Paul W. G. Elbers

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OBJECTIVES It has become possible to image the human microcirculation at the bedside using sidestream dark field (SDF) imaging. This may help the clinician when correlation between global and microvascular hemodynamics may not be straightforward. Ketanserin, a serotonin and alpha-1 adrenoceptor antagonist, is used in some countries to treat elevated blood(More)
Over 30 years ago Weil and Shubin proposed a re-classification of shock states and identified hypovolemic, cardiogenic, obstructive and distributive shock. The first three categories have in common that they are associated with a fall in cardiac output. Distributive shock, such as occurs during sepsis and septic shock, however, is associated with an(More)
n engl j med 360;7 nejm.org february 12, 2009 e9 A 51-year-old woman presented with a 3-month history of fatigue and a 2-week history of a nonproductive cough and night sweats. Chronic myeloid leukemia was diagnosed, with a leukocyte count of 398,000 per cubic millimeter. On the basis of suspected leukostasis, sidestream dark-field (SDF) imaging was(More)
Dear Editor, Ventilator-dependent patients in the intensive care unit (ICU) experience difficulties with communication, mainly due to intubation. Tube placement between the vocal cords induces loss of speech and concomitant communication problems, creating severe negative emotional reactions [1]. The magnitude of the problem is increasing as there is a(More)
The purpose of this study was to develop a rapid and fully automatic method for the assessment of microvascular density and perfusion in sidestream dark field (SDF) images. We modified algorithms previously developed by our group for microvascular density assessment and introduced a new method for microvascular perfusion assessment. To validate the new(More)
OBJECTIVE The behavior of the human microcirculation in the setting of cardiac arrest is largely unknown. Animal experiments have consistently revealed that global hemodynamics do not necessarily reflect microvascular perfusion. In addition, the time it takes for capillary blood flow to stop after the heart arrests is debated. Estimations range from 50(More)
BACKGROUND Ventilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. We summarized the current evidence on communication methods with mechanically ventilated(More)
n engl j med 370;12 nejm.org march 20, 2014 1172 These findings have implications from both regulatory and safety perspectives. First, it is clear that many approvals for the addition of phenylephrine to any number of analgesic agents were based on assumptions that were incorrect for acetaminophen. Second, the plasma exposure of phenylephrine combined with(More)
OBJECTIVES Possible benefits of pulsatile perfusion during cardiopulmonary bypass often are attributed to enhanced microvascular flow. However, there is no evidence to support this in humans. Therefore, the authors assessed whether pulsatile perfusion alters human microvascular flow. DESIGN A prospective, randomized observational crossover study. (More)
Over the past decade, critical care ultrasound has gained its place in the armamentarium of monitoring tools. A greater understanding of lung, abdominal, and vascular ultrasound plus easier access to portable machines have revolutionised the bedside assessment of our ICU patients. Because ultrasound is not only a diagnostic test, but can also be seen as a(More)