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ARDS = acute respiratory distress syndrome; ΔPCO2 = partial carbon dioxide tension gap; PEEP = positive end-expiratory pressure.
Although there were no differences in splanchnic blood flow or partial carbon dioxide tension gap between norepinephrine and dopamine, dopamine was associated with a lower mixed venous hepatic venous oxygen saturation gradient than was norepinephrine.
This is because, at first glance, fairly high levels of PEEP – up to 20 cmH2O – apparently did not compromise haemodynamics or significantly affect gastric mucosal arterial partial carbon dioxide tension gap (ΔPCO2) in these patients.
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Intramucosal-to-arterial carbon dioxide difference (the so-called P CO2 [partial carbon dioxide tension] gap) remains largely unaltered during decreased oxygen delivery, if the latter is reduced as flow is maintained.
In a recent clinical study conducted in patients with sepsis [ 20], a wide interindividual variability in carbon dioxide tension (PCO2) gap in response to fluid loading was observed.
In contrast to norepinephrine-dobutamine, epinephrine when used in septic shock increases lactate level together with a slightly enhanced lactate/pyruvate (L/P) ratio, decreases global splanchnic flow and elevates the tonometric mucosal partial CO2 tension (PCO2) gap (tonometer PCO2 minus arterial PCO2), a surrogate marker of gastric mucosal metabolism and/or perfusion.
In a case series of 11 catecholamine-dependent septic shock patients, van Haren and coworkers [ 99] showed that vasopressin (0.04 U/min) was responsible for a significant increase in gastric arterial partial carbon dioxide tension (PCO2) gap from 5 mmHg at baseline to 19 mmHg after 4 hours.
Debonding effect at the epoxy-concrete interface was considered in the model by identification of fracture energies of the interfaces and appropriate bilinear shear stress-slip and tension stress-gap models.
Thus, the project grew and took shape around two areas of tension: two gaps that shape the space, one obvious in the large rectangular courtyard onto which the internal space expands, and an internal one with a circular ring, a drum dictating the internal movement and creating a dynamic area around which the whole composition revolves.
There are black women, like me – making the case for intersectionality, bridging those tension-filled gaps between feminism and anti-racism.
None of this is to say that singers don't want or need to be loved – they do, of course – but there is tension in the gap between being loved for yourself and being loved for something that is not real.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com