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Procedure: Perfusion

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Multimodality Monitoring: Toward Improved Outcomes
Semin Respir Crit Care Med 2017; 38: 785-792 DOI: 10.1055/s-0037-1608774Multimodality monitoring provides insights into the critically ill brain-injured patient through the assessment of biochemical, physiological, and electrical data that provides insight into a patient's condition and what strategies may be available to limit further damage and improve the odds for recovery. Modalities utilized include evaluation of intracranial pressure along with cerebral perfusion pressure to determine adequate blood flow; continuous electroencephalography to protect the patient from seizures and to identify early functional manifesta...
Source: Seminars in Respiratory and Critical Care Medicine - December 20, 2017 Category: Respiratory Medicine Authors: Gandee, Richard Miller, Chad Tags: Review Article Source Type: research

Optimal Cerebral Perfusion Pressure in Centers With Different Treatment Protocols
Conclusions: Differences in optimal cerebral perfusion pressure calculation were found between centers due to demographics (age) and treatment (cerebral perfusion pressure targets). These factors should be considered in the design of trials to determine the efficacy of autoregulation-guided treatment.
Source: Critical Care Medicine - February 23, 2018 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research

Donation after Brain Death versus Donation after Circulatory Death: Lung Donor Management Issues
Semin Respir Crit Care Med 2018; 39: 138-147 DOI: 10.1055/s-0037-1615820Lung transplantation (LTx) has traditionally been limited by a lack of suitable donor lungs. With the recognition that lungs are more robust than initially thought, the size of the donor pool of available lungs has increased dramatically in the past decade. Donation after brain death (DBD) and donation after circulatory death (DCD) lungs, both ideal and extended are now routinely utilized. DBD lungs can be damaged. There are important differences in the public's understanding, legal and consent processes, intensive care unit strategies, lung pathophysi...
Source: Seminars in Respiratory and Critical Care Medicine - March 26, 2018 Category: Respiratory Medicine Authors: Snell, Gregory I. Levvey, Bronwyn J. Levin, Kovi Paraskeva, Miranda Westall, Glen Tags: Review Article Source Type: research

Endovascular Perfusion Augmentation for Critical Care: Partial Aortic Occlusion for Treatment of Severe Ischemia–Reperfusion Shock
Background: The resuscitation of patients in shock is materially intensive and many patients are refractory to maximal therapy. We hypothesized that partial inflation of an intra-aortic balloon, termed Endovascular Perfusion Augmentation for Critical Care (EPACC), would minimize material requirements while improving physiologic metrics. Methods: Swine underwent a 25% controlled bleed and 45 min of complete aortic occlusion to create a severe ischemia–reperfusion shock state. Animals received either standardized critical care (SCC) composed of IV fluids and norepinephrine delivered through an algorithmically controll...
Source: Shock - April 16, 2019 Category: Emergency Medicine Tags: Basic Science Aspects Source Type: research

Prevalence and Impact on Mechanical Ventilation Weaning of Pleural Effusion in ICU Patients
Pleural effusion is frequently encountered in patients who are mechanically ventilated in the intensive care unit and may be logically suspected in case of difficult weaning from mechanical ventilation. Through several mechanisms, pleural effusion may impair gas exchange, respiratory mechanics, and ventilation/perfusion matching. However, data exploring the respective contribution of pleural effusion on weaning failure are scarce. This review discusses the most recent findings pertaining to the potential role of pleural effusion in weaning outcome.
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research

Sublingual microcirculation in Prehospital Critical Care Medicine – a Proof of Concept Study
ConclusionThe prehospital sublingual measurement is safe and valid. Despite normal macrocirculation, microcirculation was impaired and correlated with NACA.
Source: Microcirculation - February 17, 2020 Category: Research Authors: Raphael Romano Bruno, Markus Reed, Nana ‐Yaw Bimpong‐Buta, Johanna M. Muessig, Maryna Masyuk, Stephan Binneboessel, Marcus Franz, Malte Kelm, Christian Jung Tags: ORIGINAL RESEARCH Source Type: research

Sublingual microcirculation in prehospital critical care medicine: A proof ‐of‐concept study
ConclusionThe prehospital sublingual measurement is safe and valid. Despite normal macrocirculation, microcirculation was impaired and correlated with National Advisory Committee on Aeronautics.
Source: Microcirculation - March 5, 2020 Category: Research Authors: Raphael Romano Bruno, Markus Reed, Nana ‐Yaw Bimpong‐Buta, Johanna M. Muessig, Maryna Masyuk, Stephan Binneboessel, Marcus Franz, Malte Kelm, Christian Jung Tags: ORIGINAL ARTICLE Source Type: research

Asymmetrical Lung Injury: Management and Outcome
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1744303Among mechanically ventilated patients, asymmetrical lung injury is probably extremely frequent in the intensive care unit but the lack of standardized measurements does not allow to describe any prevalence among mechanically ventilated patients. Many past studies have focused only on unilateral injury and have mostly described the effect of lateral positioning. The good lung put downward might receive more perfusion while the sick lung placed upward receive more ventilation than supine. This usually results in better oxygenation but can also promote atelectasis in the ...
Source: Seminars in Respiratory and Critical Care Medicine - July 4, 2022 Category: Respiratory Medicine Authors: Bastia, Luca Roz é, Hadrien Brochard, Laurent Tags: Review Article Source Type: research

Cardiac output measurement
Abstract: Optimization of fluid status, perfusion pressure and cardiac output in intraoperative and critical care settings improves clinical outcomes. Cardiac output is a measure of the blood pumped around the circulation. Modelling of the circulation facilitates estimation of cardiac output from readily measured variables. Methods include thermodilution, analysis of arterial pressure waveforms, Doppler measurements of blood flow velocity, electrical bioimpedance and regional oxygenation. Physical limitations of each measurement technique produce predictable as well as unquantifiable errors, leading to over- or underestima...
Source: Anaesthesia and intensive care medicine - February 1, 2013 Category: Anesthesiology Authors: Michael Gilbert Tags: Clinical measurement Source Type: research

Brain Perfusion and Oxygenation
This article describes the bedside neuromonitoring techniques that have emerged for use with these patients in the critical care area. To give the reader an understanding of the functionality of these neuromonitoring techniques, the article first summarizes the physiology of brain perfusion and oxygenation.
Source: Critical Care Nursing Clinics of North America - June 12, 2014 Category: Nursing Authors: Laura L. Lipp Source Type: research

Ventilator-Associated Lung Injury during Assisted Mechanical Ventilation
Semin Respir Crit Care Med 2014; 35: 409-417DOI: 10.1055/s-0034-1382153Assisted mechanical ventilation (MV) may be a favorable alternative to controlled MV at the early phase of acute respiratory distress syndrome (ARDS), since it requires less sedation, no paralysis and is associated with less hemodynamic deterioration, better distal organ perfusion, and lung protection, thus reducing the risk of ventilator-associated lung injury (VALI). In the present review, we discuss VALI in relation to assisted MV strategies, such as volume assist–control ventilation, pressure assist–control ventilation, pressure support ventilat...
Source: Seminars in Respiratory and Critical Care Medicine - August 8, 2014 Category: Respiratory Medicine Authors: Saddy, FelipeSutherasan, YudaRocco, Patricia R. M.Pelosi, Paolo Source Type: research

Pulse oximetry
This article updates the review on pulse oximetry that was published in 1999 in Critical Care. A summary of the recently developed multiwavelength pulse oximeters and their ability in detecting dyshemoglobins is provided. The impact of the latest signal processing techniques and reflectance technology on improving the performance of pulse oximeters during motion artifact and low perfusion conditions is critically examined. Finally, data regarding the effect of pulse oximetry on patient outcome are discussed.
Source: Critical Care - July 16, 2015 Category: Intensive Care Authors: Amal Jubran Source Type: research

Clinical and Physiological Events That Contribute to the Success Rate of Finding “Optimal” Cerebral Perfusion Pressure in Severe Brain Trauma Patients
Objective: Recently, a concept of an individually targeted level of cerebral perfusion pressure that aims to restore impaired cerebral vasoreactivity has been advocated after traumatic brain injury. The relationship between cerebral perfusion pressure and pressure reactivity index normally is supposed to have a U-shape with its minimum interpreted as the value of “optimal” cerebral perfusion pressure. The aim of this study is to investigate the relation between the absence of the optimal cerebral perfusion pressure curve and physiological variables, clinical factors, and interventions. Design: Retrospective analysis of...
Source: Critical Care Medicine - August 15, 2015 Category: Emergency Medicine Tags: Clinical Investigations Source Type: research

Intracranial pressure and cerebral perfusion pressure in patients developing brain death
Conclusions BD was universally preceded by a severe reduction of CPP, supporting loss of cerebral perfusion as a critical step in BD development. Our data shows that a negative CPP is neither sufficient nor a prerequisite to diagnose BD. In BD cases with positive CPP we speculate that arterial blood pressure dropped below a critical closing pressure, thereby causing cessation of cerebral blood flow.
Source: Journal of Critical Care - March 16, 2016 Category: Gastroenterology Source Type: research