bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paediatric Rapid Response Systems: a literature review
Authors: WINBERG H. , NILSSON K. , ÅNEMAN A. 
Published: August 2010

Background: Paediatric cardiorespiratory arrest carries a poor prognosis. The most common cause is respiratory insufficiency or hypotension/shock, which can be reversible. The use of RRSs in adult hospitals that proactively intervene when signs of physiological instability occur is widespread and increasing although the level of evidence for their efficiency is a matter of debate.Methods: A systematic literature review was undertaken to evaluate and summarise the current knowledge about paediatric RRSs.Results: Paediatric RRSs are in use in several places around the world. One study shows a statistically significant decrease in mortality rate after implementation. Two studies show a non‐significant association with decreased mortality rate. Cardiac and/or respiratory arrest rates decreased in all four before‐after studies with statistical significance in two.Conclusions: Cardiac arrest and death are rare in paediatric hospitals, which can in part explain the difficulties to demonstrate statistically significant benefits. There are also specific problems regarding calling criteria due to age related physiological diversity as well as chronic disease.
Effects of remifentanil on gastric tone
Authors: WALLDÉN JAKOB , THÖRN SVEN‐EGRON , LINDBERG GREGER , WATTWIL MAGNUS 
Published: August 2010

Objectives: Opioids are well known for impairing gastric motility. The mechanism is far from clear and there is wide interindividual variability. The purpose of this study was to evaluate the effect of remifentanil on proximal gastric tone.Materials and methods: Healthy volunteers were studied on two occasions and proximal gastric tone was measured by a gastric barostat. On the first occasion (n=8), glucagon 1 mg IV was given as a reference for a maximal relaxation of the stomach. On the second occasion (n=9), remifentanil was given in incremental doses (0.1, 0.2 and 0.3 μg/kg/min) for 15 min each, followed by a washout period of 30 min. Thereafter, remifentanil was readministered, and 10 min later glucagon 1 mg was given. Mean intragastric bag volumes were calculated for each 5‐min interval.Results: Glucagon decreased gastric tone in all subjects. Remifentanil had a marked effect on gastric tone; we found two distinct patterns of reactions with both increases and decreases in gastric tone and, during the remifentanil infusion, glucagon did not affect gastric tone.Conclusions: Remifentanil induced changes in gastric tone with both increases and decreases. The effect of remifentanil on gastric tone is probably dependent on the current state of the systems involved.
Preferences for colloid use in Scandinavian intensive care units
Authors:   The FLUIDS study investigators for the Scandinavian Critical Care Trials Group
Published: August 2010

Background: Fluid resuscitation is a frequent intervention in intensive care. Colloids are widely used, but recent data suggest harm by some of these solutions. This calls for more clinical studies on this matter, but the current preferences for colloid use in Scandinavian intensive care units (ICUs) are unknown.Methods: In March–May 2007, 120 Scandinavian ICUs were invited to answer a web‐based survey consisting of 18 questions on types of colloids, indications, contraindications and rationale of use.Results: Seventy‐three ICUs, of which 31 were university hospital units, answered the questionnaire. Most ICUs used both synthetic and natural colloids, and hydroxyethyl starch (HES) 130/0.4 was the preferred colloid in 59 units. Eleven ICUs had protocols for colloid use. The most frequent indication was second‐line fluid for hypovolaemia, but one in three ICUs used colloids as first‐line fluid. Thirty‐five ICUs had contraindications, which were mainly for the use of synthetic colloids (acute renal failure 25 units, bleeding 15 units). Most units based the use of colloids on theoretical knowledge and tradition. Sixty‐five and 54 ICUs were ready to change colloid use based on data from randomised trials of ICU patients showing changes in mortality or renal function, respectively.Conclusion: Most Scandinavian ICUs use both synthetic and natural colloids, but HES 130/0.4 is by far the preferred colloid. Few units have protocols for colloid use, but most use them for hypovolaemia, and the majority have no contraindications. Most ICUs are ready to change colloid use if randomised trials in ICU patients show changes in mortality or renal function.
Xenon alters right ventricular function
Authors: HEIN M. , BAUMERT J. H. , ROEHL A. B. , PASCH L. , SCHNOOR J. , COBURN M. , ROSSAINT R. 
Published: August 2010

Background: In contrast to other volatile anesthetics, xenon produces less cardiovascular depression with fewer fluctuations of various hemodynamic parameters, but reduces cardiac output (CO) in vivo. Besides an increase in left ventricular afterload and reduction of heart rate, an impairment of the right ventricular function might be an additional pathophysiological mechanism for the reduction of CO. Therefore, we used an animal model to study the effects of xenon as a supplemental anesthetic on right ventricular function, especially right ventricular afterload.Methods: Right ventricular function was monitored with a volumetric pulmonary artery catheter in 11 pigs during general anesthesia with thiopental. Six animals received additional 70% (volume) xenon (equivalent to 0.55 MAC minimum alveolar concentration). Parameters for systolic function, afterload, and preload were calculated at baseline and during 50 min of xenon application, and in a corresponding control group. Significant differences were detected by multivariate analyses of variance for repeated measures.Results: Xenon reduced CO on average by 30% and increased pulmonary arterial elastance by 60%, which led to a reduction of the right ventricular ejection fraction by 25%. Whereas right ventricular preload remained stable, maximal slope of pulmonary artery pressure and the right ventricular elastance increased. No effect on the ratio of stroke work and end‐diastolic volume was found.Conclusion: The reduction in CO during xenon anesthesia was partly due to an impairment of the right ventricular function, mainly caused by an increased afterload, without an impairment of systolic ventricular function.
Are women more sensitive to a pre‐curarization dose of rocuronium than men?
Authors: Mencke T. , Soltesz S. , Sauer M. , Menzebach A. , Silomon M. , Nöldge‐Schomburg G. 
Published: August 2010

Background: There is increasing evidence that there are gender‐related differences in the pharmacodynamics of neuromuscular blocking drugs. However, it is not known whether gender influences the pharmacodynamics of a pre‐curarizing dose.Methods: In the first part, we measured the neuromuscular blockade after administration of rocuronium 0.03 mg/kg (10% of ED95) after induction of anaesthesia in 20 patients (10 female and 10 male patients) by electromyography. In the second part, 40 female and 40 male patients were observed for signs and symptoms of muscle weakness 2.5 min after injection of rocuronium 0.03 mg/kg before loss of consciousness. Succinylcholine‐associated post‐operative myalgia (POM) was also assessed.Results: Median twitch heights were comparable between the two groups: 95.5 (range: 85–97; female) vs. 96.0 (range: 85–99; male), (NS). Train‐of‐four ratios were 97.5 (range: 64–100; female) vs. 99.0 (range: 52–100; male) (NS). Signs and symptoms of muscle weakness were observed in 64 (80%) patients, but there were no gender‐related differences. The incidence and severity of POM did not differ significantly between the study groups.Conclusions: Pre‐curarization with rocuronium 0.03 mg/kg affected men and women equally. Nor was the incidence and the severity of muscle weakness affected by gender.
Performance of electrical impedance tomography in detecting regional tidal volumes during one‐lung ventilation
Authors: PULLETZ S. , ELKE G. , ZICK G. , SCHÄDLER D. , SCHOLZ J. , WEILER N. , FRERICHS I. 
Published: August 2010

Background: Electrical impedance tomography (EIT) is becoming a new medical imaging modality for continuous monitoring of regional lung function in the intensive care unit or operating room. The aim of our study was to evaluate the performance of EIT in detecting regional tidal volumes in patients during volume‐controlled mechanical ventilation of one or both lungs.Methods: Ten adult patients undergoing elective thoracic surgery were included. EIT measurements were performed with the Goe‐MF II EIT system. Data were collected before surgery during ventilation of both, the right and left lungs. Tidal volumes of 800 and 400 ml were applied during bilateral and unilateral ventilation, respectively.Results: Ventilation‐related impedance changes determined in the whole chest cross‐section during the right and left lung ventilation did not significantly differ from each other and were equal to 47.6±5.6% and 48.5±7.8% (mean±SD) of the value determined during bilateral ventilation. During unilateral ventilation, EIT clearly separated the ventilated and non‐ventilated lung regions; nevertheless, ventilation‐related impedance changes were also detected at the non‐ventilated sides in areas corresponding to 3.4±4.1% and 12.4±6.9% of the scan halves during ventilation of the left and right lung, respectively. Changes in global tidal volumes were adequately detected by EIT during both bilateral and unilateral lung ventilation.Conclusion: Although good separation of the ventilated and non‐ventilated sides of the chest was possible, the data indicate that reliable quantification of regional tidal volumes during asymmetric or inhomogeneous distribution patterns requires regions‐of‐interest analysis.
Adenosine and adenosine uptake inhibitors potentiate the neuromuscular blocking action of rocuronium mediated by adenosine A1 receptors in isolated rat diaphragms
Authors: NARIMATSU E. , NIIYA T. , KAWAMATA M. , NAMIKI A. 
Published: August 2010

Background: Adenosine, which pre‐junctionally modulates neuromuscular transmission, and adenosine uptake inhibitors, which increase extracellular adenosine, have been used clinically. We investigated the effects of adenosine, dipyridamole and midazolam on the neuromuscular blocking action of rocuronium.Methods: Isometric twitch tensions of rat nerve‐hemidiaphragm preparations elicited by indirect (phrenic nerve) supra‐maximal stimulation at 0.1 Hz were evaluated (n=6 in all data).Results: Pre‐treatments with adenosine (0.1 and 1 μM) and CCPA (1 μM, adenosine A1 receptor agonist), but not that with CGS21680 (0.5 μM, A2 receptor agonist), shifted the rocuronium concentration–twitch tension curves to the left and decreased the rocuronium concentration for 50% twitch depression (IC50) compared with the control (P<0.01). The leftward shift induced by 1 μM adenosine was inhibited by pre‐treatments with theophylline (50 μM, non‐selective adenosine receptor antagonist) and DPCPX (0.2 μM, A1 receptor antagonist) but not by that with DPMA (5 μM, A2 receptor antagonist). Pre‐treatments with dipyridamole and midazolam, adenosine uptake inhibitors, shifted the curve to the left and decreased IC50 at supra‐therapeutic concentrations (10 and 2.5 μM, respectively) but not at clinical concentrations (2 and 0.5 μM, respectively), and the leftward shifts were inhibited by pre‐treatment with DPCPX (0.2 μM).Conclusion: The results indicate that adenosine potentiates the neuromuscular blocking action of rocuronium mediated by adenosine A1 receptors and that supra‐therapeutic concentrations of dipyridamole and midazolam also potentiate the action of rocuronium by increasing endogenous adenosine concentration.
Effect of continuous morphine infusion on hypoxic–ischaemic brain damage of neonatal rats
Authors: Kawaraguchi Y. , Sasaoka N. , Kawaguchi M. , Inoue S. , Hayashi H. , Konishi N. , Furuya H. 
Published: August 2010

Background: Opioids are commonly administered to critically ill neonates and infants for general anaesthesia and sedation. However, the clinical safety of these drugs, especially the effects on hypoxic–ischaemic damage of the developing brain, has not been well investigated. The present study was therefore conducted to investigate the effects of continuous morphine infusion on brain damage after hypoxic–ischaemic insults in neonatal rats.Methods: Seven‐day‐old Sprague–Dawley rats were subjected to left common carotid artery ligation followed by a 90‐min exposure of 8% oxygen. The rats were administered morphine (0.1, 0.3 or 1 mg/kg/h) or saline continuously for 72 h using osmotic minipumps. Seven days later, the rats were weighed and their brains were morphologically categorized into groups based on the following grades: 0=normal, 1=mild atrophy, 2=moderate atrophy, 3=atrophy with cystic cavitation <3 mm and 4=cystic cavitation >3 mm. For histological assessment, the ratio of the surviving neurons (ipsilateral/contralateral) was calculated in the cornu ammonis fields, CA1 and CA3, and the dentate gyrus (DG).Results: One week after recovery (P14), the rats in the 1 mg/kg/h group showed significantly poorer weight gain compared with the other groups. However, the morphological score of the brains and the ratio of the surviving neurons in the CA1, CA3 and DG were similar among the groups.Conclusion: Our results indicate that continuous administration of morphine does not worsen brain damage 7 days after hypoxic–ischaemic insults in neonatal rats.
Prognostic merit of N‐terminal‐proBNP and N‐terminal‐proANP in mechanically ventilated critically ill patients
Authors: BERDAL J.‐E. , STAVEM K. , OMLAND T. , HALL C. , SMITH‐ERICHSSEN N. 
Published: August 2010

Background: Amino‐terminal fragments of type‐A and type‐B natriuretic peptide prohormones (NT‐proBNP, NT‐proANP) are powerful prognostic markers in patients with cardiac disease, and NT‐proBNP has been demonstrated to predict outcome in severe sepsis and septic shock. We assessed the prognostic value of NT‐proBNP and NT‐proANP in a consecutive series of mechanically ventilated intensive care patients and compared their prognostic merit.Methods: Seventy unselected patients admitted to the intensive care unit (ICU) were included in the study 48 h after start of controlled mechanical ventilation. Venous blood was obtained on inclusion and assayed for NT‐proBNP and NT‐pro ANP. Univariate and multivariate logistic regression analysis was used to assess the association of NT‐proBNP and NT‐proANP levels with 30‐day mortality. Established risk factors and possible confounders were used as covariates. Discrimination of different prognostic models was assessed calculating the area under the receiver‐operating characteristics curve (ROC‐AUC).Results: NT‐proBNP and NT‐proANP levels were higher in non‐survivors (n=25) than in 30‐day survivors (n=45). Log NT‐proBNP [odds ratio (OR) 2.34, 95% CI 1.17–4.66], and log NT‐proANP (OR 2.44, 95% CI 1.12–5.30) were independently predictive of increased mortality. A prior diagnosis of chronic obstructive lung disease was predictive of decreased mortality (OR 0.29, 95% CI 0.08–1.00). The relative prognostic values, evaluated by the ROC‐AUCs of NT‐proBNP (AUC 0.74, 95% CI 0.61–0.86) and NT‐proANP (AUC 0.73, 95% CI 0.61–0.86), were nearly identical.Conclusions: High NT‐proANP and NT‐proBNP levels associated with decreased short‐term survival in unselected, mechanically ventilated ICU patients. NT‐proANP performed equally well as a prognostic indicator as NT‐proBNP, and may represent a clinically useful alternative to NT‐proBNP.
Post‐operative pressure lability and cardiac baroreflex in normotensive patients as a function of age
Authors: CIVIDJIAN A. , MEYRIEUX V. , GRATADOUR P. , SAGNARD P. , ANNAT G. , BOULEZ J. , VIALE J. P. , QUINTIN L. 
Published: August 2010

Background: Pressure lability may be linked to the loss of the cardiac baroreflex. The reduction of the sensitivity of the cardiac baroreflex has not been delineated in the post‐operative period according to age in normotensive patients. This study addresses pressure lability and slope of the cardiac baroreflex as a function of age.Methods: Patients were allocated to the following three groups: young (20–39 years, n=7), middle aged (40–59 years, n=7) and elderly (60–79 years, n=6), and studied before minor intra‐abdominal surgery under CO2 peritoneal insufflation and nitrous oxide–isoflurane–sufentanil anesthesia, up to 24 h after extubation. An electrocardiogram and non‐invasive beat‐by‐beat pressure monitoring (Finapres®) allowed offline calculation of the sensitivity of the cardiac baroreflex (‘sequence’ technique) and standard deviation (SD) of heart rate (HR; HR variability) and systolic blood pressure (SBP; pressure lability).Results: Before anesthesia, (a) an inverse relationship was observed between the slope of the cardiac baroreflex and age and (b) a trend (P<0.09) existed between the slope of the cardiac baroreflex and pressure lability, irrespective of age. During the early post‐operative period, young patients returned to their baseline slope of the cardiac baroreflex; no inverse relationship between increased SD of SBP and decreased SD of RR interval was observed. Middle‐aged and elderly patients displayed a depressed slope of the cardiac baroreflex both before and after anesthesia.Conclusion: At variance with the pre‐operative period, no simple inverse relationship was observed between increased pressure lability and depressed HR variability in young patients during the early post‐operative period.
Post‐conditioning reduces infarct size in an open‐chest porcine acute ischemia–reperfusion model
Authors: LIE R. H. , HASENKAM J. M. , NIELSEN T. T. , POULSEN R. , SLOTH E. 
Published: August 2010

Background: Timely reperfusion is a prerequisite for myocardial salvage; however, re‐oxygenation of the ischemic myocardium initiates reperfusion injury. Post‐conditioning diminishes the detrimental aftermath of an acute myocardial infarction through alleviation of reperfusion injury. Ischemic post‐conditioning consists of a series of brief interruptions in the coronary blood supply that has to be applied within the first minutes after re‐establishing the coronary flow.Methods: Sixteen female mixed Danish Landrace and Yorkshire pigs weighing 20 kg were included. The heart was exposed through a midline sternotomy. A snare was positioned around the left anterior descending coronary artery downstream of the second diagonal branch. After randomization to either no treatment (control group) or treatment by ischemic post‐conditioning (post‐conditioning group), the pigs underwent 45 min of ischemia and 180 min of reperfusion. The post‐conditioning group had a post‐conditioning algorithm applied consisting of 15 s of reperfusion alternating with 15 s of re‐occlusion repeated 10 times.Results: The groups were comparable with regard to body weight, hemodynamics and the size of the area at risk. The post‐conditioning group had an absolute reduction in infarct size of 18.1% [confidence interval (CI): 6.2: 30.0%] compared with the control group (P=0.0056). In the post‐conditioning group, infarction developed in 39.6±12.0% (1 SD) of the area at risk compared with 57.8±10.2% (1 SD) in the control group.Conclusion: When ischemic post‐conditioning was applied at reperfusion, we found an absolute reduction in infarct size of 18.1% presumably attributable to a diminished reperfusion injury. The model we have developed is suitable for further studies of this promising intervention.
Significance of retrograde diastolic uterine artery blood flow during regional anesthesia in instrumented pregnant sheep
Authors: KAVASMAA T. , MÄKIKALLIO K. , ERKINARO T. , ACHARYA G. , HAAPSAMO M. , ALAHUHTA S. , RÄSÄNEN J. 
Published: August 2010

Background: We studied the interactions between uterine and placental hemodynamics during maternal hypotension in chronically instrumented fetal sheep. In addition, we investigated maternal hemodynamic characteristics, fetoplacental hemodynamics and fetal acid–base status when a retrograde diastolic uterine artery blood flow pattern is present during maternal hypotension.Methods: Invasive maternal and fetal hemodynamic parameters, uterine (QUtA) and placental (QUA) volume blood flows and acid–base values were examined in 24 chronically instrumented sheep at baseline and during epidural‐induced maternal hypotension at 117–132 (term 145) days of gestation. Uterine artery blood flow velocity waveforms were obtained by Doppler ultrasonography.Results: Maternal hypotension decreased QUtA without affecting QUA. During hypotension, eight out of 24 sheep demonstrated a retrograde diastolic blood flow velocity waveform pattern in the uterine artery. Maternal systolic, diastolic and mean arterial blood pressures were significantly lower in the retrograde group than in the antegrade group. No statistically significant differences in QUtA, QUA and fetal blood gas values were detected between the two groups during hypotension.Conclusions: An acute decrease in uterine artery volume blood flow during maternal hypotension is not compensated by increased placental volume blood flow. A retrograde diastolic blood flow pattern in the uterine artery is related to lower maternal arterial pressures, especially during diastole. A uterine artery retrograde diastolic blood flow pattern does not have any additional detrimental short‐term effects on fetal acid–base status.
Bleeding time prolonged by daily low‐dose aspirin is shortened by one medium dose aspirin
Authors: YOKOYAMA T. , YAMASAKI F. , YAMASHITA K. , MANABE M. , SUWA K. 
Published: August 2010

Background: In planning surgery, a low‐dose aspirin regimen for prevention of thrombotic events is often discontinued in order to avoid the risk of excessive bleeding during surgery. However, this procedure increases the risk from adverse thrombotic events. We propose a different method, which may normalize the prolonged bleeding time caused by low‐dose aspirin. We verified the effectiveness of this method in healthy volunteers.Methods: Volunteers with bleeding time prolonged by taking 81 mg of aspirin a day for a period of 1 week were randomly divided into two groups. The test group of 18 volunteers received a dose of 660 mg of aspirin, while the control group of 16 received placebo. Bleeding time and maximum platelet activity were then evaluated.Results: Before 660 mg of aspirin or placebo, bleeding time was prolonged: in the aspirin group from 3.1 ± 0.7 to 6.1 ± 1.4 min (n=18), and in the placebo group from 2.9 ± 0.9 to 6.1 ± 1.5 min (n=16). This prolongation was significant in both groups at the P<0.01 level. In the test group, bleeding time was shortened to 4.5 ± 1.3 min (P<0.01), which is in the normal range, while it remained prolonged in the control group (6.0 ± 1.2 min). Platelet activity, on the other hand, was suppressed in both groups.Conclusion: We conclude that 660 mg of aspirin effectively shortens the bleeding time prolonged by daily low‐dose (81 mg) aspirin.