... Authors: CAKAR, N; STUTUNCU, A; ESEN, F; TELCI, L; DENKEL, T; AKPIR, K; KESECIOGLU, J. ... pe... more ... Authors: CAKAR, N; STUTUNCU, A; ESEN, F; TELCI, L; DENKEL, T; AKPIR, K; KESECIOGLU, J. ... percutaneous dilational tracheostomy (PDT) as an alternative to surgical tracheostomy by comparing the complication rates of 411 PDTs performed in our intensive care unit (ICU) to ...
Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality.
Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain m... more Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain management for post-thoracotomy patients.
Permeability changes in the blood-brain barrier (BBB) and their possible contribution to brain ed... more Permeability changes in the blood-brain barrier (BBB) and their possible contribution to brain edema formation have a crucial role in the pathophysiology of septic encephalopathy. Magnesium sulfate has been shown to have a protective effect on BBB integrity in multiple experimental models. In this study we determine whether magnesium sulfate administration could have any protective effects on BBB derangement in a rat model of sepsis. This randomized controlled experimental study was performed on adult male Sprague-Dawley rats. Intraperitoneal sepsis was induced by using the infected fibrin-thrombin clot model. To examine the effect of magnesium in septic and sham-operated rats, a dose of 750 micromol/kg magnesium sulfate was given intramuscularly immediately after surgery. Control groups for both infected and sham-operated rats were injected with equal volume of saline. Those rats surviving for 24 hours were anesthetized and decapitated for the investigation of brain tissue specific...
✔ Objective: It has been shown that excess amount of glutamate released after primary neuronal in... more ✔ Objective: It has been shown that excess amount of glutamate released after primary neuronal injury by head trauma causes secondary injuries in the adult brain. Aiming to prevent this secondary injury a wide range of N-Methyl-D-aspartate receptor antagonist drugs have been investigated in experimental studies. Magnesium sulphate and memantine are pharmacological agents widely used clinically for this specific indication; prevention of secondary neural injury. According to current literature although these two drugs have been used alone or in combination with different drugs, they have not been tried together in combination before. This experimental study is aimed to investigate the effect of magnesium, memantine and the combination of two agents on the permeability of blood brain barrier (BBB) and the quantity of diffuse cerebral oedema after experimentally induced traumatic brain injury. Methods: A standard traumatic brain injury was induced in Sprague-Dawley rats by a controlled impact device using a mass free falling from a certain height. Animals were introduced one of the following drugs of the same amount, intraperitoneally 30 minutes after traumatic brain injury; saline (1 ml/kg), magnesium sulphate (270 mg/kg), memantine (10 mg/kg), and magnesium sulphate plus memantine (270 mg/kg+10 mg/kg). To determine the brain oedema, the specific gravity of the injured brain tissue was evaluated. The changes in permeability of the BBB were investigated by Evans Blue dye that is known to bind to serum albumin. Results: In treatment groups, the specific gravity values significantly increased when compared with the control group. Evans blue dye content in the brain tissue was significantly reduced with respect to the control group. Conclusion: In preventing the secondary insult occurring after traumatic brain injury, NMDA receptor antagonists: Magnesium sulphate, memantine and combination of magnesium sulphate and memantine are shown to be effective by decreasing diffuse cerebral oedema and restoring the BBB.
To evaluate the effects of body temperature on ventilator-induced lung injury. Thirty-four male S... more To evaluate the effects of body temperature on ventilator-induced lung injury. Thirty-four male Sprague-Dawley rats were randomized into 6 groups based on their body temperature (normothermia, 37 +/- 1 degrees C; hypothermia, 31 +/- 1 degrees C; hyperthermia, 41 +/- 1 degrees C). Ventilator-induced lung injury was achieved by ventilating for 1 hour with pressure-controlled ventilation mode set at peak inspiratory pressure (PIP) of 30 cmH2O (high pressure, or HP) and positive end-expiratory pressure (PEEP) of 0 cmH2O. In control subjects, PIP was set at 14 cmH2O (low pressure, or LP) and PEEP set at 0 cmH2O. Systemic chemokine and cytokine (tumor necrosis factor alpha , interleukin 1 beta , interleukin 6, and monocyte chemoattractant protein 1) levels were measured. The lungs were assessed for histological changes. Serum chemokines and cytokines were significantly elevated in the hyperthermia HP group compared with all 3 groups, LP (control), normothermia HP, and hypothermia HP. Oxygenation was better but not statistically significant in hypothermia HP compared with other HP groups. Cumulative mean histology scores were higher in hyperthermia HP and normothermia HP groups compared with control and normothermia HP groups. Concomitant hyperthermia increased systemic inflammatory response during HP ventilation. Although hypothermia decreased local inflammation in the lung, it did not completely attenuate systemic inflammatory response associated with HP ventilation.
Introduction: Artificial liver support systems represent a potential useful option for the treatm... more Introduction: Artificial liver support systems represent a potential useful option for the treatment of liver failure. The outcomes of patients treated with the fractionated plasma separation and adsorption (FPSA) system are presented. Patients and methods: FPSA was performed 85 times for 27 patients (median 3 treatments/patient) with liver failure [85.2% acute liver failure (ALF) and 14.8% acute-on-chronic liver failure] using the Prometheus 4008H (Fresenius Medical Care) unit. Citrate was used for anticoagulation. A variety of clinical and biochemical parameters were assessed. Comparisons between pretreatment and post-treatment data were performed using paired t-test. Results: The 85 sessions had a mean duration of 6 h. There were significant decreases in total bilirubin (13.18 AE 9.46 mg/dL vs. 9.76 AE 7.05 mg/dL; P < 0.0001), ammonia (167.6 AE 75 mg/dL vs. 120 AE 43.8 mg/dL; P < 0.0001), blood urea nitrogen (BUN; 12.55 AE 13.03 mg/dL vs. 8.18 AE 8.15 mg/dL; P < 0.0001), creatinine (0.54 AE 0.47 mg/dL vs. 0.46 AE 0.37 mg/dL; P 5 0.0022) levels, and in pH (7.48 AE 0.05 vs. 7.44 AE 0.08; P 5 0.0045). Four patients (14.8%) received liver transplantation after the treatments; in nine patients, transplantation was not necessary anymore (33%); the remaining 14 patients did not receive a transplantation because they were either not appropriate candidates or no organ was available. Overall survival was 48.1% (4 transplanted and 9 treated patients). No hematological complications related to FPSA were observed. Conclusions: FPSA system is a safe and effective detoxification method for patients with liver dysfunction, including ALF. The system is useful as a symptomatic treatment before liver transplantation; in up to 1/3 of the cases, it can even be used as a sole method of treatment. J. Clin. Apheresis 25:195-201, 2010. V V C 2010 Wiley-Liss, Inc.
Journal of Cardiothoracic and Vascular Anesthesia, 2000
To evaluate the use of ketamine in comparison with isoflurane in the maintenance of anesthesia in... more To evaluate the use of ketamine in comparison with isoflurane in the maintenance of anesthesia in children with tetralogy of Fallot. Prospective, randomized study. University hospital. Fifty children scheduled for correction of tetralogy of Fallot. After intubation, patients were assigned randomly to receive 2 different anesthesia maintenance regimens: group I, isoflurane, 0 to 1% plus fentanyl, 0.1 microg/kg/min; group II, ketamine, 0 to 5 mg/kg/h, plus fentanyl, 0.1 microg/kg/min. Isoflurane concentration and ketamine infusion rate were adjusted to maintain arterial pressure within 25% of baseline. Hemodynamic and respiratory parameters were recorded at the end of 4 intervals: T0, before induction of anesthesia; T1, induction to 10 minutes postintubation; T2, 10 minutes postintubation to poststernotomy; and T3, poststernotomy to completion of catheterizations. In comparing group I with group II, significant differences were observed in mean arterial pressure (p &lt; 0.0001), heart rate (p &lt; 0.01), arterial oxygen saturation (p &lt; 0.0001), arterial oxygen tension (p &lt; 0.001), arterial carbon dioxide tension (p &lt; 0.001), arterial pH (p &lt; 0.0001), base excess (p &lt; 0.05), and arterial to end-tidal carbon dioxide tension difference (p &lt; 0.01) at T3. The use of ketamine anesthesia is recommended as an alternative maintenance regimen in children undergoing definitive correction of tetralogy of Fallot.
Journal of Cardiothoracic and Vascular Anesthesia, 1997
Objectives: Afterdrop in core temperatures after discontinuation of cardiopulmonary bypass (CPB) ... more Objectives: Afterdrop in core temperatures after discontinuation of cardiopulmonary bypass (CPB) is reported to be a sign of inadequate total body rewarming on CPB. The purpose of this study was to compare the effects of three different druE', regimens on hemodynamic stability and the uniformity of rewarming during the rewarming period of CPB.
Journal of Cardiothoracic and Vascular Anesthesia, 2004
To investigate the relationship between peripheral and central venous pressures in different pati... more To investigate the relationship between peripheral and central venous pressures in different patient positions (supine, prone, lithotomy, Trendelenburg, and Fowler), different catheter diameters (18 G and 20 G), and catheterization sites (dorsal hand and forearm) during surgical procedures. Prospective clinical study. University hospital. Five hundred adult patients. Peripheral over-the-needle intravenous catheters were placed in the dorsal hand or forearm. Central venous catheters were inserted via the internal jugular or subclavian vein after induction of anesthesia. Simultaneous measurements of central and peripheral venous pressures were made during stable conditions at random time points in surgery; 1953 paired measurements were performed. Mean central venous pressure was 11 +/- 3.7 mmHg and peripheral venous pressure was 13 +/- 4 mmHg (p = 0.0001). The overall correlation between central venous and peripheral venous pressures was found to be statistically significant (r = 0.89, r(2) = 0.8, p = 0.0001). Mean difference between peripheral and central venous pressure was 2 +/- 1.8 mmHg. Ninety-five percent limits of agreement were 5.6 to -1.6 mmHg. It has been assumed that replacing central venous pressure by peripheral venous pressure would cause problems in clinical interpretation. If the validity of this data is confirmed by further studies, the authors suggest that central venous pressure could be estimated by using regression equations to compare the 2 methods.
Journal of Cardiothoracic and Vascular Anesthesia, 2007
Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain m... more Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain management for post-thoracotomy patients.
Objective: To determine the time required for the partial pressure of arterial oxygen (PaO 2 ) to... more Objective: To determine the time required for the partial pressure of arterial oxygen (PaO 2 ) to reach equilibrium after a 0.20 increment or decrement in fractional inspired oxygen concentration (FIO 2 ) during mechanical ventilation. Setting: A multi-disciplinary ICU in a university hospital. Patients and methods: Twenty-five adult, non-COPD patients with stable blood gas values (PaO 2 /FIO 2 ³ 180 on the day of the study) on pressure-controlled ventilation (PCV). Following a baseline PaO 2 (PaO 2 b) measurement at FIO 2 = 0.35, the FIO 2 was increased to 0.55 for 30 min and then decreased to 0.35 without any other change in ventilatory parameters. Sequential blood gas measurements were performed at 7, 9, 11, 15, 20, 25 and 30 min in both periods. The PaO 2 values measured at the 30 th min after a step change in FIO 2 (FIO 2 = 0.55, PaO 2 [55] and FIO 2 = 0.35, PaO 2 [35]) were accepted as representative of the equilibrium values for PaO 2 . Each patient's rise and fall in PaO 2 over time, PaO 2 (t), were fitted to the following respective exponential equations: PaO 2 b + (PaO 2 [55]-PaO2b)(1-e -kt ) and PaO 2 [55] + (PaO 2 [35]-PaO 2 [55])(e -kt ) where ªtº refers to time, PaO2[55] and PaO2[35] are the final PaO 2 values obtained at a new FIO 2 of 0.55 and 0.35, after a 0.20 increment and decrement in FIO 2 , respectively. Time constant ªkº was determined by a non-linear fitting curve and 90 % oxygenation times were defined as the time required to reach 90 % of the final equilibrated PaO 2 calculated by using the non-linear fitting curves.
... Authors: CAKAR, N; STUTUNCU, A; ESEN, F; TELCI, L; DENKEL, T; AKPIR, K; KESECIOGLU, J. ... pe... more ... Authors: CAKAR, N; STUTUNCU, A; ESEN, F; TELCI, L; DENKEL, T; AKPIR, K; KESECIOGLU, J. ... percutaneous dilational tracheostomy (PDT) as an alternative to surgical tracheostomy by comparing the complication rates of 411 PDTs performed in our intensive care unit (ICU) to ...
Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ® . A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality.
Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain m... more Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain management for post-thoracotomy patients.
Permeability changes in the blood-brain barrier (BBB) and their possible contribution to brain ed... more Permeability changes in the blood-brain barrier (BBB) and their possible contribution to brain edema formation have a crucial role in the pathophysiology of septic encephalopathy. Magnesium sulfate has been shown to have a protective effect on BBB integrity in multiple experimental models. In this study we determine whether magnesium sulfate administration could have any protective effects on BBB derangement in a rat model of sepsis. This randomized controlled experimental study was performed on adult male Sprague-Dawley rats. Intraperitoneal sepsis was induced by using the infected fibrin-thrombin clot model. To examine the effect of magnesium in septic and sham-operated rats, a dose of 750 micromol/kg magnesium sulfate was given intramuscularly immediately after surgery. Control groups for both infected and sham-operated rats were injected with equal volume of saline. Those rats surviving for 24 hours were anesthetized and decapitated for the investigation of brain tissue specific...
✔ Objective: It has been shown that excess amount of glutamate released after primary neuronal in... more ✔ Objective: It has been shown that excess amount of glutamate released after primary neuronal injury by head trauma causes secondary injuries in the adult brain. Aiming to prevent this secondary injury a wide range of N-Methyl-D-aspartate receptor antagonist drugs have been investigated in experimental studies. Magnesium sulphate and memantine are pharmacological agents widely used clinically for this specific indication; prevention of secondary neural injury. According to current literature although these two drugs have been used alone or in combination with different drugs, they have not been tried together in combination before. This experimental study is aimed to investigate the effect of magnesium, memantine and the combination of two agents on the permeability of blood brain barrier (BBB) and the quantity of diffuse cerebral oedema after experimentally induced traumatic brain injury. Methods: A standard traumatic brain injury was induced in Sprague-Dawley rats by a controlled impact device using a mass free falling from a certain height. Animals were introduced one of the following drugs of the same amount, intraperitoneally 30 minutes after traumatic brain injury; saline (1 ml/kg), magnesium sulphate (270 mg/kg), memantine (10 mg/kg), and magnesium sulphate plus memantine (270 mg/kg+10 mg/kg). To determine the brain oedema, the specific gravity of the injured brain tissue was evaluated. The changes in permeability of the BBB were investigated by Evans Blue dye that is known to bind to serum albumin. Results: In treatment groups, the specific gravity values significantly increased when compared with the control group. Evans blue dye content in the brain tissue was significantly reduced with respect to the control group. Conclusion: In preventing the secondary insult occurring after traumatic brain injury, NMDA receptor antagonists: Magnesium sulphate, memantine and combination of magnesium sulphate and memantine are shown to be effective by decreasing diffuse cerebral oedema and restoring the BBB.
To evaluate the effects of body temperature on ventilator-induced lung injury. Thirty-four male S... more To evaluate the effects of body temperature on ventilator-induced lung injury. Thirty-four male Sprague-Dawley rats were randomized into 6 groups based on their body temperature (normothermia, 37 +/- 1 degrees C; hypothermia, 31 +/- 1 degrees C; hyperthermia, 41 +/- 1 degrees C). Ventilator-induced lung injury was achieved by ventilating for 1 hour with pressure-controlled ventilation mode set at peak inspiratory pressure (PIP) of 30 cmH2O (high pressure, or HP) and positive end-expiratory pressure (PEEP) of 0 cmH2O. In control subjects, PIP was set at 14 cmH2O (low pressure, or LP) and PEEP set at 0 cmH2O. Systemic chemokine and cytokine (tumor necrosis factor alpha , interleukin 1 beta , interleukin 6, and monocyte chemoattractant protein 1) levels were measured. The lungs were assessed for histological changes. Serum chemokines and cytokines were significantly elevated in the hyperthermia HP group compared with all 3 groups, LP (control), normothermia HP, and hypothermia HP. Oxygenation was better but not statistically significant in hypothermia HP compared with other HP groups. Cumulative mean histology scores were higher in hyperthermia HP and normothermia HP groups compared with control and normothermia HP groups. Concomitant hyperthermia increased systemic inflammatory response during HP ventilation. Although hypothermia decreased local inflammation in the lung, it did not completely attenuate systemic inflammatory response associated with HP ventilation.
Introduction: Artificial liver support systems represent a potential useful option for the treatm... more Introduction: Artificial liver support systems represent a potential useful option for the treatment of liver failure. The outcomes of patients treated with the fractionated plasma separation and adsorption (FPSA) system are presented. Patients and methods: FPSA was performed 85 times for 27 patients (median 3 treatments/patient) with liver failure [85.2% acute liver failure (ALF) and 14.8% acute-on-chronic liver failure] using the Prometheus 4008H (Fresenius Medical Care) unit. Citrate was used for anticoagulation. A variety of clinical and biochemical parameters were assessed. Comparisons between pretreatment and post-treatment data were performed using paired t-test. Results: The 85 sessions had a mean duration of 6 h. There were significant decreases in total bilirubin (13.18 AE 9.46 mg/dL vs. 9.76 AE 7.05 mg/dL; P < 0.0001), ammonia (167.6 AE 75 mg/dL vs. 120 AE 43.8 mg/dL; P < 0.0001), blood urea nitrogen (BUN; 12.55 AE 13.03 mg/dL vs. 8.18 AE 8.15 mg/dL; P < 0.0001), creatinine (0.54 AE 0.47 mg/dL vs. 0.46 AE 0.37 mg/dL; P 5 0.0022) levels, and in pH (7.48 AE 0.05 vs. 7.44 AE 0.08; P 5 0.0045). Four patients (14.8%) received liver transplantation after the treatments; in nine patients, transplantation was not necessary anymore (33%); the remaining 14 patients did not receive a transplantation because they were either not appropriate candidates or no organ was available. Overall survival was 48.1% (4 transplanted and 9 treated patients). No hematological complications related to FPSA were observed. Conclusions: FPSA system is a safe and effective detoxification method for patients with liver dysfunction, including ALF. The system is useful as a symptomatic treatment before liver transplantation; in up to 1/3 of the cases, it can even be used as a sole method of treatment. J. Clin. Apheresis 25:195-201, 2010. V V C 2010 Wiley-Liss, Inc.
Journal of Cardiothoracic and Vascular Anesthesia, 2000
To evaluate the use of ketamine in comparison with isoflurane in the maintenance of anesthesia in... more To evaluate the use of ketamine in comparison with isoflurane in the maintenance of anesthesia in children with tetralogy of Fallot. Prospective, randomized study. University hospital. Fifty children scheduled for correction of tetralogy of Fallot. After intubation, patients were assigned randomly to receive 2 different anesthesia maintenance regimens: group I, isoflurane, 0 to 1% plus fentanyl, 0.1 microg/kg/min; group II, ketamine, 0 to 5 mg/kg/h, plus fentanyl, 0.1 microg/kg/min. Isoflurane concentration and ketamine infusion rate were adjusted to maintain arterial pressure within 25% of baseline. Hemodynamic and respiratory parameters were recorded at the end of 4 intervals: T0, before induction of anesthesia; T1, induction to 10 minutes postintubation; T2, 10 minutes postintubation to poststernotomy; and T3, poststernotomy to completion of catheterizations. In comparing group I with group II, significant differences were observed in mean arterial pressure (p &lt; 0.0001), heart rate (p &lt; 0.01), arterial oxygen saturation (p &lt; 0.0001), arterial oxygen tension (p &lt; 0.001), arterial carbon dioxide tension (p &lt; 0.001), arterial pH (p &lt; 0.0001), base excess (p &lt; 0.05), and arterial to end-tidal carbon dioxide tension difference (p &lt; 0.01) at T3. The use of ketamine anesthesia is recommended as an alternative maintenance regimen in children undergoing definitive correction of tetralogy of Fallot.
Journal of Cardiothoracic and Vascular Anesthesia, 1997
Objectives: Afterdrop in core temperatures after discontinuation of cardiopulmonary bypass (CPB) ... more Objectives: Afterdrop in core temperatures after discontinuation of cardiopulmonary bypass (CPB) is reported to be a sign of inadequate total body rewarming on CPB. The purpose of this study was to compare the effects of three different druE', regimens on hemodynamic stability and the uniformity of rewarming during the rewarming period of CPB.
Journal of Cardiothoracic and Vascular Anesthesia, 2004
To investigate the relationship between peripheral and central venous pressures in different pati... more To investigate the relationship between peripheral and central venous pressures in different patient positions (supine, prone, lithotomy, Trendelenburg, and Fowler), different catheter diameters (18 G and 20 G), and catheterization sites (dorsal hand and forearm) during surgical procedures. Prospective clinical study. University hospital. Five hundred adult patients. Peripheral over-the-needle intravenous catheters were placed in the dorsal hand or forearm. Central venous catheters were inserted via the internal jugular or subclavian vein after induction of anesthesia. Simultaneous measurements of central and peripheral venous pressures were made during stable conditions at random time points in surgery; 1953 paired measurements were performed. Mean central venous pressure was 11 +/- 3.7 mmHg and peripheral venous pressure was 13 +/- 4 mmHg (p = 0.0001). The overall correlation between central venous and peripheral venous pressures was found to be statistically significant (r = 0.89, r(2) = 0.8, p = 0.0001). Mean difference between peripheral and central venous pressure was 2 +/- 1.8 mmHg. Ninety-five percent limits of agreement were 5.6 to -1.6 mmHg. It has been assumed that replacing central venous pressure by peripheral venous pressure would cause problems in clinical interpretation. If the validity of this data is confirmed by further studies, the authors suggest that central venous pressure could be estimated by using regression equations to compare the 2 methods.
Journal of Cardiothoracic and Vascular Anesthesia, 2007
Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain m... more Objective: The purpose of this study was to investigate the effect of magnesium sulfate on pain management for post-thoracotomy patients.
Objective: To determine the time required for the partial pressure of arterial oxygen (PaO 2 ) to... more Objective: To determine the time required for the partial pressure of arterial oxygen (PaO 2 ) to reach equilibrium after a 0.20 increment or decrement in fractional inspired oxygen concentration (FIO 2 ) during mechanical ventilation. Setting: A multi-disciplinary ICU in a university hospital. Patients and methods: Twenty-five adult, non-COPD patients with stable blood gas values (PaO 2 /FIO 2 ³ 180 on the day of the study) on pressure-controlled ventilation (PCV). Following a baseline PaO 2 (PaO 2 b) measurement at FIO 2 = 0.35, the FIO 2 was increased to 0.55 for 30 min and then decreased to 0.35 without any other change in ventilatory parameters. Sequential blood gas measurements were performed at 7, 9, 11, 15, 20, 25 and 30 min in both periods. The PaO 2 values measured at the 30 th min after a step change in FIO 2 (FIO 2 = 0.55, PaO 2 [55] and FIO 2 = 0.35, PaO 2 [35]) were accepted as representative of the equilibrium values for PaO 2 . Each patient's rise and fall in PaO 2 over time, PaO 2 (t), were fitted to the following respective exponential equations: PaO 2 b + (PaO 2 [55]-PaO2b)(1-e -kt ) and PaO 2 [55] + (PaO 2 [35]-PaO 2 [55])(e -kt ) where ªtº refers to time, PaO2[55] and PaO2[35] are the final PaO 2 values obtained at a new FIO 2 of 0.55 and 0.35, after a 0.20 increment and decrement in FIO 2 , respectively. Time constant ªkº was determined by a non-linear fitting curve and 90 % oxygenation times were defined as the time required to reach 90 % of the final equilibrated PaO 2 calculated by using the non-linear fitting curves.
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