'Acute Respiratory Distress Syndrome' in relatie tot sepsis : enkele pathogenetische en therapeutische aspecten

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A double blind comparison of lidocaine 5% with glucose and lidocaine 2% with glucose for spinal anesthesia

Contains fulltext : 21606___.PDF (publisher's version ) (Open Access

Extravascular lung water index measurement in critically ill children does not correlate with a chest x-ray score of pulmonary edema.

Contains fulltext : 88622.pdf (publisher's version ) (Open Access)INTRODUCTION: Extravascular lung water index (EVLWI) can be measured at the bedside using the transpulmonary thermodilution technique (TPTD). The goal of this study was to compare EVLWI values with a chest x-ray score of pulmonary edema and markers of oxygenation in critically ill children. METHODS: This was a prospective observational study in a pediatric intensive care unit of a university hospital. We included 27 critically ill children with an indication for advanced invasive hemodynamic monitoring. No specific interventions for the purpose of the study were carried out. Measurements included EVLWI and other relevant hemodynamic variables. Blood gas analysis, ventilator parameters, chest x-ray and TPTD measurements were obtained within a three-hour time frame. Two radiologists assessed the chest x-ray and determined a score for pulmonary edema. RESULTS: A total of 103 measurements from 24 patients were eligible for final analysis. Mean age was two years (range: two months to eight years). Median cardiac index was 4.00 (range: 1.65 to 10.85) l/min/m2. Median EVLWI was 16 (range: 6 to 31) ml/kg. The weighted kappa between the chest x-ray scores of the two radiologists was 0.53. There was no significant correlation between EVLWI or chest x-ray score and the number of ventilator days, severity of illness or markers of oxygenation. There was no correlation between EVLWI and the chest x-ray score. EVLWI was significantly correlated with age and length (r2 of 0.47 and 0.67 respectively). CONCLUSIONS: The extravascular lung water index in critically ill children does not correlate with a chest x-ray score of pulmonary edema, nor with markers of oxygenation

Continuous non-invasive finger arterial pressure monitoring reflects intra-arterial pressure changes in children undergoing cardiac surgery.

Contains fulltext : 88974.pdf (publisher's version ) (Closed access)BACKGROUND: Continuous non-invasive measurement of finger arterial pressure (FAP) is a reliable technology in adults. FAP is measured with an inflatable cuff around the finger and simultaneously converted to a reconstructed brachial artery pressure waveform (reBAP) by the Nexfin device. We assessed the adequacy of a prototype device (Nexfin-paediatric), designed for a paediatric population, for detecting rapid arterial pressure changes in children during cardiac surgery. METHODS: Thirteen anaesthetized children with a median age of 11 months (2 months-7 yr) undergoing congenital cardiac surgery were included in the study. reBAP and intra-arterial pressure (IAP) were recorded simultaneously during the surgical procedure. To assess the accuracy of reBAP in tracking arterial pressure changes, the four largest IAP variations within a 5 min time interval were identified from each procedure. These variations were compared offline with reBAP during a 10 s control period before and a 10 s period after an arterial pressure change had occurred. RESULTS: In 10 out of 13 children, a non-invasive arterial pressure recording could be obtained. Therefore, recordings from these 10 children were eligible for further analysis, resulting in 40 data points. The correlation coefficient between reBAP and IAP in tracking mean arterial pressure (MAP) changes was 0.98. reBAP followed changes in IAP with a mean bias for systolic, diastolic arterial pressure, and MAP of 0.0 mm Hg (sd 5.8), 0.1 (sd 2.8), and 0.19 (sd 2.7), respectively. CONCLUSIONS: The prototype device closely follows arterial pressure changes in children. However, in a considerable number of attempts, obtaining a signal was time-consuming or unsuccessful. This technique seems promising but requires further technical development.1 oktober 201