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R Bellomo

Publications and source records attributed to R Bellomo.

At least 37 records · Page 2Linked to original sources
PubMed2005

Extracorporeal blood treatment (EBT) methods in SIRS/Sepsis.

BACKGROUND: Extracorporeal blood purification treatment (EBT) methods have been used in the treatment of experimental and human SIRS/Sepsis in a variety of settings and with variable reports of efficacy and safety. Their role in the management of SIRS/Sepsis remains controversial. OBJECTIVES: To develop consensus statements regarding important aspects of research, practice and technical management concerning EBT. METHODS: Systematic review of published study. Evidence-based grading of information available. Consensus development regarding fundamental questions about EBT. RESULTS: Consensus was achieved on all questions posed during the conference. It was agreed that there is currently a clear biological rational for EBT in SIRS and Sepsis. It was agreed that conventional CVVH has sufficiently been shown not to be effective in SIRS/Sepsis in the absence of concomitant ARF and that other therapies such as plasmapheresis or high-volume hemofiltration or coupled plasma filtration adsorption appear more promising and should be tested in multicentre randomized controlled trials. Patients with ARF and SIRS/Sepsis should be treated differently from those with ARF alone even though current practice in this field is not well known. Patients with refractory septic shock should be considered for EBT. Appropriate end points for clinical trials can be defined and chosen according to the goals of the trial. Different technologies exist for EBT and better understanding of the merits and safety of each is needed as well as better standardization of methodology and dose. CONCLUSIONS: Broad consensus can be achieved on several aspects of EBT and can be used to inform clinical practice and to help guide the establishment of a future research agenda.

Acute Kidney Injury↗
PubMed2005

Management of fluid balance in CRRT: a technical approach.

BACKGROUND: The possibility of making fluid balance errors during continuous renal replacement therapy has been identified since the beginning of this modality of treatment. The advent of automated machines has partially overcome this problem. Nevertheless, there are conditions and operation modes in which the potential for fluid balance errors is still present. OBJECTIVE: To analyse fluid balance management in CRRT therapies across a range of currently marketed machine. METHODS: The tests were conducted in vitro, utilizing saline solution for the blood circuit and regular dialysate/reinfusate for the dialysate/reinfusion circuit. The methodology used was based on the voluntary creation of a fluid balance error by altering the correct flow in the circuit of the different machines. Subsequently, the time for alarm occurrence and the threshold value for fluid balance error was evaluated. The alarm was overridden and the overall fluid error allowed by the machine was evaluated. Each machine was tested in conditions of different dialysate/filtrate flow rates and in different simulated treatment modalities. RESULTS: Fluid balance errors can be easily avoided not only by a correct and careful adherence to the protocols of use of the current CRRT machines, but also by the compliance to prescriptions and programmed controls during therapy. Most importantly, if an alarm appears on the machine, one can try to override it without major problems; major problems may occur when multiple override commands are operated without identifying the problem and solving it adequately. CONCLUSION: Machines seem to be designed with adequate safety features and accurate alarm systems. However, features and alarms can be manipulated by operators creating the opportunity for serious error. Physicians and nurses involved in prescription and delivery of CRRT should have precise protocols and defined procedures in relation to machine alarms to prevent major clinical problems.

Acute Kidney Injury↗
PubMed2005

Plasma acid-base changes in chronic renal failure: a Stewart analysis.

The bicarbonate centered approach to acid-base physiology involves complex explanations for the metabolic acidosis associated with chronic renal failure. We used the alternate Stewart approach to acid-base physiology to quantify the acid-base chemistry of patients with chronic renal failure. We examined the plasma and urine chemistry of 19 patients with chronic renal failure who were predialysis and 20 healthy volunteers. We compared the plasma strong-ion-difference due to sodium,potassium,and chloride ions as well as the weak acids albumin and phosphate. We used a simplified Fencl-Stewart approach to quantify the effects of sodium-chloride, albumin, and unmeasured ions on base-excess. The chronic renal failure group had a greater metabolic acidosis, with a base-excess that differed from the healthy group by a mean of -2.7 mmol/L, p = 0.04. This was associated with a strong ion acidosis due to both increased chloride and decreased sodium. The anion gap, strong-ion-gap, and base-excess effect of unmeasured ions were similar in both groups suggesting that unmeasured ions had only a minor role in the acid-base status in this group of patients.

Acid-Base Equilibrium↗
PubMed2005

A comparison of two citrate anticoagulation regimens for continuous veno-venous hemofiltration.

AIMS: To assess the safety and efficacy of two different commercial citrate containing pre-filter replacement fluids during continuous veno-venous hemofiltration (CVVH) in patients with frequent filter clotting. SETTING: Four intensive care units. PATIENTS: Sixty-three critically ill patients with acute renal failure (ARF). DESIGN: Prospective observational study. METHODS: We used a commercial citrate fluid (citrate: 11 mmol/L -fluid A) as predilution replacement for CVVH. We then changed to a new commercial citrate fluid (citrate: 14 mmol/L-fluid B) as replacement fluid and performed statistical comparisons. Replacement fluid rate was fixed at 2,000 ml/hour. RESULTS: Filter life was 12.2 hour with fluid A compared with 17.1 hour with fluid B on average (p=0.0001). Mean post filter ionized calcium concentration was 0.52 mmol/L with fluid A compared with 0.40 mmol/L with fluid B (p<0.0001). Citrate intolerance led to cessation of treatment in one patient with fluid A and one patient with fluid B. Overall ionized calcium levels were higher (A: 1.18 vs B: 1.13 mmol/L; p<0.0001) and bicarbonate was lower (A: 22.4 vs B: 24.5 mmol/L; p<0.0001) during treatment with fluid A. Alkalemia was seen in 10 patients treated with fluid A and 16 patients treated with fluid B (NS). CONCLUSIONS: We have developed a simple approach to regional citrate anticoagulation for CVVH using a commercial citrate-containing fluid as replacement fluid. Increasing citrate concentration from 11 to 14 mmol/L increased filter life while maintaining relative safety and simplicity.

Acute Kidney Injury↗
PubMed2005

A pilot study of pulse contour cardiac output monitoring in patients with septic shock.

OBJECTIVE: To assess the relationship between PiCCO-derived signals and conventional measures of pre-load and gas exchange in patients with septic shock. METHODS: Prospective observational study of 23 patients with septic shock. Scheduled collection of clinical, conventional haemodynamic and PiCCO derived variables. Statistical analysis of correlations. RESULTS: Patients had a mean SAPS II score of 53.5 +/- 14.5 with 78.3% on mechanical ventilation at PiCCO insertion. PiCCO monitoring lasted a mean of 4.3 +/- 2.9 days. SAPS II predicted 28-day mortality was 54.2%, while actual mortality was 39.1%. At PiCCO insertion, there was an inverse correlation between cardiac (CI) and extravascular lung water index (EVLWI) (r = -0.442; p < 0.05). During treatment, the most significant correlation was between the PiCCO-derived global end-diastolic volume index (GEDVI) and PaO(2)/F(I)O(2) ratio (r = 0.386; p < 0.01). There was also a correlation between changes in GEDVI and changes in CI (r = 0.329; p < 0.01). Increases in EVLWI correlated with decreases in PaO(2)/F(I)O(2) ratio( )(r = -0.332; p < 0.01). CONCLUSIONS: PiCCO-derived pre-load and extravascular lung water signals show logical associations with conventional indirect indicators of haemodynamic and fluid status suggesting physiological and clinical relevance.

Journal Article↗
PubMed2005

A before and after trial of the effect of a high-dependency unit on post-operative morbidity and mortality.

OBJECTIVE: It has been suggested that the availability of a high-dependency unit (HDU), to facilitate graded admission to, and discharge from, an intensive care unit (ICU), might decrease post-operative morbidity. We wished to determine whether the addition of a 4-bed HDU to a tertiary 17-bed ICU facility at a University-affiliated hospital would decrease post-operative morbidity and mortality. PATIENTS AND METHODS: A prospective controlled before-and-after trial was performed with the opening of a 4-bed HDU. Consecutive patients admitted to hospital for major surgery during a 4-month control (pre-HDU) phase and during a 4-month intervention (HDU) phase were studied for the incidence of serious adverse events (SAEs), mortality after major surgery and mean duration of hospital stay. RESULTS: There were 1319 operations performed in 1125 patients during the pre-HDU period and 1369 operations performed in 1127 patients during the HDU period. During the HDU period there was an excess in unscheduled surgery cases (674 during HDU vs. 531 during the pre-HDU period; p < 0.0001). In the pre-HDU period, there were 414 SAEs in 190 patients compared with 456 SAEs in 209 patients during the HDU period (NS). There were no significant changes in any of the individual SAEs measured except for the incidence of post-operative acute pulmonary edema, which increased from 19 cases to 46 during the HDU period (p = 0.028). This increase was associated with a greater number of patients requiring re-intubation (52 vs. 75 cases; p = 0.044). The introduction of an HDU had no effect on mortality (80 deaths vs. 76; NS) and failed to reduce mean hospital length of stay (21.8 vs. 24 days; NS). CONCLUSIONS: The introduction of a 4-bed HDU in a teaching hospital was associated with a marked increase in unscheduled surgery and failed to reduce the incidence of post-operative SAEs, post-operative mortality, and mean duration of hospital stay.

Journal Article↗
PubMed2004

Strong ions, weak acids and base excess: a simplified Fencl-Stewart approach to clinical acid-base disorders.

BACKGROUND: The Fencl-Stewart approach to acid-base disorders uses five equations of varying complexity to estimate the base excess effects of the important components: the strong ion difference (sodium and chloride), the total weak acid concentration (albumin) and unmeasured ions. Although this approach is straightforward, most people would need a calculator to use the equations. We proposed four simpler equations that require only mental arithmetic and tested the hypothesis that these simpler equations would have good agreement with more complex Fencl-Stewart equations. METHODS: We reduced two complex equations for the sodium-chloride effect on base excess to one simple equation: sodium-chloride effect (meq litre(-1))=[Na(+)]-[Cl(-)]-38. We simplified the equation of the albumin effect on base excess to an equation with two constants: albumin effect (meq litre(-1))=0.25x(42-[albumin]g litre(-1)). Using 300 blood samples from critically ill patients, we examined the agreement between the more complex Fencl-Stewart equations and our simplified versions with Bland-Altman analyses. RESULTS: The estimates of the sodium-chloride effect on base excess agreed well, with no bias and limits of agreement of -0.5 to 0.5 meq litre(-1). The albumin effect estimates required log transformation. The simplified estimate was, on average, 90% of the Fencl-Stewart estimate. The limits of agreement for this percentage were 82-98%. CONCLUSIONS: The simplified equations agree well with the previous, more complex equations. Our findings suggest a useful, simple way to use the Fencl-Stewart approach to analyse acid-base disorders in clinical practice.

Acid-Base Imbalance↗
PubMed2004

Ultrafiltration in patients with hypervolemia and congestive heart failure.

Fluid overload may occur in patients with myocardial dysfunction and different clinical problems. Myocoardial dysfunction may be a consequence of heart dilatation with reduced contractility, ventricular stiffness with diastolic dysfunction or the consequence of myocardial injury or circulating myocardial depressant factors as seen in sepsis. In all cases, cardiac support can be achieved by the optimization of fluid balance, the reduction in organ edema and the restoration of desirable levels of pre- and afterload. Several reports have shown that myocardial elastance can improve after hemofiltration with restoration of adequate fluid balance. In such conditions, continuous extracorporeal therapy may result in remarkable cardiovascular stability with maintenance of hemodynamic parameters, including mean arterial pressure, heart rate and systemic vascular resistance. Such stability, which is achieved through the slow continuous ultrafiltration and continuous refilling of the intravascular volume from the interstitium, enables the stability of the circulating blood volume and the preservation of organ perfusion. This is also crucial for renal recovery during acute renal failure.

Blood Volume↗
PubMed2004

Super high flux hemodialysis at high dialysate flows: an ex vivo assessment.

BACKGROUND AND OBJECTIVES: The removal of cytokines by standard hemofiltration is limited. Super high flux membranes may significantly improve removal even when used in dialysis mode. We sought to measure cytokine clearance using a large surface super high-flux membrane and a standard hemodialysis setting. SETTING: ICU laboratory of a tertiary institution. SUBJECTS: Six healthy volunteers. METHODS: Blood form healthy volunteers was incubated for 4 hours with E. coli endotoxin to stimulate cytokine production. Cytokine containing blood was then circulated through a dialysis circuit at 3 different dialysate flow rates. Blood and dialysate were sampled for cytokine and albumin measurements and calculation of clearances. RESULTS: Super high-flux dialysis achieved high median cytokine clearances (IL-1 clearance of 106 ml/min, IL-6 clearance of 66.8 ml/min, IL-8 clearance of 61.7 ml/min and TNF clearance of 36.1 ml/min). Increasing dialysate flow rate from 300 to 500 ml/min did not significantly increase cytokine clearances. Albumin clearances however were between 2.7 and 5.4 ml/min. CONCLUSIONS: Cytokine dialysis is feasible at high dialysate flow rates yielding high cytokine clearances. Albumin loss, however, is appreciable and may require separate supplementation in the clinical setting.

Albumins↗
PubMed2004

Prolonged daily intermittent renal replacement therapy in ICU patients by ICU nurses and ICU physicians.

OBJECTIVES: Prolonged daily intermittent renal replacement therapy (PDIRRT) has been proposed as a new form of treatment for severe acute renal failure (ARF). However, this treatment has so far implied a) full dependence on nephrological input, b) lack of any convective clearance and c) limited purification of dialysate water. The aim of this study was to establish the feasibility and safety of performing PDIRRT in the ICU with a) no nephrological input, b) the addition of some convective clearance with on-line fluid replacement and c) a new advanced water purification system. DESIGN: Prospective observational study. PATIENTS: Fourteen patients treated with PDIRRT. SETTING: ICU of tertiary institution. INTERVENTIONS: Treatment of patients with severe ARF and critical illness with PDIRRT. Prescription of treatment by ICU physicians. Conduct of treatment by ICU nurses. Use of combined convective and diffusive therapy with on-line generation of fluid replacement, application of a double-filtration water purification system. MEASUREMENTS AND MAIN RESULTS: We prospectively collected demographic, biochemical, hemodynamic and clinical data in 14 patients, who received 30 PDIRRT treatments for a cumulative treatment time of 205.4 hours. The mean age was 57.9 +/- 16.0. Eight patients were male and 6 female. Their mean APACHE II score was 24.6 +/- 5.9 and their SAPS II score was 41.7 +/- 18.8. PDIRRT was used after at least 24 hours of initial stabilization with continuous veno-venous hemofiltration (CVVH). Blood flow was kept at 100 ml/min dialysate flow at 200 ml/min and convective clearance varied from 21 ml/min to 33 ml/min. All patients were either anuric or oliguric (UO < 400 ml/day). Ten patients were on mechanical ventilation and 11 patients on vasopressor support. Mean treatment session time was 6.9 +/- 1.8 hours. The mean pre-PDIRRT urea was 19.2 +/- 6.9 mmol/L and the creatinine was 274 +/- 116 micromol/L. The mean pre-PDIRRT lactate was 2.95 +/- 2.24 mmol/L. Following treatment, all had significantly decreased to 13.2 +/- 6.3 mmol/L, 215 +/- 95 micromol/L and 2.25 +/- 1.61 mmol/L, respectively (p=<0.0001, <0.0001, <0.05). Bicarbonate levels remained stable during treatment (23.0 +/- 3.8 mmol/L to 23.1 +/- 2.5 mmol/L). Mean norepinephrine dose changed from 8.8 +/- 11.9 microg/min to 12.9 +/- 27.0 microg/min after treatment (NS). There were no complications of therapy. Patient ICU survival was 71.4%. CONCLUSIONS: PDIRRT with combined diffusive and convective clearance is an efficacious form of renal replacement, which can be safely and effectively conducted by ICU nurses following prescription by ICU physicians without any nephrological involvement and with adequate double filtration water purification.

Acute Kidney Injury↗
PubMed2004

Cytokine removal during continuous renal replacement therapy: an ex vivo comparison of convection and diffusion.

BACKGROUND AND OBJECTIVES: It is unknown whether cytokine adsorption to the membrane during continuous renal replacement therapy is affected by the technique. Such knowledge might affect the choice of technique in vivo. Accordingly, we conducted an ex vivo study to test whether continuous veno-venous hemofiltration (CVVH) or continuous veno-venous hemodialysis (CVVHD) affect cytokine adsorption differently. SETTING: Laboratory attached to the Intensive Care Unit of a tertiary hospital. DESIGN: Six healthy human volunteers donated blood, which was incubated with endotoxin. Control blood was left at room temperature, and treatment blood was recirculated for eight hours through closed circuits using polyacrylonitrile membranes (AN69). The effect of CVVH and CVVHD on cytokine removal from the circuits was compared. MEASUREMENTS: The concentrations of interleukins (IL)-1beta, 6, 8, 10 and TNF were measured in the control samples, pre-and post-filter and in the effluent at baseline and hourly thereafter. The clearances by adsorption, and filtration were calculated. RESULTS: Control cytokine concentrations remained the same or increased slightly. Adsorption was the major mechanism of removal for all cytokines with the exception of IL-1beta, but the effect was short-lived. Peak adsorption generally occurred at baseline before the start of CVVH and CVVHD, with clearances ranging from 43.7 ml/min (for IL-8) to 7.6 ml/min (for IL-10). The time-weighted average total clearances during CVVH were 23.3, 4.3, 3.8, -2.0, and 15 ml/min for IL-8, IL-1beta, TNF, IL-6, and IL-10 respectively. The corresponding clearances during CVVHD were 19.0, 10.7, 2.7, 2.4, and 0.3 ml/min. IL-10 clearances were greater during CVVH than CVVHD (p=0.03). Non adsorptive CVVH clearance of IL-1beta was greater than CVVHD clearance, but this advantage was outweighed by an increased tendency of the membrane to release IL-1beta into the circuit during HF. CONCLUSIONS: The technique of solute removal had only a minor effect on the magnitude of cytokine adsorption, and neither technique had the advantage for all the measured cytokines.

Adsorption↗
PubMed2004

First clinical trial for a new CRRT machine: the Prismaflex.

A new CRRT machine has been designed to fulfill the expectations of nephrologists and intensivists operating in the common ground of critical care nephrology. The new equipment is called "Prismaflex" (Gambro-Dasco, Mirandola, Modena) and it is the natural evolution of the Prisma machine that has been utilized worldwide for CRRT in the last decade. We performed a preliminary "alfa trial" to establish usability, flexibility and realiability of the new device. Accuracy was also tested by recording various operational parameters during different intermittent and continuous renal replacement modalities. Forty-one runs were conducted on 13 patients and the difference between delivered and prescribed parameters was always lower than 2%. We concluded that the new Prismaflex is a well designed new machine for CRRT and can be safely and effectively utilized in the critical care nephrology setting.

Acute Kidney Injury↗
PubMed2004

Kidney failure associated with liver transplantation or liver failure: the impact of continuous veno-venous hemofiltration.

BACKGROUND AND AIMS: The short-term outcome of critically ill patients with kidney failure combined with severe liver failure or orthotopic liver transplantation (OLTx) is poor. We sought to test the hypothesis that, with the exclusive use of continuous veno-venous hemofilration (CVVH) with minimal heparin-anticoagulation, the short and long-term outcomes of these patients would be improved. PATIENTS: Sixty-six consecutive patients with combined liver and kidney failure SETTING: Intensive Care Unit of tertiary hospital DESIGN: Retrospective interrogation of prospectively collected databases INTERVENTION: Treatment of all patients with continuous veno-venous hemofiltration (CVVH) by protocol with 2L/h of ultrafiltration rate and minimal use of circuit heparinization. Retrieval of specific information on demographic, clinical, therapeutic and outcome details. MEASUREMENTS AND MAIN RESULTS: From July 1995 to April 2004, 66 patients with combined liver and renal failure received continuous veno-venous hemofiltration (CVVH). Of these, 26 received liver transplantation and 40 did not. There were no significant differences in age, APACHE II score, bilirubin, ALT, INR or albumin on admission. The average duration of CVVH was 9.5 days for OLTx patients and 5 days for non-transplanted patients (p=0.013). Heparin anticoagulation was used in only 12% of OLTx patients and 20% of non-transplanted patients. ICU mortality was 15% in OLTx patients and 63% in non-transplanted patients (p<0.0005); hospital mortality was 23% compared to 70% (p<0. 001). Mean survival time at follow up was 1,120 days compared to 358 days (p<0.0001). CONCLUSIONS: ARF associated with OLTx has a much better outcome than ARF without OLTx. Furthermore, management based on a conservative anticoagulation policy and CVVH as the exclusive form of renal support was associated with the best ICU, hospital and long term survival reported so far.

Cause of Death↗
PubMed2004

A pilot study of the effect of altering airway pressure on systolic pulse pressure variation in the systemic and pulmonary arterial circulations.

OBJECTIVE: Systolic pressure variation results from cyclical fluctuation in the intra-thoracic pressure associated with mechanical ventilation and has been used as a measure of relative hypovolemia in mechanically ventilated patients. The impact of the magnitude of the tidal volume and airway pressure on systolic pressure variation, however, has not been examined in mechanically ventilated patients. METHODS: Two patients underwent monitoring following elective cardiac surgery. Tidal volume was randomly varied between 3 and 11 mL/kg over a two minute interval, and the corresponding airway pressure was monitored, as were the effects on the systolic pressure variation of the systemic and pulmonary circulations. RESULTS: There was a strong correlation between increasing tidal volume and peak airway pressure (p<0.0001). In addition, peak airway pressure strongly correlated with the systolic pressure variation of both the systemic and pulmonary circulations (p<0.0001). The increase in diastolic pulmonary arterial pressure induced by insufflation correlated well with the associated increase in systolic blood pressure (p<0.0001). Similarly, the increase in systolic pulmonary artery pressure (PAP) correlated with the associated decrease in systolic blood pressure induced by insufflation (p<0.0001). CONCLUSIONS: Systolic pressure variation in the systemic and pulmonary circulations is affected by tidal volume and peak airway pressure. This should be considered when using systolic pressure variation as a marker of intravascular volume status. Our findings regarding the correlations between changes in the pulmonary arterial pressure and the systemic arterial pressure induced by mechanical ventilation are consistent with the proposed physiological mechanisms of systolic pressure variation.

Journal Article↗
PubMed2004

A rapid intravenous phosphate replacement protocol for critically ill patients.

OBJECTIVE: There is a high incidence of hypophosphataemia in the critically ill. It is known that even moderate hypophosphataemia can produce a variety of adverse consequences. Many phosphate replacement regimens have been suggested, most are conservative and few validated in the critical care environment. We designed a study to determine the apparent volume of distribution of phosphate and quantify phosphate loss in critically ill patients following rapid phosphate infusion. With these data we sought to design a phosphate replacement protocol. METHODS: A prospective clinical study of an infusion of 14.5 mmol of phosphate ions over 1 hour in seven patients with mild, moderate or severe hypophosphataemia was performed. Serum phosphate, total calcium, ionised calcium, urea, creatinine, urinary phosphate excretion and creatinine clearance were measured prior to phosphate administration. Urinary phosphate excretion and creatinine clearance and serum phosphate levels were followed for 24 hours. RESULTS: The median phosphate increment was 0.65 mmol/L (0.17 - 0.85). The median initial volume of distribution was 0.45 L/kg (0.21 - 0.87). There was no reduction in ionised calcium or creatinine clearance. The renal phosphate threshold was reduced in all patients. CONCLUSIONS: The apparent volume of distribution of phosphate in this group of critically ill patients is large. Urinary phosphate losses contributed to the development of hypophosphataemia in these patients. In this patient cohort, there were no adverse effects from phosphate infusion of 14.5 mmol/hr. A rational protocol based on the estimated volume of distribution and estimated urinary losses can be developed to achieve the rapid and sustained correction of hypophosphataemia in such patients.

Journal Article↗
PubMed2004

Pseudo tamponade soon after cardiac surgery: a report of three cases.

OBJECTIVE: To describe a syndrome suggestive of tamponade but secondary to increased intra-thoracic pressure due to undetected dyssynchronous expiratory efforts in mechanically ventilated patients soon after cardiac surgery. METHODS: A retrospective chart review of three patients immediately after cardiac surgery. RESULTS: All patients developed the tetrad of decreased blood pressure, increased central venous pressure, decreased cardiac index and decreased urine output soon after cardiac surgery without other obvious reasons. In all patients, tamponade was suspected. In all cases, physical examination found no marked evidence of patient-ventilator dyssynchrony but evidence of abdominal muscle tensing and intermittent expiratory efforts not in synchrony with the ventilator cycle. In all patients, sedation and muscle relaxation led to a decrease in central venous pressure, improved blood pressure and improved cardiac index and urine output with full resolution of the syndrome. All patients were successfully extubated within 24 hours of surgery. CONCLUSIONS: In some postoperative cardiac surgery patients expiratory efforts which are not in synchrony with mechanical ventilation and not immediately obvious to clinicians or intensive care unit nurses can simulate tamponade. Greater awareness of this syndrome may decrease the chance of diagnostic error.

Journal Article↗