic interventions in which participated 63 patients admitted to the intensive care unit (ICU) with the clinical diagnosis of severe sepsis (21) or septic shock (42) [3] and 10 healthy adults that served as controls
This study shows for the first time that preoperative measurement of C-reactive protein (CRP) may offer a useful, predictive marker in risk stratification for postoperative infections in patients scheduled for cardiac surgery
Summary
Lipopolysaccharides (LPS) are known to be involved in the pathogenesis of septic shock and multiorgan failure. Conclusions: The combination of these two new and not very well known techniques, TGI and BIPAP, were useful in avoiding the adverse effects of high pressures and volumes to counteract the effects of high arterial CO2 levels in patients with limited cardio-circulatory status and acute or chronic lung and cerebral diseases In this small sample, considering the influence of time in the reduction of PACO2 and in the increase of pH values, the best moment to verify the response of TGI is beyond 60 min. Methods: 24 critically ill, MV patients (mean APACHE II score: 21, mean age 64 ± 14 yrs, 15 men), hospitalized in a medical intensive care unit, were prospectively included for 24-h esophageal pH and duodenogastroesophageal reflux (DGER) studies (Digitrapper III pH-meter and fiber-optic sensor for the presence of bilirubin, Bilitec 2000, Synectics, Sweden) with single sensors placed 5 cm proximal to the lower esophageal sphincter (LES) and instrumented with a nasogastric tube. Discussion and conclusion: The comparisons between institutions must be corrected for several factors: variations in casemix, patients co-morbidites, status of previous disease, delays in referral, social factors and access to
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