M Cobas Meyer

Evaluation of noninvasive determinants for capillary leakage syndrome in septic shock patients

AbstractObjective: Capillary leakage syndrome (CLS) is a frequent complication in sepsis, characterized by loss of intravasal fluids leading to generalized edema and hemodynamic instability despite massive fluid therapy. In spite of its importance no standardized diagnostic criteria are available for CLS. Design: Prospective clinical study. Setting: 1800-bed university hospital Patients: Six septic shock patients with CLS were compared to six control patients. Measurements and results: CLS was clinically determined by generalized edema, positive fluid balance, and weight gain. Plasma volume was measured by indocyanine green, red blood cell volume by chromium-51 labeled erythrocytes, and colloid osmotic pressure before and 90 min after the administration of 300 ml 20% albumin. Extracellular water (ECW) was measured using the inulin distribution volume and bioelectrical impedance analysis. Red blood cells averaged 20.2±1.0 ml/kg body weight in CLS patients and 23.3±4.1 in controls. ECW was higher in CLS patients than in controls (40.0±6.9 vs. 21.7±3.7 l; p<0.05). ECW of inulin was correlated with that measured by bioelectrical impedance analysis (r=0.74, p<0.01). The increase in colloid osmotic pressure over the 90 min was less in CLS patients than in controls (1.1±0.3 vs. 2.8±1.3 mmHg; p<0.05). Conclusion: These results suggest that measurements of an increased ECW using bioelectrical impedance analysis combined with a different response of colloid osmotic pressure to administration of albumin can discriminate noninvasively between patients with and those without CLS.

Septic shock after liver transplantation for Caroli's disease: clinical improvement after treatment with C1-esterase inhibitor.

Abstract The extent of complement and contact activation is related to outcome in sepsis. A low functional index of their main blocker C1-esterase inhibitor (C1-INH) is considered as a relative deficiency of C1-INH and might contribute to the development of fatal complications in the intensive care unit. The first results of therapeutic intervention with C1-INH concentrate in septic shock are promising. We report on our experience of C1-INH concentrate administration in a young woman with Carolis disease as ultimate rescue therapy for septic shock with capillary leakage syndrome after combined liver and kidney transplantation. No focus of infection was detectable and thus surgical intervention was not indicated. Antibiotic therapy at that time included vancomycin, tobramycin, meropenem and fluconazol. Hemodynamic stabilization occurred within hours after administration of C1-INH concentrate. Simultaneously a reduction in vasopressor medication was possible and negative fluid balance was achieved.

Xenon inhalation increases airway pressure in ventilated patients.

Background: The inert gas xenon, known as an anaesthetic for nearly 50 years, is also used as a contrast agent during computerised tomography (CT)‐scanning. As xenon has a higher density and viscosity than air, xenon inhalation may increase airway resistance.