Perioperative proADM-change is associated with the development of acute respiratory distress syndrome in critically ill cardiac surgery patients: a prospective cohort study.

Biomarkers of acute respiratory distress syndrome (ARDS) after cardiac-surgery may help risk-stratification and management. Preoperative single-value proADM increases predictive capacity of scoring-system EuroSCORE. To include the impact of surgery, we aim to assess the predictive value of the perioperative proADM-change on development of ARDS in 40 cardiac-surgery patients.

Higher Tinzaparin Dosing Is Needed to Achieve Target Anti-Xa Levels in Pediatric Cardiac Intensive Care Patients.

Objectives: This study was conducted to evaluate tinzaparin dosing and therapeutic drug monitoring.

Design: Retrospective study.

Setting: Single tertiary-level PICU.

Effectiveness and Clinical Outcomes of a Two-Step Implementation of Conservative Oxygenation Targets in Critically Ill Patients: A Before and After Trial.

Objectives: Conservative oxygen therapy is aimed at the prevention of harm by iatrogenic hyperoxia while preserving adequate tissue oxygenation. Our aim was to study the effectiveness and clinical outcomes of a two-step implementation of conservative oxygenation targets in the ICU.

Design: This was a before and after stepwise implementation study of conservative oxygenation targets, between July 2011 and July 2014.

PReVENT--protective ventilation in patients without ARDS at start of ventilation: study protocol for a randomized controlled trial.

Background: It is uncertain whether lung-protective mechanical ventilation using low tidal volumes should be used in all critically ill patients, irrespective of the presence of the acute respiratory distress syndrome (ARDS). A low tidal volume strategy includes use of higher respiratory rates, which could be associated with increased sedation needs, a higher incidence of delirium, and an increased risk of patient-ventilator asynchrony and ICU-acquired weakness. Another alleged side-effect of low tidal volume ventilation is the risk of atelectasis.

Evaluation of a bedside device to assess the activated partial thromboplastin time for heparin monitoring in infants.

To determine the relationship between the activated partial thromboplastin time (aPTT) measured with a standard laboratory assay and the aPTT measured with a bedside device in infants on heparin therapy after cardiothoracic surgery. Twenty infants aged below 1 year who were on heparin therapy were included. Exclusion criteria were prematurity, dysmaturity and the use of anticoagulants other than heparin.

Comparing hemodynamic effects with three different measurement devices, of two methods of external leg compression versus passive leg raising in patients after cardiac surgery.

External leg compression (ELC) may increase cardiac output (CO) in fluid-responsive patients like passive leg raising (PLR). We compared the hemodynamic effects of two methods of ELC and PLR measured by thermodilution (COtd), pressure curve analysis Modelflow™ (COmf) and ultra-sound HemoSonic™ (COhs), to evaluate the method with the greatest hemodynamic effect and the most accurate less invasive method to measure that effect. We compared hemodynamic effects of two different ELC methods (circular, A (n = 16), vs.

Cardiac output response to norepinephrine in postoperative cardiac surgery patients: interpretation with venous return and cardiac function curves.

Objective: We studied the variable effects of norepinephrine infusion on cardiac output in postoperative cardiac surgical patients in whom norepinephrine increased mean arterial pressure. We hypothesized that the directional change in cardiac output would be determined by baseline cardiac function, as quantified by stroke volume variation, and the subsequent changes in mean systemic filling pressure and vasomotor tone.

Design: Intervention study.

Estimation of mean systemic filling pressure in postoperative cardiac surgery patients with three methods.

Purpose: To assess the level of agreement between different bedside estimates of effective circulating blood volume-mean systemic filling pressure (Pmsf), arm equilibrium pressure (Parm) and model analog (Pmsa)-in ICU patients.

Methods: Eleven mechanically ventilated postoperative cardiac surgery patients were studied. Sequential measures were made in the supine position, rotating the bed to a 30° head-up tilt and after fluid loading (500 ml colloid).

Determination of vascular waterfall phenomenon by bedside measurement of mean systemic filling pressure and critical closing pressure in the intensive care unit.

Background: Mean systemic filling pressure (Pmsf) can be determined at the bedside by measuring central venous pressure (Pcv) and cardiac output (CO) during inspiratory hold maneuvers. Critical closing pressure (Pcc) can be determined using the same method measuring arterial pressure (Pa) and CO. If Pcc > Pmsf, there is then a vascular waterfall.

Arm occlusion pressure is a useful predictor of an increase in cardiac output after fluid loading following cardiac surgery.

Background And Objective: In pharmacological research, arm occlusion pressure is used to study haemodynamic effects of drugs. However, arm occlusion pressure might be an indicator of static filling pressure of the arm. We hypothesised that arm occlusion pressure can be used to predict fluid loading responsiveness.

Assessing fluid responses after coronary surgery: role of mathematical coupling of global end-diastolic volume to cardiac output measured by transpulmonary thermodilution.

Background: Mathematical coupling may explain in part why cardiac filling volumes obtained by transpulmonary thermodilution may better predict and monitor responses of cardiac output to fluid loading than pressures obtained by pulmonary artery catheters (PACs).

Methods: Eleven consecutive patients with hypovolaemia after coronary surgery and a PAC, allowing central venous pressure (CVP) and continuous cardiac index (CCIp) measurements, received a femoral artery catheter for transpulmonary thermodilution measurements of global end-diastolic blood volume index (GEDVI) and cardiac index (CItp). One to five colloid fluid-loading steps of 250 ml were done in each patient (n = 48 total).

Transpulmonary versus continuous thermodilution cardiac output after valvular and coronary artery surgery.

Residual left-sided valvular insufficiencies after valvular surgery may confound transpulmonary thermodilution cardiac output (COtp). We compared the technique with the continuous right-sided thermodilution technique (CCO) after valvular surgery (n=8) and coronary artery surgery (n=8). Patients with pulmonary and femoral artery catheters in the intensive care unit (ICU) were included.

Relative value of pressures and volumes in assessing fluid responsiveness after valvular and coronary artery surgery.

Background And Aims: Cardiac function may differ after valvular (VS) and coronary artery (CAS) surgery and this may affect assessment of fluid responsiveness. The aim of the study was to compare VS and CAS in the value of cardiac filling pressures and volumes herein.

Methods: There were eight consecutive patients after VS and eight after CAS, with femoral and pulmonary artery catheters in place.