Alveolar recruitment during prone position: time matters.

Alveolar recruitment is one of the beneficial effects of prone positioning in patients with ARDS (acute respiratory distress syndrome). However, responses vary among patients and, therefore, we hypothesized that alveolar recruitment is an individual time-dependent process and its measurement might be helpful to 'dose' prone positioning individually. In 13 patients diagnosed with ARDS, EELV (end-expiratory lung volume) was measured in the supine position, immediately after turning to the prone position, at 1, 2, 4 and 8 h in the prone position and after returning to the supine position.

Volume measurement of cerebral blood flow: assessment of cerebral circulatory arrest.

Background: Cerebral blood flow (CBF) volume can be measured at bedside by color duplex flowmetry of the extracranial cerebral arteries. In neurointensive care patients, we prospectively tested the hypothesis that a CBF volume <100 ml/min indicates imminent cerebral circulatory arrest.

Methods: CBF volume was determined as sum of flow volumes in the internal carotid and vertebral arteries of both sides.

Management of liver transplantation in a patient with a history of heparin-induced thrombocytopenia.

Heparin-induced thrombocytopenia (HIT) is an adverse immune-mediated drug reaction in which antibodies are generated usually towards complexes of the soluble platelet protein platelet-factor-4 (PF4) and heparin. The resulting immune complexes activate platelets intravascularly, which increases the generation of thrombin. Therefore, HIT is strongly associated with thrombosis and heparin is thought to be contraindicated.

Influence of underlying disease on the outcome of critically ill patients with acute renal failure.

Background And Objective: The development of acute renal failure (ARF) in critically ill patients is associated with an increase in hospital mortality. Recently, it was shown that starting renal replacement therapy early and using high-filtrate flow rates can improve the outcome, but this could not be confirmed in later investigations. Studying selected patient subgroups could provide a useful basis for patient selection in future trials evaluating the outcome of renal replacement therapies.

[Noninvasive determination of cardiac output in ventilated patients . Clinical evaluation of a simplified quick method].

Objective: This study was performed to evaluate a new simplified rebreathing method to determine cardiac output (CO) in mechanically ventilated patients.

Methods: Using a rebreathing system (AMIS 2001, Innovision, Dänemark), effective pulmonary blood flow (PBF) and oxygen consumption (V(radical)O2) were determined non-invasively in 40 patients. After estimation of arterial (CaO2) and capillary oxygen (CcO2) content from the results of an arterial blood gas analysis, intrapulmonary shunt was calculated as Q(s)/Q(t) = [CcO2CaO2] * PBF/V(radical)O(2).