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To evaluate a monitor of pulmonary gas exchange (Deltatrac, Datex) in a clinical setting.After in vitro evaluation, comparison over 2 min between VO2 and VCO2 values measured by the Deltatrac and the Douglas bag technique. Comparisons were also achieved over 8 h periods between the Deltatrac and a system using a mass-spectrometer.Polyvalent intensive care unit (ICU 15 beds) in a 1200 bed general hospital.Comparison with the Douglas bag technique in 10 patients undergoing controlled ventilation. Comparison with the mass-spectrometer system in 25 other patients undergoing controlled or pressure support ventilation.Compared to the results obtained by the Douglas bag technique, the bias (+/- 2 SD) for VO2 and VCO2 was -3.5 +/- 26.6 and 6.1 +/- 12.7 ml.min-1, respectively. By comparison with the mass-spectrometer system, the bias for VO2 and RQ was -5.8 +/- 16.0 ml.min-1 and 0.018 +/- 0.048, respectively. No drift between the two systems was observed over time.The Deltatrac appears suitable for VO2 and VCO2 measurements in ventilated patients and equivalent to a mass-spectrometer system for long term measurements.

CONFUSIONAL STATE IN ICU PATIENTS AFTER. WEANING FROM MECHANICAL VENTILATION AND SEDATION. F Pochard, JJ Lanore, M Belghith, JP Mira, B Renaud, F Bellivier, I Hamy, JF Vax; laire, F Brunet, JF Dhainaut. Confusional state (CS) is known to be frequent in ICU pts. It can result in a poorer prognosis at time of weaning from mechanical ventilation (MV). The aim of this study was to prospectively assess the incidence of CS in pts requiring MV and sedation during more than 24 hours, at time of weaning. Thirty-three survivor pts, Age 48.3, SAPS 15.4, OSF 1.7, OMEGA score 34a, were consecutively included. Reason for admission to ICU was acute lung injury (20), cardiac failure (5), septic shock (3), other (5). Length of MV was 17 days. Pharmacological agents used were flunitrazepam for narcose (33 pts, 35 mg/d, 11 d) and phenoperidine for analgesia (30 pts, 39 mg/d, 12 d). Neither pt had psychosis previous history, nor neurological disease. Fourteen pts suffered CS, defined as the onset of at least 2 of the following signs: disorientation, anxiety, auditory or visual hallucinations, agitation, clouding of consciousness, incoherence, perceptive disturbances, sleep disorders, after weaning from MV. No CS appeared in the 10 pts who had sedation during less than 5 days; in the other23 pts, incidence of CS was 64 % (p < .001). No metabolic etiology was found. The incidence of CS is high in ICU patients when weaning from MV and sedation; this incidence increases with the duration of MV. It should be treated with neuroleptics drugs. Further studies should be performed, in order to consider prevention of CS.

A 65-year-old man developed postsurgical septic shock, unresponsive to plasma volume expansion and administration of dopamine and dobutamine. A continuous norepinephrine infusion was then started and the dose increased to 0.62 micrograms.kg-1.min-1 until the mean arterial pressure was 70 mmHg. Prior to and during the norepinephrine infusion, oxygen consumption was continuously measured with a mass spectrometer system. There was a parallel increase in mean arterial pressure and oxygen consumption (+ 35%). There was also an increase in cardiac index and oxygen delivery. Systemic vascular resistance was only transiently increased. In this case with septic shock, norepinephrine infusion improved hemodynamic variables with an associated increase in oxygen consumption.

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.