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J Takala

Publications and source records attributed to J Takala.

At least 19 recordsLinked to original sources
PubMed2006

Changes in respiratory mechanics and gas exchange during the acute respiratory distress syndrome.

BACKGROUND: The time course of impairment of respiratory mechanics and gas exchange in the acute respiratory distress syndrome (ARDS) remains poorly defined. We assessed the changes in respiratory mechanics and gas exchange during ARDS. We hypothesized that due to the changes in respiratory mechanics over time, ventilatory strategies based on rigid volume or pressure limits might fail to prevent overdistension throughout the disease process. METHODS: Seventeen severe ARDS patients {PaO2/FiO2 10.1 (9.2-14.3) kPa; 76 (69-107) mmHg [median (25th-75th percentiles)] and bilateral infiltrates} were studied during the acute, intermediate, and late stages of ARDS (at 1-3, 4-6 and 7 days after diagnosis). Severity of lung injury, gas exchange, and hemodynamics were assessed. Pressure-volume (PV) curves of the respiratory system were obtained, and upper and lower inflection points (UIP, LIP) and recruitment were estimated. RESULTS: (1) UIP decreased from early to established (intermediate and late) ARDS [30 (28-30) cmH2O, 27 (25-30) cmH2O and 25 (23-28) cmH2O (P=0.014)]; (2) oxygenation improved in survivors and in patients with non-pulmonary etiology in late ARDS, whereas all patients developed hypercapnia from early to established ARDS; and (3) dead-space ventilation and pulmonary shunt were larger in patients with pulmonary etiology during late ARDS. CONCLUSION: We found a decrease in UIP from acute to established ARDS. If applied to our data, the inspiratory pressure limit advocated by the ARDSnet (30 cmH2O) would produce ventilation over the UIP, with a consequent increased risk of overdistension in 12%, 43% and 65% of our patients during the acute, intermediate and late phases of ARDS, respectively. Lung protective strategies based on fixed tidal volume or pressure limits may thus not fully avoid the risk of lung overdistension throughout ARDS.

Adult↗
PubMed2006

Practical sources of error in measuring pulmonary artery occlusion pressure: a study in participants of a special intensivist training program of The Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).

BACKGROUND: Physiological data obtained with the pulmonary artery catheter (PAC) are susceptible to errors in measurement and interpretation. Little attention has been paid to the relevance of errors in hemodynamic measurements performed in the intensive care unit (ICU). The aim of this study was to assess the errors related to the technical aspects (zeroing and reference level) and actual measurement (curve interpretation) of the pulmonary artery occlusion pressure (PAOP). METHODS: Forty-seven participants in a special ICU training program and 22 ICU nurses were tested without pre-announcement. All participants had previously been exposed to the clinical use of the method. The first task was to set up a pressure measurement system for PAC (zeroing and reference level) and the second to measure the PAOP. RESULTS: The median difference from the reference mid-axillary zero level was - 3 cm (-8 to + 9 cm) for physicians and -1 cm (-5 to + 1 cm) for nurses. The median difference from the reference PAOP was 0 mmHg (-3 to 5 mmHg) for physicians and 1 mmHg (-1 to 15 mmHg) for nurses. When PAOP values were adjusted for the differences from the reference transducer level, the median differences from the reference PAOP values were 2 mmHg (-6 to 9 mmHg) for physicians and 2 mmHg (-6 to 16 mmHg) for nurses. CONCLUSIONS: Measurement of the PAOP is susceptible to substantial error as a result of practical mistakes. Comparison of results between ICUs or practitioners is therefore not possible.

Calibration↗
PubMed2005

Lack of effect of ranitidine on gastric luminal pH and mucosal PCO2 during the first day in the ICU.

BACKGROUND: Histamine(2) (H(2))-blocking agents can attenuate intragastric CO(2)-production by reducing gastric acid secretion and preventing the interaction between H(+) and bicarbonate. However, gastric acid production may be impaired in acute circulatory failure due to poor mucosal perfusion, and H(2)-blockade could further impair mucosal perfusion. METHODS: Forty patients with acute circulatory and/or respiratory failure, age 61 +/- 16 years (mean +/- SD), APACHE II score 21 +/- 7, and SOFA score 8 +/- 3, received randomly either ranitidine, 50 mg (R) or placebo (P) every 8 h. Gastric intraluminal pH (gpH; antimony probe with external reference electrode) and mucosal pCO(2) (prCO(2), semicontinuous air-tonometry) were measured during 24 h, and blood gases were taken at 6-h intervals. RESULTS: Gastric intraluminal pH was 4.3 +/- 2.4 in P and 5.1 +/- 1.6 in R (NS). Mean prCO(2) was 6.8 +/- 2.7 kPa in P and 7.4 +/- 2.1 kPa in R, and mucosal-arterial pCO(2) gradient (Delta pCO(2)) was 2.2 +/- 2.9 kPa and 2.4 +/- 2.4 kPa, respectively (NS). Within-patient variabilities of gpH and prCO(2) were not influenced by ranitidine. A posthoc analysis revealed that non-survival in R was associated with a low mucosal pHi after 24 h (P = 0.002). This was explained by a low arterial pH but not by differences in gpH or prCO(2). CONCLUSION: In acute respiratory and circulatory failure, H(2) blockade has an inconsistent impact on gpH and does not reduce variabilities of gpH or prCO(2).

Acute Disease↗
PubMed2005

Oxygen extraction in pigs subjected to low-dose infusion of endotoxin after major abdominal surgery.

BACKGROUND: Sepsis may impair O(2) extraction due to blood flow redistribution or decreased utilization of the available oxygen. METHODS: We assessed the effect of endotoxemia on systemic and regional O(2) extraction and lactate handling in pigs, randomized to receive either endotoxin (0.4 microg kg(-1) h(-1); n = 10) or saline infusion (controls; n = 9) for 12 h. RESULTS: High baseline regional and systemic O(2) extraction in the endotoxin group (median 56%, range 45-77%) and in the controls (67%, 49-72%) was maintained until the end of the experiment (endotoxin group: 60%, 50-71%; controls: 60%, 50-74%) despite hypotension and a decrease in stroke volume in endotoxic animals. Hepatic lactate exchange decreased during endotoxemia from 14 micromol kg(-1) min(-1) (range 10-28 micromol kg(-1) min(-1)) to 10 (range 3-15) micromol kg(-1) min(-1); P < 0.01), but remained stable in the controls, with 13 micromol min(-1) (4-18 micromol min(-1)) at baseline and 7 micromol min(-1) (3-17 micromol min(-1)) after 12 h of saline infusion. CONCLUSIONS: The high and sustained oxygen consumption and oxygen extraction in this endotoxemic model speak against any major impairment of hepatosplanchnic or systemic oxygen extraction and oxidative metabolism. The reduced hepatic lactate exchange despite an unchanged hepatic lactate influx suggests altered metabolic activities independent of oxygen consumption.

Abdomen↗
PubMed2005

Does ICU length of stay influence quality of life?

BACKGROUND: Patients with prolonged stay in the intensive care unit (ICU) use a disproportionate share of resources. However, it is not known if such treatment results in impaired quality of life (QOL) as compared to patients with a short length of stay (LOS) when taking into account the initial severity of illness. METHODS: Prospective, observational case-control study in a university hospital surgical and trauma adult ICU. All patients admitted to the ICU during a 1-year period were included. Patients with a cumulative LOS in the ICU > 7 days, surviving up to 1 year after ICU admission and consenting were identified (group L, n = 75) and matched to individuals with a shorter stay (group S). Matching criteria were diagnostic group and severity of illness. Health-related quality of life (HRQOL) was assessed 1 year after admission using the short-form 36 (SF-36) and was compared between groups and to the general population. Further, overall QOL was estimated using a visual analogue scale (VAS) and willingness to consent to future intensive care, and was compared between groups L and S. RESULTS: Based on ANCOVA, a significant difference between groups L and S was noted for two out of eight scales: role physical (P = 0.033) and vitality (P = 0.041). No differences were found for the physical component summary (P = 0.065), the mental component summary (P = 0.267) or the VAS (P = 0.316). Further, there was no difference in expectation to consent to future intensive care (P = 0.149). As compared to the general population, we found similar scores for the mental component summary and for three of eight scales in group L and five of eight scales in group S. CONCLUSIONS: When taking into account severity of illness, HRQOL 1 year after intensive care is comparable between patients with a short and a long LOS in the ICU. Thus, prolonged stay in the ICU per se must not be taken as an indicator of future poorer HRQOL. However, as compared to the general population, significant differences, mostly in physical aspects of QOL, were found for both groups of patients.

Aged↗
PubMed2004

Pressure-volume relationships in acute lung injury: methodological and clinical implications.

BACKGROUND: Pressure-volume relationships (PV curves) are the only available method for bedside monitoring of respiratory mechanics. Alveolar recruitment modifies the results obtained from the PV curves. We hypothesized that method-related differences may influence PV-curve guided ventilatory management. METHODS: Twelve acute lung injury (ALI) patients [PaO2/FiO2 13.0 +/- 1.5 kPa (97.6 +/- 11.3 mmHg), bilateral pulmonary infiltrates] were studied. Two PV curves [one at variable, and another at constant level of positive end-expiratory pressure (PEEP)] were obtained from each patient using constant inspiratory flow and end-inspiratory and -expiratory occlusions. Upper and lower inflection points (UIP, LIP) were estimated. Recruitment due to PEEP and during inflation was assessed by respiratory inductive plethysmography (RIP). RESULTS: (1) Pressure-volume curves at constant PEEP tended to provide higher LIP values compared with curves at variable PEEP (mean difference +/- SEM 5.1 +/- 1.9 cmH2O); and (2) recruitment occurred throughout the PV curve with no relationship with LIP or UIP. CONCLUSION: Pressure-volume curves obtained using variable PEEP translate a different physiological reality and seem to be clinically more relevant than curves constructed at constant PEEP. If curves constructed at constant PEEP are used to set the ventilator, unnecessarily high PEEP levels may be used. Respiratory inductive plethysmography technology may be used for monitoring of recruitment at the bedside.

Adolescent↗
PubMed2004

The effect of carbon dioxide, respiratory rate and tidal volume on human heart rate variability.

BACKGROUND: Heart rate variability (HRV) has been used for assessment of depth of anesthesia. Alterations in respiratory rate and tidal volume modulate the sympatovagal neural drive to the heart. The changes in PaCO2 that accompany changes in breathing pattern may, through chemoreceptors in the brainstem, independently influence the autonomic control of the heart and modulate HRV. METHODS: We measured the effects of PaCO2, tidal volume and respiratory rate on HRV during spontaneous and mechanical ventilation in 22 healthy volunteers and in 25 mechanically ventilated anesthetized patients. RESULTS: Adding CO2 to the inspiratory gas increased high frequency (HF) and low frequency (LF) components of HRV in awake volunteers both during spontaneous and mechanical ventilation, while this effect of CO2 was abolished in patients during anesthesia. Increase of tidal volume increased HF component of HRV only in volunteers during spontaneous ventilation. On the other hand, when respiratory rate was reduced, the balance of HF and LF power moved toward LF power in all study groups. Breathing frequency altered HRV independent on PaCO2, tidal volume and the level of consciousness. In contrast, the effect of PaCO2 appeared to be related to normal level of consciousness, suggesting that a cortical modulation of the autonomic nervous activity contributes to the effects of PaCO2 on HRV. CONCLUSIONS: PaCO2, tidal volume and respiratory rate should be controlled when HRV power spectrum is measured in conscious patients or volunteers, while in anesthetized patients small changes in end-tidal CO2 or tidal volume do not modulate HRV if respiratory rate remains unchanged.

Adult↗
PubMed2003

Effects of cerebral perfusion pressure and increased fraction of inspired oxygen on brain tissue oxygen, lactate and glucose in patients with severe head injury.

OBJECTIVE: The purpose of the study was to measure the effects of increased inspired oxygen on patients suffering severe head injury and consequent influences on the correlations between CPP and brain tissue oxygen (PtiO2) and the effects on brain microdialysate glucose and lactate. METHODS: In a prospective, observational study 20 patients suffering severe head injury (GCS< or =8) were studied between January 2000 and December 2001. Each patient received an intraparenchymal ICP device and an oxygen sensor and, in 17 patients brain microdialysis was performed at the cortical-subcortical junction. A 6 h 100% oxygen challenge (F IO2 1.0) ( Period A) was performed as early as possible in the first 24 hours after injury and compared with a similar 6 hour period following the challenge ( Period B). Statistics were performed using the linear correlation analysis, one sample t-test, as well as the Lorentzian peak correlation analysis. RESULTS: F IO2 was positively correlated with PtiO2 (p < 0.0001) over the whole study period. PtiO2 was significantly higher (p < 0.001) during Period A compared to Period B. CPP was positively correlated with PtiO2 (p < 0.001) during the whole study. PtiO2 peaked at a CPP value of 78 mmHg performing a Lorentzian peak correlation analysis of all patients over the whole study. During Period A the brain microdialysate lactate was significantly lower (p = 0.015) compared with Period B. However the brain microdialysate glucose remained unchanged. CONCLUSION: PtiO2 is significantly positively correlated with F IO2, meaning that PtiO2 can be improved by the simple manipulation of increasing F IO2 and ABGAO2. PtiO2 is positively correlated with CPP, peaking at a CPP value of 78 mmHg. Brain microdialysate lactate can be lowered by increasing PtiO2 values, as observed during the oxygen challenge, whereas microdialysate glucose is unchanged during this procedure. Extension of the oxygen challenge time and measurement of the intermediate energy metabolite pyruvate may clarify the metabolic effects of the intervention. Prospective comparative studies, including analysis of outcome on a larger multicenter basis, are necessary to assess the long term clinical benefits of this procedure.

Adolescent↗
PubMed2003

Resource use in the ICU: short- vs. long-term patients.

BACKGROUND: Intensive care medicine uses a disproportionate share of medical resources, and little is known about the distribution of resources between different patient groups. METHODS: In this prospective observational study, all patients admitted between 1 January 1998 and 31 December 1999 to our medical-surgical university's ICU were assigned to one of two groups according to length of stay (LOS): patients staying more than 7 days in the unit (group L) and those staying a maximum of 7 days (group S). Resource use was estimated using TISS-28, number of nursing shifts, use of mechanical ventilation, and use of renal replacement therapy. Further, SAPS II and ICU and hospital mortalities were recorded. RESULTS: Of 5481 patients, 583 (10.6%) were in group L and 4898 in group S (89.4%). Patients in group L were more severely sick upon admission than those in group S. Patients in group L stayed a total of 9726 days in the ICU (52.5% of the total LOS). In group L, 69.2% of all shifts with respiratory support and 80.1% of all shifts with renal replacement were used. Further, group L patients consumed 53.4% (909225) of all TISS points provided. The ICU-mortality rates were 14.4% in group L and 7.2% in group S, and the hospital mortality rates were 19.9% and 9.8%, respectively. A mean of 1898 TISS points was used per patient surviving the hospital stay in group L compared with 190 points in group S. CONCLUSIONS: In this university-based, medical-surgical adult ICU, 11% of all patients stayed more than 7 days in the unit and consumed more than 50% of all resources. Thus, a highly disproportionate amount of resources were used per survivor in group L compared with those in group S.

Adolescent↗
PubMed2002

Customized prediction models based on APACHE II and SAPS II scores in patients with prolonged length of stay in the ICU.

OBJECTIVE: To study customized APACHE II and SAPS II models in predicting hospital death in patients with a prolonged length of stay in the ICU. DESIGN: Prospectively collected database. SETTING: Thirteen ICUs with 5-10 beds in Finnish secondary referral hospitals. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The database was collected between 1994 and 1999 and included 23,953 ICU admissions. In order to customize the original APACHE II and SAPS II models and to validate the models, the database was randomly divided into customization data ( n=12,064) and into validation data ( n=11,889). Logistic regression analysis was used for customization. As the length of the ICU stay was prolonged, the calibration and discrimination of both customized models worsened gradually in the validation data. Patients whose ICU stay lasted 7 days or longer (1,312 patients) consumed more than one half of all ICU days and TISS-points. Among these patients, goodness-of-fit statistics was 221.5 and 306.3 ( P<0.0001 for both) and the areas under ROC curve 0.65 and 0.62 for the customized APACHE and SAPS models, respectively. The models underestimated the risk of death in the low range and overestimated it in the high range of predicted mortality. On the other hand, both models discriminated well between survivors and non-survivors if the ICU stay was 2 days or less. CONCLUSIONS: Despite customization, the predictive models may not support clinical decision-making in those patients who require a high share of resources. More relevant instruments are needed for the prediction of outcome of patient groups who consume the major part of ICU resources.

APACHE↗
PubMed2002

Procalcitonin and neopterin as indicators of infection in critically ill patients.

BACKGROUND: : In critically ill patients, severe infection and systemic inflammation due to non-infectious causes produce very similar clinical presentations, and traditional infection markers do not always differentiate these two conditions. Both procalcitonin and neopterin have been suggested to aid in the early diagnosis of bacterial infections and in differentiating bacterial infections from systemic inflammatory, non-infectious diseases or from viral infections. METHODS: : Procalcitonin (PCT) and neopterin were analyzed in 208 ICU patients who developed acute fever or septic shock. Blood samples were taken every 8th h within 48 h of the onset of fever or septic shock. RESULTS: : A total 162/208 of patients had infection, the most common location being the respiratory tract. Mortality was higher in infected patients (31.4% vs. 10.9%; P < 0.01). The optimum cut-off levels in identifying patients with infection of daily peak PCT were 0.8 microg/L on day 1 and 0.9 microg/L on day 2, and both sensitivity (67.7% and 60.9%, respectively) and specificity (47.8% and 63%) were poor. Accordingly, the optimum cut-off values of peak neopterin were 18 and 16 pg/L. The sensitivity was 62.7% on day 1 and 69.3% on day 2, while specificity was correspondingly 78.3% and 67.9%. There were no significant differences between the markers in discriminating between patients with infection or inflammation. Both PCT and neopterin increased with the severity of infection. They were higher in non-survivors. CONCLUSION: : PCT and neopterin were equally effective, although not very accurate in differentiating between infection and inflammation in critically ill patients. Neopterin was more specific than PCT, suggesting that neopterin is related to the activity of inflammatory response.

Adult↗
PubMed2002

Factors related to non-compliance with antihypertensive drug therapy.

The objectives were to study the associations of perceived health care-related and patient-related factors with self-reported noncompliance with antihypertensive treatment. General practitioners identified all of their hypertensive patients in 26 health centres during 1 week in 1996 (n = 2219). A total of 1782 (80%) patients participated in the study, of whom 1561 were on antihypertensive medication. Based on 82 opinion statements in two questionnaires, 14 problem indices were formed by using factor analysis. Out of these, summary variables concerning problems related to the health care system and the patients were formed. Logistic regression models, including interaction analyses, were used to study the associations with non-compliance. The results were that the majority of patients had at least one perceived health care system-related (88%) and patient-related problem (92%). A high number of both perceived health care system-related problems (adjusted OR 4.77; 95% CI 2.76, 8.26) and patient-related problems (adjusted OR 3.23; 95% CI 1.79, 5.81) were associated with self-reported non-compliance. The experience of adverse drug effects was also associated with non-compliance (adjusted OR 1.41; 95% CI 1.03, 1.94). In conclusion self-reported non-compliance was associated with multiple risks of both perceived health care system-related and patient-related problems.

Aged↗
PubMed2002

Janus faces of the white coat effect: blood pressure not only rises, it may also fall.

For reliable control of hypertension, it is essential to know the prevalence of the white coat effect (WCE), which is defined as either a difference of 10 mmHg or more in systolic blood pressure (BP) and/or a difference of 5 mmHg or more in diastolic BP measured by a general practitioner (GP), a nurse, or the patient him/herself. The objective was to assess the WCE in hypertensive patients visiting GPs in primary healthcare centres. A blinded, randomised study in six primary healthcare centres was conducted, where eight GPs, nine nurses and 210 patients (92 men and 118 women) on a hypertension control regimen participated. Heart rate and BP in GPs', nurses' and self-service rooms were measured twice using a sphygmomanometer and an automatic device. Altogether, 148 patients (70%) performed the self-measurements of BP and heart rate perfectly successfully in all the three rooms. These were included in the final analyses. One out of three patients (33%) showed a marked alerting WCE in the GP's room (systolic BP rose by at least 10 mmHg and/or diastolic BP by at least 5 mmHg). On the contrary, one out of 10 (10%) showed a marked relaxing WCE in the GP's room (systolic BP decreased by at least 10 mmHg and/or diastolic BP by at least 5 mmHg). It can be concluded that the WCE in general practice has two faces: an alerting reaction and a relaxing reaction. This should be taken into account in hypertension control.

Adult↗
PubMed2002

Increased hepatosplanchnic inflammation precedes the development of organ dysfunction after elective high-risk surgery.

This study investigated the relationship of the hepatosplanchnic production and uptake of inflammatory mediators, hepatosplanchnic perfusion, and outcome during major abdominal surgery to evaluate the hypothesis that regional production of inflammatory mediators precedes the development of hepatic dysfunction. This retrospective analysis of data and blood samples collected during a randomized controlled clinical trial included high-risk surgical patients undergoing major abdominal surgery in a 24-bed university-afilliated intensive care unit. Patients were divided into a subgroup that developed hepatic dysfunction (HD+) postoperatively and a subgroup without hepatic dysfunction (HD-). Hepatic vein and arterial plasma levels of IL-6, IL-8, s-E-selectin, s-ICAM-1, and the TNF-receptors 55 and 75 were measured, and the flux was calculated by multiplying the difference in hepatic vein minus arterial levels of the mediators by the hepatosplanchnic flow. Systemic (thermodilution) and total hepatosplanchnic blood flow (using indocyanine green [ICG]-dilution method) and gastric intramucosal pH (pHi) were assessed preoperatively, 4, 24, and 36 h postoperatively. Of a total of 26 patients, 6 patients developed hepatic dysfunction after their abdominal surgery (mean 6 days postoperatively). The number of sepsis-related deaths and postoperative days on the ventilator were significantly higher in this group. A higher production of IL-8, TNF-receptor-75 and 55 in the hepatosplanchnic area in the HD+ subgroups was found, which preceded the development of organ dysfunction (P = 0.04, P = 0.02, and P = 0.02, respectively). Moreover, the uptake of s-ICAM-1 was significantly increased in this subgroup. Furthermore, total hepatosplanchnic blood flow was significantly higher and pHi was significantly lower in the HD+ group, whereas global hemodynamic data were similar in the two subgroups. In conclusion, the development of postoperative organ dysfunction is preceded by an increased regional inflammatory response, indicated by an increased soluble TNF-receptor shedding and IL-8 production from the hepatosplanchnic area together with an increased uptake of s-ICAM-1. Moreover, an increased total hepatosplanchnic blood flow with intramucosal acidosis was associated with this regional inflammatory response.

Aged↗
PubMed2001

Effect of an acute increase in PCO2 on splanchnic perfusion and metabolism.

OBJECTIVES: To evaluate the acute effects of an increase in PCO2 on splanchnic tissue perfusion and metabolism. DESIGN: Clinical prospective study in the intensive care unit in a university clinic. PATIENTS: Six patients with severe acute lung injury requiring mechanical ventilation. All patients had bilateral infiltrates on chest radiography, a PaO2/FIO2 ratio less than 200 mmHg, and stable hemodynamics without vasoactive drugs. INTERVENTIONS: PCO2 was increased 5-20% by an added dead space from baseline, followed by a return to baseline. MEASUREMENTS AND RESULTS: Splanchnic blood flow was measured using primed continuous infusion of indocyanine green dye with hepatic venous sampling and systemic hemodynamics by routine monitoring; we also determined the gastric mucosal-arterial PCO2 difference and splanchnic lactate/pyruvate exchange. PCO2 was increased by an added dead space; after 60 min all measurements were repeated; after return to baseline a third measurement followed. The increase in PCO2 had no significant effect on splanchnic blood flow or indices of perfusion and metabolism. CONCLUSION: Our results suggest that acute moderate changes in PCO2 have no major effect on splanchnic perfusion and metabolism.

Adolescent↗
PubMed2001

Non-occlusive small bowel necrosis during gastric tube feeding: a case report.

Small bowel necrosis is known as a rare, but serious complication of jejunal tube feeding. We report a case of non-occlusive small bowel necrosis with gastric tube feeding. The patient had a moderate multiple trauma with head injury. Abdominal distension developed after several days of uneventful nasogastric tube feeding. At laparotomy patchy necrosis of the small bowel was found without signs of bowel obstruction or impaired mesenteric perfusion. The patient recovered after a prolonged ICU stay. In this case the large doses of clonidine, given due to an alcohol withdrawal syndrome, were suspected to be a major contributing factor to the development of the small bowel necrosis by impairing gut motility and mucosal perfusion. We conclude that, first, small bowel necrosis can occur after primarily uneventful enteral feeding, even with gastric feeding; second, clonidine can dramatically impair gastrointestinal function in critically ill patients by impairing gut motility and mucosal perfusion.

Adrenergic alpha-Agonists↗
PubMed2001

Gastric tonometry after subarachnoid hemorrhage.

OBJECTIVE: To evaluate splanchnic tissue perfusion, assessed by gastric tonometry, in patients with subarachnoid hemorrhage (SAH) and to study the effect of treatment, either surgical or endovascular, and the severity of initial SAH on splanchnic tissue perfusion. DESIGN: Prospective observational substudy, part of a randomised controlled trial of early treatment of ruptured intracranial aneurysms. SETTING: Intensive care unit (ICU) of a university hospital. PATIENTS: A consecutive sample of 26 patients [13 surgical (7/6 Hunt & Hess Grade I-II/H & H Gr IV-V) and 13 endovascular (3/10 H & H Gr I-II/H & H Gr IV-V)] out of 56 SAH patients randomly assigned to either endovascular or surgical treatment during the substudy period between 1 May 1995 and 31 August 1996. All patients were treated within 72 h after SAH. MEASUREMENTS AND RESULTS: After treatment of a ruptured aneurysm, hemodynamics and gastric intramucosal pCO2 were measured during the first 4 h and between 6 h and 12 h after aneurysm treatment. In the whole sample, neither the gastric intramucosal-arterial pCO2 difference (pCO2 gap) (1.5+/-1.9 kPa and 1.7+/-1.2 kPa, NS) nor gastric intramucosal pH (7.28+/-0.12 and 7.29+/-0.08, NS) changed during the study. There were no differences in pCO2 gap or gastric intramucosal pH between treatment groups or Hunt & Hess grade groups during the study period. CONCLUSIONS: Splanchnic tissue perfusion may be insufficient even though there is no systemic hemodynamic disturbance in patients after SAH. Neither the therapeutic treatment nor pre-treatment Hunt & Hess grade is associated with a specific pattern of pCO2 gap.

Aged↗