Gastric intramucosal pH is stable during titration of positive end-expiratory pressure to improve oxygenation in acute respiratory distress syndrome

BACKGROUND: Optimal positive end-expiratory pressure (PEEP) is an important component of adequate mechanical ventilation in acute lung injury and acute respiratory distress syndrome (ARDS). In the present study we tested the effect on gastric intramucosal pH of incremental increases in PEEP level (i.e. PEEP titration) to improve oxygenation in ARDS. Seventeen consecutive patients with ARDS, as defined by consensus criteria, were included in this clinical, prospective study. All patients were haemodynamically stable, and were not receiving vasopressors. From an initial level of 5 cmH(2)O, PEEP was titrated at 2 cmH(2)O increments until the partial arterial oxygen tension was 300 mmHg or greater, peak airway pressure was 45 cmH(2)O or greater, or mean arterial blood pressure decreased by 20% or more of the baseline value. Optimal PEEP was defined as the level of PEEP that achieved the best oxygenation. The maximum PEEP was the highest PEEP level reached during titration in each patient. RESULTS: Gastric mucosal pH was measured using gastric tonometry at all levels of PEEP. The thermodilution technique was used for measurement of cardiac index. Gastric mucosal pH was similar at baseline and at optimal PEEP levels, but it was slightly reduced at maximum PEEP. Cardiac index and oxygen delivery remained stable at all PEEP levels. CONCLUSION: Incremental titration of PEEP based on improvement in oxygenation does not decrease gastric intramucosal perfusion when cardiac output is preserved in patients with ARDS

Evidence of historical seismicity and volcanism in the Armenian Highland (from Armenian and other sources)

This work presents a summary on the development of studies of historical earthquakes in Armenia and adjacent parts of Turkey and Iran. Since ancient times, this region has been an arena where active geodynamic and seismic history intermingled with no less active and dynamic evolution of human cultures and societies. A long-term historical record in this region beginning as early as the 8th century B.C. provides abundant evidence that can make an inestimable contribution to studies of historical seismicity and volcanism in the area. We discuss the main research methodology and sources used, and dwell on the principal catalogues of historical earthquakes compiled to date

Acute Kidney Injury Classification in Neuro-ICU Patient Group

Objective: To investigate the role of acute kidney injury (AKI) classification system for kidney injury outcome in neuro-Intensive care unit (ICU) patients. Material and Method: Total 432 patients who admitted to ICU between 2005 and 2009 evaluated in this study. All patients’ AKI stage, Acute Physiology and Chronic Health Evaluation (APACHE-II), Sequential Organ Failure Assessment Score (SOFA), Glasgow Coma Score (GCS), Glasgow Outcome Score (GOS), mortality rate, length of ICU stay, need for intubation, and mechanical ventilation were recorded. Results: AKI was found in 24 of all 432 patents’ (5.5%). We found that, patients with AKI had higher APHACE-II score, SOFA score and mortality rates; longer ICU stay, duration of mechanical ventilation and intubation and lower GCS and GOS than without AKI group. Conclusion: Length of ICU stay and mortality rate were higher in AKI positive group

Single-Center Analysis of Acute Intoxication: Six-Year Data Case

Objective: This retrospective study on the acute intoxication cases registered at the Acıbadem Kadıköy Hospital between January 2005 and December 2011 was performed to find out the number and types of poisoning cases treated. Material and Method: Their distribution according to patient’s sex and age, chronology, type of toxic agents involved, intentionality, history, symptoms, clinical development, treatment and toxicological analysis used for diagnosis were evaluated. Results: Data from a total of 128 patients with a mean age of 30.29±14.95 years (77% women) were included. The highest rates of poisoning were recorded on the months December, January, June. Based on the examination on toxic intakes, it was found that the most frequent toxic agent is antidepressants with 101 occurrences (78%). Ethyl alcohol overdose counts as the second with 14% appearing at mostly high level alcohol addicted male patients. It has been observed that 84% of the incidents are suicidal. The implementation of general intensive care was discussed in the case study which indicates a mortality rate of 0.7%. Conclusion: The results illustrate that social factors have impact on the cause and source of poisoning and epidemiologic surveys are important to cure the acute poisoning cases