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  • 1
    ISSN: 1432-1238
    Keywords: Key words Fluid resuscitation ; Haemodynamic monitoring ; Stroke distance ; Doppler ultrasound ; Hypovolaemic shock ; Severe sepsis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To assess the feasibility of constructing left ventricular response curves non-invasively during the fluid resuscitation of critically ill patients in the emergency department (ED) using a portable suprasternal Doppler ultrasound (PSSDU) device.¶Design: Prospective case series.¶Setting: Emergency department, Catholic University of Leuven, Belgium. Patients: Shocked patients in the ED were diagnosed by predefined criteria. Only those thought to require standardised intravenous colloid challenges were observed i. e., sequential boluses of 3.5 ml/kg/10 min titrated against changes in stroke distance (Doppler surrogate for left ventricular stroke volume).¶Results: A total of 50 shocked patients were studied. Stroke distance was measurable in 45 patients. 35 patients were fluid responders in terms of stroke distance. Group mean stroke distance increased during resuscitation (8.6 ± 4.1 cm to 19.5 ± 4.6 cm, P 〈 0.001) and then reached a plateau value (19.6 ± 4.6 cm, P = 0.488). No response to fluid was seen in nine patients of which eight had severe sepsis. Alternative therapeutic approaches increased stroke distance for all of these patients. Evidence for right ventricular dysfunction was found as a cause for fluid non-response in the majority of patients with sepsis.¶Conclusions: Previous experimental work has shown that changes in central blood flow can be derived using the PSSDU device. This clinical feasibility study suggests that the PSSDU can help tailor haemodynamic therapy for an individual patient and give an early indication of treatment failure in the ED.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-0533
    Keywords: Triethyltin ; Myelin ; Brain oedema ; CSF pressure ; Electrolytes
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Following a single intravenous (i.v.) injection of triethyltin (10 mg/kg) in rats, vacuoles appeared in the myelin sheath within 3 h and they progressively increased in size between 6 and 24h. Their development was closely correlated with a progressive increase in water, sodium, and chloride content of the brain, and of cerebrospinal fluid (CSF) pressure. Oedema was more extensive in tissues consisting predominantly of white matter rather than grey matter. The sustanined increase in CSF pressure did not precede the development of lesions and was the result of, rather than the cause of, brain oedema and swelling. These findings indicate that triethyltin has a direct effect on the myelin sheath.
    Type of Medium: Electronic Resource
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