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Biomedical subjects

A Meier-Hellmann

Publications and source records attributed to A Meier-Hellmann.

At least 37 records · Page 2Linked to original sources
PubMed2000

Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution.

OBJECTIVE: Transpulmonary double-indicator dilution is a useful monitoring technique for measurement of intrathoracic blood volume (ITBV) and extravascular lung water (EVLW). In this study, we compared a simpler approach using single arterial thermodilution derived measurements of ITBV and EVLW with the double-indicator dilution technique. DESIGN: Prospective observational clinical study. SETTING: Surgical intensive care units of two university hospitals. PATIENTS AND METHODS: Global end-diastolic volume (GEDV) derived from single thermodilution was used for calculation of ITBV. Structural regression analysis of the first two thermo-dye dilution measurements in a derivation population of 57 critically ill patients (38 male, 19 female, 18-79 years, 56 +/- 15 years) revealed ITBV = (1.25 x GEDV)-28.4 (ml). This equation was then applied to all first measurements in a validation population of 209 critically ill patients (139 male, 70 female, 10-88 years, mean 53 +/- 19 years), and single-thermodilution ITBV (ITBV(ST)) and EVLW (EVLW(ST)) was calculated and compared to thermo-dye dilution derived values (ITBV(TD), EVLW(TD)). For inter-individual comparison, absolute values for ITBV and EVLW were normalised as indexed by body surface area (ITBVI) and body weight (EVLWI), respectively. MEASUREMENTS AND RESULTS: Linear regression analysis yielded a correlation of ITBVI(ST) = (1.05 x ITBVI(TD))-58.0 (ml/m2), r = 0.97, P < 0.0001. Bias between ITBVI(TD) and ITBVI(ST) was 7.6 (ml/m2) with a standard deviation of 57.4 (ml/m2). Single-thermodilution EVLWI (EVLWI(ST)) was calculated using ITBVI(ST) and revealed the correlation EVLWI(ST) = (0.83 x EVLWI(TD)) + 1.6 (ml/kg), r = 0.96, P < 0.0001. Bias between EVLWI(TD) and EVLWI(ST) was -0.2 (ml/kg) with a standard deviation of 1.4 (ml/kg). In detail, EVLWI(ST) systematically overestimated EVLWI(TD) at low-normal values for EVLWI and underestimated EVLWI at higher values (above 12 ml/kg). CONCLUSION: Determinations of ITBV and EVLW by single thermodilution agreed closely with the corresponding values from the double-indicator technique. Since transpulmonary single thermodilution is simple to apply, less invasive and cheaper, all these features make it a promising technique for the bedside. Nevertheless, further validation studies are needed in the future.

Adolescent↗
PubMed2000

Is the placement of a pulmonary artery catheter still justified solely for the measurement of cardiac output?

OBJECTIVE: The authors compared four clinical techniques of measuring cardiac output (CO) in critically ill patients: pulmonary artery thermodilution (CO[PA]), transpulmonary aortic thermodilution (CO[AORTA]), Fick principle-derived (CO[FICK]), and continuous pulmonary artery (CCO) measurements. DESIGN: Prospective clinical study. SETTING: Surgical intensive care unit of a university hospital. PARTICIPANTS: Twelve adult patients suffering from sepsis or septic shock. INTERVENTIONS: All patients were deeply sedated and mechanically ventilated in a pressure-controlled mode. Each patient received a 7.5F five-lumen pulmonary artery catheter for the continuous measurement of cardiac output and a 4F aortic catheter with an integrated thermistor. The thermistors of the two different catheters were connected to one computer system (COLD-Z021, Pulsion Medical Systems, Munich, Germany). Whole-body oxygen consumption was measured by indirect calorimetry using a metabolic cart (Deltatrac, Datex-Engstroem, Helsinki, Finland) over a 5-minute period, at the end of which arterial and mixed venous blood gases were taken and measured by co-oximetry. During each measuring period, three bolus CO measurements were performed. A total number of 51 CO measurements was analyzed. RESULTS: Linear regression analysis revealed the highest correlation between CO(AORTA) and CO(PA) (r = 0.98), whereas agreement between these two techniques and CCO was lower (r = 0.92 and r = 0.93). All three techniques correlated comparably with CO(FICK) (r = 0.85, r = 0.83, and r = 0.83). CONCLUSION: The correlations among the four CO techniques were high and similar, with CO(PA) and CO(AORTA) techniques showing the highest agreement. Because CO with similar accuracy can be obtained from transpulmonary aortic thermodilution in a less-invasive manner, it appears that the placement of a pulmonary artery catheter solely for the measurement of CO is no longer justified, unless continuous CO measurements are needed.

Adult↗
PubMed2000

Haemodynamic management of a patient with septic shock.

For supportive therapy in sepsis, an adequate volume loading is likely the first step, and possibly the most important step in the treatment of patients with septic shock. However, it is still a matter of debate what kind of fluids, endpoints for resuscitation and monitoring techniques should be used. Nevertheless, therapies which closely control volume loading and regional perfusion are becoming more utilized. An elevated global O2-supply (DO2) may be necessary and beneficial in most of these patients but the increase of DO2 should be guided by the measurement of parameters assessing global and regional oxygenation. Routine strategies for elevating DO2 by the use of very high dosages of catecholamines cannot be recommended. Vasopressors should be used to achieve an adequate perfusion pressure. With norepinephrine, no negative effects on regional perfusion have been demonstrated when the patient is adequately volume resuscitated and the DO2 is normal or even slightly elevated. In contrast, epinephrine should be avoided because it seems to redistribute blood flow away from the splanchnic region. There is controversy whether dopamine should still be used as a first-line drug in patients with septic shock, because there are some clinical and experimental data that indicate unfavourable effects on mucosal perfusion of the gut. To date, there are no convincing data to support the routine use of low-dose dopamine or dopexamine in patients with sepsis. Neither low-dose dopamine nor dopexamine have been proven to prevent renal failure in septic patients. Furthermore, there is evidence that low-dose dopamine may reduce mucosal perfusion in the gut in some patients. Dopexamine has been suggested to improve splanchnic perfusion but because these effects remain somewhat controversial, there is as yet no reason for a general recommendation for dopexamine in septic patients. These recommendations are currently limited by the lack of sufficient outcome studies and studies which evaluate regional perfusion. Until the various catecholamine regimes are more fully examined, recommendations for catecholamine support in sepsis must be considered 'conditional'.

Adrenergic alpha-Agonists↗
PubMed2000

Transoesophageal echocardiographic assessment of haemodynamic changes during laparoscopic herniorrhaphy in small children.

Laparoscopic techniques for surgery are gradually becoming established in paediatric surgery. Technical aspects, such as the maximum safe gas insufflation pressure, are still open to discussion. We used transoesophageal echocardiography to study the haemodynamic changes in eight small children undergoing laparoscopic herniorrhaphy, with two different levels of intra-abdominal pressure (IAP), 6 and 12 mm Hg. End-tidal carbon dioxide tension was maintained constant at 4.3-4.7 kPa. After baseline measurements, an IAP of 12 mm Hg was applied for 10 min. Next, IAP was decreased to 6 mm Hg, followed by a second period of 12 mm Hg. Haemodynamic measurements were obtained at each stage. A further measurement was obtained 10 min after abdominal deflation at the end of surgery while anaesthesia was unchanged. Cardiac index (CI) decreased significantly only after the first 12 mm Hg level of IAP. The subsequent decrease in IAP to 6 mm Hg caused return of CI to baseline levels. The second increase in IAP did not cause any reduction in CI. The initial reduction in CI, although statistically significant, did not appear to be clinically important. We conclude that an IAP of up to 12 mm Hg appeared to be safe in healthy small children undergoing laparoscopic herniorrhaphy.

Cardiac Output↗
PubMed2000

Do fluid administration and reduction in norepinephrine dose improve global and splanchnic haemodynamics?

We studied global and splanchnic haemodynamics in patients with septic shock, while reducing norepinephrine doses by progressive fluid loading administration. Ten patients (six female, four male, aged 39-86 yr, mean 61 yr) were assessed using a transpulmonary thermo-dye dilution technique to measure cardiac output, intrathoracic blood volume and total blood volume. Splanchnic blood flow was measured by the steady state indocyanine green technique using a hepatic venous catheter. Gastric mucosal blood flow was estimated by regional carbon dioxide tension (PRCO2). Hydroxyethylstarch was infused in two stages while maintaining mean arterial pressure, allowing a reduction in norepinephrine dose from 0.54 to 0.33 to 0.21 microgram kg-1 min-1. Mean (SD) heart rate significantly decreased, from 104 (13) to 94 (15) beats min-1. Total blood volume index (mean (SD)) increased from 2650 (638) to 3655 (885) ml m-2, intrathoracic blood volume index from 888 (204) to 1050 (248) ml m-2 and cardiac index from 3.6 (1.0) to 4.0 (0.9) litres min-1 m-2. Splanchnic blood flow did not change significantly--either absolute (from 0.81 to 0.98 litres min-1 m-2) or fractional (from 22.3% to 23.9%). Gastric mucosal (PRCO2) increased from 7.5 (2.5) to 9.0 (2.8) kPa. The PCO2 gap, i.e. the difference between regional and end-tidal PCO2, increased from 3.1 (2.5) to 4.0 (2.9) kPa. Marked individual variation in responses suggests that norepinephrine dose reduction by fluid loading in patients with stabilized septic shock does not necessarily increase global or splanchnic blood flow.

Adult↗
PubMed2000

Effect of dopexamine on outcome after major abdominal surgery: a prospective, randomized, controlled multicenter study. European Multicenter Study Group on Dopexamine in Major Abdominal Surgery.

OBJECTIVE: To test the hypothesis that dopexamine reduces postoperative mortality and morbidity in high-risk, major abdominal surgery patients, when given to fluid-resuscitated patients starting before the operation and continued for 24 hrs after surgery. DESIGN: Prospective, randomized, controlled, double-blind multicenter trial. SETTING: Intensive care units in 13 hospitals from six European countries. PATIENTS: A total of 412 patients with predefined high-risk criteria, undergoing major abdominal surgery with an expected duration of at least 1.5 hrs. INTERVENTIONS: The patients received placebo (n = 140), dopexamine at 0.5 microg/kg/min (n = 135), or dopexamine at 2.0 microg/kg/ min (n = 137) starting after preoperative hemodynamic stabilization and continued for 24 hrs after surgery. MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was mortality at 28 days. Analysis was by intention to treat. Dopexamine had no effect on mortality (at 28 days, 13%, 7%, and 15%, for the groups receiving placebo, dopexamine at 0.5 microg/kg/ min, and dopexamine at 2.0 microg/kg/min, respectively), despite the expected dose-dependent hemodynamic responses. No effect was observed on the occurrence of organ dysfunction, duration of intensive care unit stay, or length of hospital stay. CONCLUSION: We conclude that dopexamine in doses that result in increased cardiac output and oxygen delivery after preoperative stabilization with fluids does not improve outcome after major abdominal surgery compared with fluids alone. Based on post hoc subgroup analysis and stratification according to the number of risk factors, we suggest that the concept should be further tested in patients at higher risk of complications or undergoing emergency surgery.

Adrenergic beta-Agonists↗
PubMed2000

N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: results of a prospective, randomized, double-blind study.

OBJECTIVE: In septic shock, decreased splanchnic blood flow is reported, despite adequate systemic hemodynamics. Aacetylcysteine (NAC) was found to increase hepatosplanchnic blood flow in experimental settings. In septic shock patients, NAC improved the clearance of indocyanine green and the relationship of systemic oxygen consumption to oxygen demand. We investigated the influence of NAC on liver blood flow, hepatosplanchnic oxygen transport-related variables, and liver function during early septic shock. DESIGN: Prospective, randomized, double-blind study. SETTING: Septic shock patients admitted to an interdisciplinary surgical intensive care unit. PATIENTS: We examined 60 septic shock patients within 24 hrs after onset of sepsis. They were conventionally resuscitated with volume and inotropes and were in stable condition. A gastric tonometer was inserted into the stomach and a catheter into the hepatic vein. Microsomal liver function was assessed by using the plasma appearance of monoethylglycinexylidide (MEGX). INTERVENTIONS: Subjects randomly received either a bolus of 150 mg/kg iv NAC over 15 mins and a subsequent continuous infusion of 12.5 mg/kg/hr NAC over 90 mins (n = 30) or placebo (n = 30). MEASUREMENTS AND MAIN RESULTS: Measurements were performed before (baseline) and 60 mins after beginning the infusion (infusion). After NAC, a significant increase in absolute liver blood flow index (2.7 vs. 3.3 L/min/m2; p = .01) and cardiac index (5.0 vs. 5.7 L/min/m2; p = .02) was observed. Fractional liver blood flow index (cardiac index-related liver blood flow index) did not change. The difference between arterial and gastric mucosal carbon dioxide tension decreased (p = .05) and MEGX increased (p = .04). Liver blood flow index and MEGX correlated significantly (r(s) = .57; p < or = .01). CONCLUSIONS: After NAC treatment, hepatosplanchnic flow and function improved and may, therefore, suggest enhanced nutritive blood flow. The increase of liver blood flow index was not caused by redistribution to the hepatosplanchnic area, but by an increase of cardiac index. Because of its correlation with liver blood flow index, MEGX may be helpful in identifying patients who benefit from NAC treatment in early septic shock.

Acetylcysteine↗
PubMed1999

Advantages of endoscopic therapy of gastrojejunal dissociation in critical care patients.

OBJECTIVE: To evaluate the advantages of a new three-lumen tube (Trelumina) and a percutaneous endoscopic gastrostomy (EntriStar) with a jejunal insertion tube (PEGJ) as a safe method of early enteral nutrition and simultaneous gastric decompression as well as fast reduction of the high gastric reflux in critical care patients. DESIGN: Retrospective, descriptive case series. SETTING: Two anaesthesiological and one surgical intensive care unit (ICU) in a university hospital. PATIENTS: Sixty-five consecutive critically ill patients with gastrojejunal dissociation. The mean Acute Physiology and Chronic Health Evaluation Score (APACHE II) was 19. INTERVENTIONS: Placement of 46 Trelumina and 19 PEGJ under endoscopic control. MEASUREMENTS AND MAIN RESULTS: None of the known percutaneous endoscopic gastrostomy (PEG) complications like wound infection, bleeding or organ perforation were seen. One secondary dislocation of the jejunal insertion tube and four dislocations of the jejunal part of the Trelumina were found. The average gastric reflux of the Trelumina and the PEGJ amounted to 1700 +/- 230 ml/day. Forty-three patients showed a clear decrease in the gastric reflux to 450 +/- 200 ml/day within the first 24 h of tube placement. The average time of reduction to normal gastric reflux volumes (0-200 ml/day) amounted to 4 -/+ 2 days. Forty-three (71 %) of the patients showed improved intestinal passage as expressed by regular peristalsis and defaecation. The price for 1 day enteral feeding via Trelumina or PEGJ was 10 times lower than 1 day total parenteral nutrition. CONCLUSIONS: Placement of the Trelumina and the PEGJ is a safe, successful and inexpensive means of early enteral nutrition and simultaneous gastric reflux reduction in critical care patients.

Adolescent↗
PubMed1999

Comparison of pulmonary artery and arterial thermodilution cardiac output in critically ill patients.

OBJECTIVE: We studied the agreement between cardiac output measurements via pulmonary artery thermodilution [CO(PA)], regarded as the current clinical gold standard, and aortic transpulmonary thermodilution [CO(AORTA)]. DESIGN: Prospective clinical study. SETTING: Surgical intensive care unit of a university hospital. PATIENTS: 37 patients with sepsis or septic shock (n = 34) and subarachnoid haemorrhage (n = 3). MEASUREMENTS AND RESULTS: We analysed 449 simultaneous cardiac output measurements. All patients were deeply sedated and mechanically ventilated in a pressure controlled mode. Each patient received a 7.5-F five-lumen pulmonary artery catheter and a 4-F aortic catheter with an integrated thermistor. The thermistors of the two different catheters were connected to one computer system (COLD-Z021, Pulsion Medical Systems, Munich, Germany). Linear regression analysis revealed: CO(AORTA) = 0.96. CO(PA) + 1.02 (l/min) (r = 0.97, p < 0.0001). CO(AORTA) was consistently higher than CO(PA) with a bias of 0.68 (l/min) and a standard deviation of 0.62 (l/min). CONCLUSION: Cardiac output derived from aortic transpulmonary thermodilution is suitable for measurement in the intensive care unit. Measurements of CO(AORTA) are consistent with, but slightly higher than, those obtained from pulmonary artery thermodilution.

Adult↗
PubMed1999

Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with sepsis or septic shock.

PURPOSE: The purpose of this study was to analyze three different variables of cardiac preload; central venous pressure (CVP), pulmonary artery occlusion pressure (PAOP), and intrathoracic blood volume index (ITBVI) that served as the best indicator of cardiac function, that is, cardiac index (C1) or stroke index (SI). MATERIALS AND METHODS: This was a prospective study in 57 critically ill patients with sepsis or septic shock in whom 581 hemodynamic profiles were analyzed. One patient was included a second time after a period of 6 weeks. All patients were sedated and mechanically ventilated. Each patient had a 7.5-Frfive-lumen pulmonary artery catheter (PAC) and a 4-Fr catheter with an integrated thermistor and fiberoptic that was advanced into the descending aorta via a femoral artery sheath. The study was performed in the surgical intensive care unit of a university hospital. RESULTS: Linear regression analysis of the first profile for each case (n = 58) revealed a significant correlation between ITBVI and SI (r = 0.66). For comparison, correlations for PAOP/SI (r = 0.06) and CVP/SI (r = 0.10) were poor. The analysis of all second profiles showed that only the change in ITBVI reflected the change in SI (r = 0.67), whereas PAOP (r = 0.07) and CVP (r = 0.05) failed. Furthermore, a positive change in SI (n = 265) was most often associated with an increase in ITBVI (n = 189, 71.3%), less for PAOP (n = 122, 46.0%) and CVP (n = 137, 51.7%). A reduction in SI (n = 256) was accompanied by a decrease in ITBVI (n = 176, 68.8%), PAOP (n = 119, 46.5%), and CVP (n = 118, 46.1%). An increase in ITBVI (n = 269) was accompanied by an increase in SI in 189 cases (70.3%). In these, PAOP increased only in 91 (48.1%) and CVP in 101 cases (53.4%), respectively. Accordingly, a positive change in PAOP (n = 218) was associated with an increase in SI in 122 cases (56.0%). ITBVI increased in 91 (74.6%) and CVP in 84 (68.9%) of these cases. A decrease in ITBVI (n = 250) was associated with a decrease in SI in 176 cases (70.4%). Decreases in PAOP (n = 89, 50.6%) and CVP (n = 91, 51.7%) did not reflect these changes. However, when PAOP (n = 229) and SI decreased (n = 119, 52.0%), ITBVI decreased in 89 (74.8%) and CVP in 73 cases (61.3%). CONCLUSIONS: In comparison with cardiac filling pressures, ITBVI seems to be the more reliable indicator of cardiac preload in patients with sepsis or septic shock.

Adult↗
PubMed1999

[Serum level-adjusted dosage of once-daily aminoglycoside therapy in critical illness: results of a prospective study].

OBJECTIVE: In critically ill patients, the adjustment of target peak and trough levels of tobramycin was investigated because aminoglycoside pharmacokinetics can be changed by multiple influences. Sufficient but not too high peak serum concentrations and low trough levels, however, should be achieved to ensure a therapeutic effect and to minimize toxicity. METHODS: 70 critically ill patients of 51 +/- 18 years were monitored daily during their aminoglycoside treatment on the intensive care unit targeting a peak of about 12 micrograms/ml 30 minutes after infusion and a trough level below 1 to 2 micrograms/ml. Dose recommendations were given daily, taking into consideration serum levels, dose predictions (Bayesian method, ABBOTTBASE), creatinine clearance and clinical findings. Creatinine clearance was estimated according to the Cockcroft-Gault-formula as well as directly by the urine collection method. RESULTS: The standardized initial dose of 400 mg tobramycin led to average peak serum levels of 14.2 +/- 3.9 micrograms/ml in the patients with an apparent distribution volume of 0.345 +/- 0.074 L/kg. In 95% of the patients, the initial peak was higher than 8.5 micrograms/ml; levels higher than 20 micrograms/ml were observed in 7%, extremely low concentrations (below 5 micrograms/ml) in 2%. With individually adjusted doses between 160 and 560 mg, a mean peak of 11.5 +/- 2.7 micrograms/ml was measured subsequently. The levels amounted to 96 +/- 23% of the predicted values, deviations greater than 50% occurred in 5%. The target trough level was achieved in 99%, in less than 3% the dosing interval was extended up to 72 hours. A tobramycin clearance below 80 ml/min/1.73 m2 was associated with average 80% and 33% higher creatinine clearance values according to the Cockcroft-method and the direct method, respectively. CONCLUSION: Target peak and trough aminoglycoside levels are adjustable even in critically ill patients. Reduced tobramycin clearance can be associated with normal creatinine clearance. Assuming an exact methodology, a reduced "direct" creatinine clearance, however, indicates a reduced drug clearance.

Anti-Bacterial Agents↗
PubMed1999

Sensitivity and specificity of various markers of inflammation for the prediction of tumor necrosis factor-alpha and interleukin-6 in patients with sepsis.

OBJECTIVES: To determine correlations and predictive strength of surrogate markers (body temperature, leukocyte count, C-reactive protein [CRP], and procalcitonin [PCT]) with elevated levels of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) in septic patients. DESIGN: Prospective consecutive case series. SETTING: Surgical intensive care unit (ICU) of a university hospital. PATIENTS: A total of 175 patients experiencing intensive care unit stays >48 hrs categorized for sepsis according to ACCP/ SCCM Consensus Conference criteria. MEASUREMENTS AND MAIN RESULTS: CRP and PCT were both significantly correlated with TNF-alpha and IL-6. Based on the area-under-the-curve of the receiver operating characteristics curves, predicting capability was highest for PCT (0.814 for TNF-alpha >40 pg/mL and 0.794 for IL-6 >500 pg/mL), moderate with CRP (0.732 and 0.716, respectively), and lowest for leukocyte count (0.493 and 0.483, respectively) and body temperature (0.587 and 0.589, respectively). Sensitivity, specificity, positive, and negative predictive values and test effectiveness all followed this same pattern of being highest for PCT followed by CRP, with leukocyte count and body temperature being lowest. CONCLUSION: PCT may be an early and better marker of elevated cytokines than the more classic criteria of inflammation.

Adolescent↗
PubMed1999

Dopexamine increases splanchnic blood flow but decreases gastric mucosal pH in severe septic patients treated with dobutamine.

OBJECTIVE: To assess the effects of dopexamine on splanchnic blood flow and splanchnic oxygen uptake in septic patients. DESIGN: A prospective, controlled trial. SETTING: A ten-bed intensive care unit (ICU) in a university hospital. PATIENTS: Twelve patients with severe sepsis (according to the criteria of the 1992 American College of Chest Physicians/Society of Critical Care Medicine consensus conference) being stabilized by volume loading and treated to an elevated oxygen delivery by dobutamine infusion. INTERVENTIONS: Infusion of increasing dosages of dopexamine (0.5, 1.0, 2.0, and 4.0 microg/kg/min). MEASUREMENTS AND MAIN RESULTS: Systemic and splanchnic hemodynamic and oxygen transport parameters as well as gastric mucosal pH (pHi) were measured. A hepatic venous catheter technique with indocyanine green dye dilution was used to determine splanchnic blood flow. Dopexamine increased global and splanchnic oxygen delivery without affecting oxygen consumption (VO2). Splanchnic blood flow increased proportionally to cardiac output, indicating that there was no selective effect of dopexamine on the splanchnic flow. Dopexamine decreased pHi in a dose-dependent fashion in all 12 patients. CONCLUSIONS: In hemodynamically stable, hyperdynamic septic patients being treated with dobutamine, dopexamine has no selective effect on splanchnic blood flow. In fact, a decreased pHi suggests a harmful effect on gastric mucosal perfusion.

Adult↗
PubMed1999

Supportive therapy of the sepsis syndrome.

Adequate volume loading may be the most important step in the treatment of patients with septic shock. Techniques allowing us to achieve and tightly control volume loading and regional perfusion are considered to be helpful. An elevated oxygen delivery may be beneficial in some patients but the increase of oxygen delivery should be guided by the measurement of parameters assessing global and regional oxygenation. Forcing an increase in oxygen delivery by the use of very high dosages of catecholamines can be harmful. Vasopressors should be used for achieving an adequate perfusion pressure. For norepinephrine, no negative effects on regional perfusion have been demonstrated. Epinephrine and dopamine should be avoided because they seem to redistribute blood flow away from the splanchnic region. There are no convincing data yet to support the routine use of low dose dopamine or dopexamine in patients with sepsis. Neither low dose dopamine nor dopexamine has been proven to prevent renal failure in septic patients. Furthermore, there is evidence that low dose dopamine may reduce mucosal perfusion in the gut in some patients. There is some suggestion that dopexamine can improve splanchnic perfusion but since these effects remain somewhat controversial, there is no reason for a general recommendation for dopexamine in septic patients.

Cardiovascular Agents↗
PubMed1998

[Procalcitonin. A new diagnostic parameter for severe infections and sepsis].

Procalcitonin (PCT), a glycoprotein consisting of 116 amino acids, has been proposed as a new marker of severe infection. The site of production under this condition remains unknown. The serum PCT concentration is determined by an immunoluminometric assay of 40 microliters serum or plasma requiring approximately two hours. Elevations of PCT are for instance associated with levels of lipopolysaccharide and the cytokines TNF-alpha and IL-6. Bacterial, parasitic or fungal infections developing septic complications in contrast to local infections, often show values exceeding 2 ng/ml. The specificity of the parameter in this context increases with its concentrations. Therapeutic actions that confine the infection locally are reflected by a decrease of the PCT value. PCT may be elevated within the first days after extended surgery or polytrauma, in some malignancies, heat-stroke and during treatment of some hematologic diseases without an existing sepsis or severe infection. Previous studies indicate certain benefits of PCT compared to traditional markers of inflammation or sepsis, where the ability to indicate a generalized infection is the primary advantage.

Biomarkers↗