IntroductionPulse-pressure variation (PPV) due to increased right ventricular afterload and dysfunction may misleadingly suggest volume responsiveness. We aimed to assess prediction of volume responsiveness with PPV in patients with increased pulmonary artery pressure.MethodsFifteen cardiac surgery patients with a history of increased pulmonary artery pressure (mean pressure, 27 ± 5 mm Hg (mean ± SD) before fluid challenges) and seven septic shock patients (mean pulmonary artery pressure, 33 ± 10 mm Hg) were challenged with 200 ml hydroxyethyl starch boli ordered on clinical indication. PPV, right ventricular ejection fraction (EF) and end-diastolic volume (EDV), stroke volume (SV), and intravascular pressures were measured before and after volume challenges.ResultsOf 69 fluid challenges, 19 (28%) increased SV > 10%. PPV did not predict volume responsiveness (area under the receiver operating characteristic curve, 0.555; P = 0.485). PPV was ≥13% before 46 (67%) fluid challenges, and SV increased in 13 (28%). Right ventricular EF decreased in none of the fluid challenges, resulting in increased SV, and in 44% of those in which SV did not increase (P = 0.0003). EDV increased in 28% of fluid challenges, resulting in increased SV, and in 44% of those in which SV did not increase (P = 0.272).ConclusionsBoth early after cardiac surgery and in septic shock, patients with increased pulmonary artery pressure respond poorly to fluid administration. Under these conditions, PPV cannot be used to predict fluid responsiveness. The frequent reduction in right ventricular EF when SV did not increase suggests that right ventricular dysfunction contributed to the poor response to fluids.

Background: There are only a few prospective clinical trials investigating the effects of different anesthetic techniques on clinical outcomes after lumbar spine surgery. The purpose of this study was to evaluate clinical outcomes in patients receiving general (GA) and regional anesthesia (RA) for lumbar spine surgery. Methods: This was a single-center, 2-arm, trial in which 100 patients undergoing lumbar spine surgery were randomized to receive either RA or GA (50 per group). The primary endpoint was morphine consumption during the first postoperative 48 hours. In addition, anesthesia time, transition time (defined as time from end of surgery to admission to the postoperative anesthesia care unit), visual analogue scale (VAS) for pain, and patient satisfaction at hospital discharge were recorded. Results: There was no difference in the primary endpoint (cumulative morphine consumption at 48 h) between the 2 anesthesia types. Anesthesia and transition times were significantly shorter in the RA compared with the GA group—anesthesia time 125.4±23.6 minutes for GA versus 99.4±13.5 minutes for RA, transition time 22.5 minutes for GA versus 10.0 minutes for RA (both P<0.001). The VAS for pain on arrival to the postoperative anesthetic care unit was lower for patients who received RA compared with GA (crude and adjusted, both <0.001). 84% of patients in the RA group were completely satisfied compared with 74% in the GA group (P<0.001). There was a significant difference in the sex analysis for VAS for pain over time; females reported higher VAS for pain from the preoperative assessment to 6 weeks after the operation (P<0.001). Conclusions: There was no difference in postoperative morphine consumption in patients receiving GA and RA for lumbar spine surgery. RA was associated with shorter anesthesia and transition times, lower VAS for pain at arrival at the postoperative anesthesia care unit, and higher patient satisfaction at hospital discharge.

Conclusion(s):Glipzide improved haemodynamics in ovine endotoxaemia and may represent a beneficial therapeutic option to treat arterial hypotension resulting from sepsis and systemic inflammatory response syndrome (SIRS). Background and Goal of Study:We established a hemoperfused in vitro system for isolated organ perfusion giving access to investigations on intestinal function. Since coagulation is an important aspect in research on microcirculation and sepsis we investigated different heparinisation protocols, with respect to both functionality and sensitivity of the system's behaviour. Materials and Methods: Porcine jejunal segments (191 Ϯ 40 g), normotherm, hemoperfusion for 3h in an isolated perfusion circuit including an oxygenation unit; n ϭ 4-5 per group; anticoagulation with unfractionated heparin was performed in 2-3 steps: 1. animal, 2. blood reservoir, 3. with (w) or without (w/o) priming (P) of the perfusion circuit. Heparin doses in the blood reservoir were high (Hi) versus low (Lo); total heparin doses given in I.U.: group 1: 40.819 Ϯ 910 (HiHep w P), group 2: 15.750 Ϯ 500 (HiHep w/o P), group 3: 10.904 Ϯ 413 (LoHep w P), group 4: 6.375 Ϯ 679 (LoHep w P). Viability criteria were: oxygen consumption, vascular resistance (SVR), edema formation (i.e. organ weights before/after), thromboplastin time (TPZ), fibrinogen, ATIII, and platelets. Non parametric tests, median [inter-quartile range], p Ͻ 0.05. Results and Discussion: Groups 1 and 2 (HiHep w P and w/o P) showed massive bleeding (mucosa ϩ serosa and mucosa, respectively), whereas both LoHep groups did not show bleeding. Group 4 (LoHep w/o P) showed significantly higher SVR compared to group 3 (LoHep w P) (0.53 [0.35] vs. 0.17 [0.14] mmHg*min/ml*100 g). Significantly highest oxygen consumption was found in group 3 (143.7 [78.4] vs. 66.7 [39.7] mol/min*100 g). Group 4 was characterised by a tendency for activated TPZ-INR (1.1 [0.16]) and constant decrease in fibrinogen and ATIII-concentrations. Group 3, in contrast, showed stable values of the coagulation pattern. Platelets were stable in all groups. Group 3 (LoHep w P) provided stable perfusion conditions, and a still maintained functional capacity. Conclusion: This study shows that each heparinisation protocol is associated with a particular pattern of viability criteria in isolated perfused intestine. The latter should be taken into account for comparison of data obtained from different in vitro models and in vivo versus in vitro comparison. Background and Goal of Study: Immunological interventions in endotoxemia and sepsis have been tested in experimental [1] and clinical studies [2].Our group evaluated the effects of an IgM-enriched preparation in a model of gram negative bacteraemia. Materials and Methods: After institutional approval 10 New Zealand White rabbits (2-3 kg) were randomized to a treatment or control group. In the intervention group IgM-enriched solution (Pentaglobin ® : 2 ml/kg/h) was applied. In addition, LPS was infused in both groups at a rate of 40 g/kg/h. After intravenous ...