32 research outputs found
Strategies for the determination of cefazolin in plasma and microdialysis samples by short‐end capillary zone electrophoresis
No full textDifferent ventilation intensities among various categories of patients ventilated for reasons other than ARDS––A pooled analysis of 4 observational studies
No full textPurpose: We investigated driving pressure (Delta P) and mechanical power (MP) and associations with clinical outcomes in critically ill patients ventilated for reasons other than ARDS. Materials and methods: Individual patient data analysis of a pooled database that included patients from four observational studies of ventilation. Delta P and MP were compared among invasively ventilated non-ARDS patients with sepsis, with pneumonia, and not having sepsis or pneumonia. The primary endpoint was Delta P; secondary endpoints included MP, ICU mortality and length of stay, and duration of ventilation. Results: This analysis included 372 (11%) sepsis patients, 944 (28%) pneumonia patients, and 2040 (61%) patients ventilated for any other reason. On day 1, median Delta P was higher in sepsis (14 [11-18] cmH(2)O) and pneumonia patients (14 [11-18]cmH(2)O), as compared to patients not having sepsis or pneumonia (13 [10-16] cmH(2)O) (P < 0.001). Median MP was also higher in sepsis and pneumonia patients. Delta P, as opposed to MP, was associated with ICU mortality in sepsis and pneumonia patients. Conclusions: The intensity of ventilation differed between patients with sepsis or pneumonia and patients receiving ventilation for any other reason; Delta P was associated with higher mortality in sepsis and pneumonia patients
Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery
No full textAbstract Background Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP) and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery. Methods The PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO") trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH2O with recruitment maneuvers (the lung-protective strategy) or mechanical ventilation with the level of PEEP at maximum 2 cmH2O without recruitment maneuvers (the conventional strategy). The primary endpoint is any post-operative pulmonary complication. Discussion The PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications. Trial registration ISRCTN: ISRCTN70332574</p
Clonidine Added to the Anesthetic Solution Enhances Analgesia and Improves Oxygenation After Intercostal Nerve Block for Thoracotomy
No full textBritish Journal of Clinical Pharmacology / Cefuroxime plasma and tissue concentrations in patients undergoing elective cardiac surgery: Continuous vs bolus application. A pilot study
No full textAims
Surgical site infections contribute to morbidity and mortality after surgery. The authors hypothesized that higher antibiotic tissue concentrations can be reached for a prolonged time span by continuous administration of prophylactic cefuroxime compared to bolus administration.
Methods
Twelve patients undergoing elective cardiac surgery were investigated. Group A received 1.5 g cefuroxime as bolus infusions before surgery, and 12 and 24 hours thereafter. In group B, a continuous infusion of 3.0 g cefuroxime was started after a bolus of 1.5 g. Cefuroxim levels were determined in blood and tissue (microdialysis). T test, Wilcoxon signed rank test and test were used for statistical analysis.
Results
The area under the curve (AUC) of plasma cefuroxime concentrations was greater in group B (399 [333518]) as compared to group A (257 [177297] h mg L, [median and interquartile range], P = .026). Furthermore, a significantly longer percentage of time > minimal inhibitory concentrations of 2 mg L (100% vs 50%), 4 mg L (100% vs 42%), 8 mg L (100% vs 17%) and 16 mg L (83% vs 8%) was found for free plasma cefuroxime in group B. In group B, area under the curve in subcutaneous tissue (78 [61113] h mg L) and median peak concentration (33 [2638] mg L) were markedly higher compared to group A (P = 0.041 and P = .026, respectively).
Conclusions
Higher cefuroxime concentrations were measured in plasma and subcutaneously over a prolonged period of time when cefuroxime was administered continuously. The clinical implication of this finding still has to be elucidated.(VLID)509872
The Influence of Lung Volume Reduction Surgery on Ventilatory Mechanics in Patients Suffering from Severe Chronic Obstructive Pulmonary Disease
No full textThe Influence of Lung Volume Reduction Surgery on Ventilatory Mechanics in Patients Suffering from Severe Chronic Obstructive Pulmonary Disease
No full text
