Chest
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A 73-year-old man with ARDS-multiple organ failure due to Chlamydia psittaci, was successively supported with conventional respiratory techniques. After 48 hours of no clinical improvement, HFV was superimposed to CMV in order to combine the advantages of each one. Since improvement has been seen in all ventilatory parameters, this method is suggested as another mode of ventilation for patients with refractory hypoxia and hypercarbia who do not respond to conventional respiratory care.
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Continuous measurement of mixed venous oxygen saturation (SvO2) has been suggested as an adjunct in monitoring critically ill patients. We evaluated SvO2 monitoring in 24 patients suffering from complicated myocardial infarctions. Cardiac output and arterial lactate levels were measured when there were persistent 5 percent changes in SvO2, and otherwise, every 12 hours or as indicated clinically. ⋯ Survivors had significantly higher mean SvO2 and cardiac indices than nonsurvivors (p less than 0.01). The clinical management of patients with myocardial infarction may not be altered in view of the limitations of SvO2 in reflecting tissue hypoxia. We conclude that continuous monitoring of SvO2 may not be a sensitive measure of cardiac output after acute myocardial infarction.