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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The single breath test for carbon dioxide (SBT-CO2) is the plot of expired FCO2 or CO2% against expired volume. It can be monitored during anaesthesia and in the intensive care unit with modest additions to generally available equipment. This paper describes some aspects of a computer program for presenting SBT-CO2 during controlled ventilation, in particular, the corrections to the primary data necessary for scientific accuracy. Examples are given of how the use of SBT-CO2 has increased our understanding of factors which influence the arterial-end-tidal PCO2 difference (PaCO2-PE,CO2). PaCO2-PE, CO2 is, in a given individual, usually dependent on tidal volume and frequency. Changes in lung volume and manoeuvres such as opening the pleura also affect gas exchange. Monitoring CO2 elimination gives a measure of metabolic rate if ventilation and pulmonary perfusion are maintained. This facilitates ventilatory therapy in situations where CO2 production is greatly increased, e.g. sepsis and tetanus. On the other hand, if metabolism and ventilation are unchanged, a reduction in CO2 elimination implies reduced pulmonary perfusion. This can be seen during increased right-left shunting, such as in surgery in patients with congenital heart disease.
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PMID:On-line expiratory CO2 monitoring. 309 79

Hypercapnia is a poorly investigated problem in the management of postoperative complications. In order to define the clinical implication of postoperative hypercapnia, hospital records of fifty patients, who had hypercapnia (PaCO2 greater than or equal to 45 torr) within 30 days after major laparotomy, were analyzed retrospectively. Patients with chronic pulmonary disease, prolonged apnea, additional thoracotomy and inadequate setting of ventilator were excluded. Results were as follows. 1. Thirty-two patients were hypercapnic before the 3rd postoperative day. These patients had various causes for hypercapnia, and clinical course and outcome were dependent on the underlying clinical problem. 2. Eighteen patients showed hypercapnia after the 4th postoperative day. In these patients, invasive infection was a common problem and 17 out of 18 patients died mainly of sepsis. 3. Sites of septic focus were mostly in the abdominal area (i.e., intraperitoneal, retroperitoneal and intrahepatic), and in most cases, hypercapnia preceded the establishment of diagnosis of septic focus or the recognition of other organ dysfunction. CO2 retention in the septic patients was due to the increased dead space ventilation by ventilation-perfusion maldistribution. Therefore, hypercapnia found after the 4th day following laparotomy seems to indicate potential intraabdominal sepsis and prompts the necessity for effective drainage.
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PMID:[Hypercapnia following major laparotomy--retrospective analysis of 50 cases]. 336 24

Twenty mechanically ventilated patients with acute renal failure were studied on 31 occasions to determine their energy expenditure (EE) during a 2 h period before a hemodialysis. Oxygen consumption and CO2 elimination were measured continuously with a mass spectrometer system. EE (1660 +/- 48 kcal day-1) was close to the total caloric intake (1682 +/- 83 kcal day-1) and represented 1.19 +/- 0.03 times the predicted resting energy expenditure (PREE) with large inter-individual variations (0.7-1.7 PREE). EE/PREE was higher when sepsis was present (1.31 +/- 0.03 versus 1.14 +/- 0.02; p less than 0.05). Glucose oxidation rate (4.35 mg kg-1 min-1) exceeded glucose intake (2.6 mg kg-1 min-1). Respiratory quotient was 1.02 +/- 0.01. Nitrogen loss was 17.3 +/- 1.7 g day-1 and nitrogen balance -11.9 +/- 1.9 g day-1. In conclusion, EE values were scattered but never exceeded 1.7 times the PREE. Sepsis increased EE. With a nutritional support covering EE, nitrogen balance remained markedly negative and a preferential utilisation of glucose and lipogenesis occurred.
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PMID:Energy expenditure in the acute renal failure patient mechanically ventilated. 366 74

The management of severe adult respiratory distress syndrome in critically injured patients requires the frequent measurement of arterial blood gases for adjustment of cardiovascular and ventilatory support. Since these require blood withdrawal and laboratory determinations, a noninvasive method of assessment of arterial gas tensions would permit more frequent assessment of the patient as well as permitting rapid changes in the patient's ventilatory status to be detected earlier in the clinical course. The role of transcutaneous O2 and CO2 tension in providing these measurements was evaluated in 92 studies in 38 critically ill patients with ARDS due to trauma and/or sepsis. All patients were normodynamic or hyperdynamic at the time of study (cardiac index 2.5 to 7.6 L/min/m2) and were intubated and on increased inspired oxygen fractions (FIO2 = 30 to 100%) delivered by mechanical ventilation, had a range of body temperature from 35.0 to 39.5 degrees C and pH from 7.29 to 7.57 The data from a transcutaneous O2 and CO2 sensor applied to the skin of the anterior thorax were analyzed by multiple regression analysis of variances. Prediction of the arterial oxygen tension (PaO2) from 52 to 253 torr was possible from regression-corrected measurements of the transcutaneous O2 (TcO2): [PaO2 = 1.1 (TcO2) - 0.28 (FIO2) + 45.5]. The arterial carbon dioxide tension (PaCO2) from 26 to 57 torr was predicted from the transcutaneous CO2 (TcCO2):[PaCO2 = 0.76 (TcCO2) + 0.06 (FIO2) + 0.035 (TcO2) + 4.1]. With these corrections, a noninvasive Respiratory Index was computed for assessing ARDS severity, and dynamic changes in arterial gases could be followed in response to postural changes, ventilatory alterations, or cardiovascular perturbations. These data suggest that a reasonable estimate of the arterial blood gases can be obtained from a regression-corrected measurement of the transcutaneous O2 and CO2 tensions in critically injured normodynamic or hyperdynamic ARDS patients.
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PMID:Prediction of arterial blood gases by transcutaneous O2 and CO2 in critically ill hyperdynamic trauma patients. 368 36

The effect of gram-negative sepsis on the kinetics and oxidation of very low-density lipoprotein (VLDL) fatty acids was assessed in conscious dogs in the normal state and 24 h after infusion of live Escherichia coli. VLDL, labeled with [2-3H]glycerol and [1-14C]palmitic acid, was used to trace VLDL kinetics and oxidation, and [1-13C]palmitic acid bound to albumin was infused simultaneously to quantify kinetics and oxidation of free fatty acid (FFA) in plasma. Sepsis caused a fivefold increase in the rate of VLDL production (RaVLDL). In the control dogs, the direct oxidation of VLDL-fatty acids was not an important contributor to their overall energy metabolism, but in dogs with sepsis, 17% of the total rate of CO2 production could be accounted for by VLDL-fatty acid oxidation. When glucose was infused into dogs with insulin and glucagon levels clamped at basal levels (by means of infusion of somatostatin and replacement of the hormones), RaVLDL increased significantly in the control dogs, but it did not increase further in dogs with sepsis. We conclude that the increase in triglyceride concentration in fasting dogs with gram-negative sepsis is the result of an increase in VLDL production and that the fatty acids in VLDL can serve as an important source of energy in sepsis.
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PMID:Effect of sepsis on VLDL kinetics: responses in basal state and during glucose infusion. 389 May 59

Hemodynamic and respiratory effects of a continuous 5-h intravenous infusion of live Escherichia coli were studied in rats. Control animals were infused with saline. Rats infused with 1.8 +/- 0.4 X 10(10) bacteria/h did not survive a 5-h infusion. These animals developed early hypotension and reduced cardiac output (CO) measured by thermal dilution technique. Rats infused with 8.0 +/- 0.4 X 10(9) bacteria/h survived a 5-h infusion with hypotension and reduced CO occurring later in the course of bacteremia. Heart rate was markedly elevated in both septic groups. Arterial blood gas measurements revealed that partial pressure of O2 was not affected by bacteremia, but partial pressure of CO2 was significantly decreased. Arterial pH remained within the normal range indicating respiratory compensation of a metabolic acidosis. Since hypotension and reduced CO were accompanied by a fall in right atrial pressure (RAP) during bacteremia, a third septic group was studied to evaluate cardiac performance during volume loading. After 3-5 h of bacteremia, a 40% reduction in CO was associated with a significant drop in arterial pressure and RAP. Despite volume loading, ventricular stroke work and arterial pressure were significantly reduced compared with control animals. The results indicate that severe gram-negative bacteremia produces myocardial depression in the rat. This model can be useful for further studies of cardiac dysfunction during sepsis.
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PMID:Cardiopulmonary response of the rat to gram-negative bacteremia. 636 87

Cardiorespiratory and metabolic data were collected in 36 septic patients and 80 patients critically ill after nonseptic general surgery or trauma. Septic patients, particularly nonsurviving septics, showed early and sustained increases in metabolic rate, oxygen consumption, cardiac work, and minute ventilatory volume. They had lower levels of respiratory quotient and total peripheral resistance than nonseptic patients. High cardiac work was related to increasing oxygen transport. Both increases in metabolic utilization with high CO2 production, and abnormal increases in VD/VT appeared responsible for the higher minute ventilatory volumes. Respiratory quotient was negatively related to metabolic rate; this relation was modulated by the rate of caloric intake and, in nonseptic patients, was also influenced by the hemodynamic state. These data suggest that poor prognosis in sepsis is characterized by an early sustained stress response with more severe abnormalities in cardiovascular, metabolic, and respiratory function than is seen in the nonseptic stress response. The need for early support of physiologic functions and early and aggressive nutritional intervention is emphasized.
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PMID:Cardiorespiratory and metabolic adequacy and their relation to survival in sepsis. 641 5

Utilization of exogenous fat emulsion (Intralipid) in control, early septic, and late septic rats were studied. After intravenous infusion of 14C-Intralipid, cumulative amounts of 14CO2 in the expired breath in the 6-hr period were 42.8 +/- 1.8, 35.0 +/- 1.8, and 28.5 +/- 1.6% of the injected dose, respectively, for the three groups. The amount and the maximum rate of CO2 production correlated with the severity of sepsis. Significantly greater amounts of plasma triglyceride and free fatty acids were also observed in septic rats. The hyperlipemia associated with the observed decrease in plasma clearance of lipids may account for the decreased utilization of exogenous fat in septic rats.
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PMID:Utilization of exogenous fat emulsion (Intralipid) in septic rats. 642 68

Management of total parenteral nutrition (TPN) in depressed glucose metabolism was investigated clinically and experimentally in view of insulin control and/or new component of carbohydrate solution. Fifty TPN cases out of 837 for 9 years were successfully performed insulin control, while 17 patients were unable to get sufficient calory in spite of insulin administration. Cumulative expired CO2 after injection of radioactive carbohydrate in rats showed that each carbohydrate was utilized in the order of glucose, fructose, maltose, sorbitol and xylitol even in depressed glucose metabolism and that depressed carbohydrate metabolism was improved by adequate insulin injection. Combined use of glucose, fructose and xylitol at 4:2:1 (GFX) was was experimentally revealed to be superior to glucose alone as carbohydrate source of TPN in depressed glucose metabolism. Compared with conventional TPN (C-TPN), GFX-TPN showed lower blood glucose and insulin level in rabbits of sepsis and rats of streptozotocin diabetes. Contents of fructose 2,6 bisphosphate and triglyceride and activities of fructose 6 phosphate 2 kinase, acetyl CoA carboxylase and fatty acid synthetase in liver of these animals supported that GFX had favourable effects on glucose and fat utilization in depressed glucose Blood glucose of early postoperative patients was lower in GFX-TPN than in C-TPN.
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PMID:[Keypoints and compositions of total parenteral nutrition for patients with low glucose tolerance levels]. 643 89

Total parenteral nutrition (TPN) using glucose as nonprotein calories was associated with increases in O2 consumption (VO2) and CO2 production (VCO2). The magnitude of the changes was a function of the patient's clinical state and glucose load. Depleted patients showed a minimal increase in VO2, while VCO2 increased 23%. Minute ventilation (VE) increased 32%. Hypermetabolic patients (major trauma, sepsis) had a 30% increase in VO2 and a 57% increase in VCO2, while VE increased 71%. Patients with mild to moderate injuries (energy expenditure +/- 15% of normal) showed a 21% increase in VO2 and a 53% increase in VCO2, while VE increased 121%. Large carbohydrate intakes were associated with increases in CO2 production in all patients, while increases in O2 consumption were seen primarily in hypermetabolic patients. These changes suggest that the high glucose loads of TPN may be a physiologic stress.
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PMID:Respiratory changes induced by the large glucose loads of total parenteral nutrition. 676 43


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