Chest
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Comparative Study
Temporal hemodynamic and oxygen transport patterns in medical patients. Septic shock.
Because of the gradual insidious transitions between localized infection, generalized infection, and septic shock, it is difficult to compare data of patients in various stages and to differentiate primary from secondary and tertiary events. The aim of the present study was to describe the sequential pattern of hemodynamic and oxygen transport patterns of survivors and nonsurvivors of septic shock in order to evaluate possible physiologic mechanisms and to provide a template to relate the sequence of physiologic events to biochemical mediators. ⋯ We conclude that increased cardiac index and DO2 represent compensations for circulatory inadequacies that limit body metabolism as reflected by VO2. Cardiac index, DO2, and VO2 values of survivors were higher than those of nonsurvivors and normal values. Therapy directed toward increasing cardiac index to supranormal values empirically determined by survivors has been reported to improve outcome. Additional studies to describe temporal relationships of biochemical mediators of these physiologic patterns are needed.
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Case Reports
Massive macroglossia as a presenting feature of hypothyroid-associated pericardial effusion.
An 81-year-old woman presented with massive macroglossia and signs of both hypothyroidism and pericardial tamponade. Drainage of the pericardial effusion produced dramatic resolution of the macroglossia. Marked elevation of central venous pressure may result in macroglossia, possibly because of anomalous venous drainage of the tongue.
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Case Reports
Increased blood pressure during inverse ratio ventilation in two patients with adult respiratory distress syndrome.
Inverse ratio ventilation (IRV) is increasingly used in the supportive treatment of patients with hypoxemic respiratory failure. A recent study suggests that IRV reduces cardiac output with minimal effect on mean arterial pressure. We report two cases in which IRV led to reproducible increases in mean arterial pressure. Concomitant hemodynamic measurements suggest that these responses occurred as a result of increased vascular resistance.