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Lange, Neale; Schuster, Daniel P.

doi:10.1186/cc342

Cited by 80 publications

(29 citation statements)

References 47 publications

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“…PVPI and ELWI in DLR and DLR/ULI groups were significantly higher than those in ILR and ILR/ULI groups at 6 hours after injury when DLR and DLR/ULI groups were not given fluid resuscitation. It is possible that ELWI and PVPI are overestimated by PiCCO system because of hypovolemia which is one of the limitations of PiCCO system [43]. …”

Section: Discussionmentioning

confidence: 99%

Ulinastatin Suppresses Burn-Induced Lipid Peroxidation and Reduces Fluid Requirements in a Swine Model

Luo¹,

Du²,

Lin³

et al. 2013

Oxidative Medicine and Cellular Longevity

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Objective. Lipid peroxidation plays a critical role in burn-induced plasma leakage, and ulinastatin has been reported to reduce lipid peroxidation in various models. This study aims to examine whether ulinastatin reduces fluid requirements through inhibition of lipid peroxidation in a swine burn model. Methods. Forty miniature swine were subjected to 40% TBSA burns and were randomly allocated to the following four groups: immediate lactated Ringer's resuscitation (ILR), immediate LR containing ulinastatin (ILR/ULI), delayed LR resuscitation (DLR), and delayed LR containing ulinastatin (DLR/ULI). Hemodynamic variables, net fluid accumulation, and plasma thiobarbituric acid reactive substances (TBARS) concentrations were measured. Heart, liver, lung, skeletal muscle, and ileum were harvested at 48 hours after burn for evaluation of TBARS concentrations, activities of antioxidant enzymes, and tissue water content. Results. Ulinastatin significantly reduced pulmonary vascular permeability index (PVPI) and extravascular lung water index (ELWI), net fluid accumulation, and water content of heart, lung, and ileum in both immediate or delayed resuscitation groups. Furthermore, ulinastatin infusion significantly reduced plasma and tissue concentrations of TBARS in both immediate or delayed resuscitation groups. Conclusions. These results indicate that ulinastatin can reduce fluid requirements through inhibition of lipid peroxidation.

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Section: Discussionmentioning

confidence: 99%

Ulinastatin Suppresses Burn-Induced Lipid Peroxidation and Reduces Fluid Requirements in a Swine Model

Luo¹,

Du²,

Lin³

et al. 2013

Oxidative Medicine and Cellular Longevity

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“…Other methods are thus required to measure EVLW directly. The gold standard is gravimetry [ 15 ]. This ex vivo method consists in measuring the difference in the weight of the lungs before and after they have been dried out.…”

Section: How To Measure Evlw?mentioning

confidence: 99%

“…EVLW can be estimated by computed tomography [ 16 ] or magnetic resonance imaging [ 15 ], but such techniques are not appropriate for convenient and repeated assessment. Isotopic methods [ 17 ] can only be used for research and electrical impedance tomography [ 18 ] is currently not sufficiently validated.…”

Section: How To Measure Evlw?mentioning

confidence: 99%

Extravascular lung water in critical care: recent advances and clinical applications

Jozwiak

Teboul

Monnet

2015

Ann. Intensive Care

165

121

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Extravascular lung water (EVLW) is the amount of fluid that is accumulated in the interstitial and alveolar spaces. In lung oedema, EVLW increases either because of increased lung permeability or because of increased hydrostatic pressure in the pulmonary capillaries, or both. Increased EVLW is always potentially life-threatening, mainly because it impairs gas exchange and reduces lung compliance. The only technique that provides an easy measurement of EVLW at the bedside is transpulmonary thermodilution. The validation of EVLW measurements by thermodilution was based on studies showing reasonable correlations with gravimetry or thermo-dye dilution in experimental and clinical studies. EVLW should be indexed to predicted body weight. This indexation reduces the proportion of ARDS patients for whom EVLW is in the normal range. Compared to non-indexed EVLW, indexed EVLW (EVLWI) is better correlated with the lung injury score and the oxygenation and it is a better predictor of mortality of patients with acute lung injury or acute respiratory distress syndrome (ARDS). Transpulmonary thermodilution also provides the pulmonary vascular permeability index (PVPI), which is an indirect reflection of the integrity of the alveolocapillary barrier. As clinical applications, EVLWI and PVPI may be useful to guide fluid management of patients at risk of fluid overload, as during septic shock and ARDS. High EVLWI and PVPI values predict mortality in several categories of critically ill patients, especially during ARDS. Thus, fluid administration should be limited when EVLWI is already high. Whatever the value of EVLWI, PVPI may indicate that fluid administration is particularly at risk of aggravating lung oedema. In the acute phase of haemodynamic resuscitation during septic shock and ARDS, high EVLWI and PVPI values may warn of the risk of fluid overload and prevent excessive volume expansion. At the post-resuscitation phase, they may prompt initiation of fluid removal thereby achieving a negative fluid balance.

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“…Normal values are 5 to 7 mL/kg (indexed to predicted body weight), and quantities above 10 mL/kg are associated with adverse clinical outcomes [33]. …”

Section: Monitoring Systemsmentioning

confidence: 99%

Clinical review: Respiratory monitoring in the ICU - a consensus of 16

et al. 2012

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Monitoring plays an important role in the current management of patients with acute respiratory failure but sometimes lacks definition regarding which 'signals' and 'derived variables' should be prioritized as well as specifics related to timing (continuous versus intermittent) and modality (static versus dynamic). Many new techniques of respiratory monitoring have been made available for clinical use recently, but their place is not always well defined. Appropriate use of available monitoring techniques and correct interpretation of the data provided can help improve our understanding of the disease processes involved and the effects of clinical interventions. In this consensus paper, we provide an overview of the important parameters that can and should be monitored in the critically ill patient with respiratory failure and discuss how the data provided can impact on clinical management.

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Untitled

Cited by 80 publications

References 47 publications

Ulinastatin Suppresses Burn-Induced Lipid Peroxidation and Reduces Fluid Requirements in a Swine Model

Ulinastatin Suppresses Burn-Induced Lipid Peroxidation and Reduces Fluid Requirements in a Swine Model

Extravascular lung water in critical care: recent advances and clinical applications

Clinical review: Respiratory monitoring in the ICU - a consensus of 16

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