Anesthesiology
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Numerous problems can occur with liquid oxygen delivery systems, in part because of the complexities of such systems. These systems must comply with guidelines of the Joint Commission on Accreditation of Hospitals. During the past year, 18 major problems with the liquid oxygen delivery system have occurred at the authors' hospital. ⋯ Twice, excessive depletion of the reserve supply occurred owing to failure of the vacuum seal on the reserve supply vessel. Eight other potentially serious mishaps have also been reported. These problems, which are inherent in liquid oxygen delivery systems, are for the most part preventable.
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To assess the change in venous admixture during breathing of 100 per cent oxygen (FIO2 1.0), shunt fraction (Qs/Qt) was calculated at a maintenance FIO2 (FIO2m:0.27--0.70) and at FIO2 1.0 in 40 studies of 34 patients with acute respiratory failure. At FIO2 1.0 Qs/Qt increased in 26 studies, but did not increase in 14 studies. ⋯ Respiratory failure was more severe in those in whom Qs/Qt decreased with oxygen, as indicated by high Qs/Qt values at FIO2m, evidence of diffuse pulmonary disease by roentgenography, and signs of adult respiratory distress syndrome. The authors conclude that changes in Qs/Qt in response to FIO2 1.0 in acute respiratory failure are related to the severity of respiratory insufficiency.