Intensive care medicine
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Intensive care medicine · Jan 1981
Case ReportsEffect of PEEP on gas exchange, pulmonary mechanics, and hemodynamics in adult respiratory distress syndrome (ARDS).
The effect of positive end-expiratory pressure on a value resulting in maximum static effective compliance was studied in 13 artificially ventilated patients suffering from adult respiratory distress syndrome. Applying positive end-expiratory pressure in this manner resulted in improvement of oxygen delivery and left ventricular stroke work. ⋯ We conclude that the response to positive end-expiratory pressure depends on the importance of the venous admixture. Artificial ventilation with positive end-expiratory pressure on a level resulting in maximum static effective compliance is indicated in cases with high venous admixture.
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Insensible fluid losses were estimated using fluid balances and body weight changes in twelve artificially ventilated patients with severe tetanus. Studies were carried out over initial twenty day periods of treatment on six patients aged between 26 and 49 years and six aged 63 to 78. ⋯ When quantified, insensible fluid losses appeared greatest in the younger patients (up to 3.81 per day) and increased throughout the period of study. Dehydration will tend to occur unless the magnitude of these insensible losses is appreciated and taken into account when managing fluids.
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Intensive care medicine · Jan 1981
Randomized Controlled Trial Clinical TrialCan postoperative continuous positive airway pressure (CPAP) prevent pulmonary complications after abdominal surgery?
Twenty-four patients underwent elective cholecystectomy. They were randomized into two groups, one consisting of 13 patients having CPAP* by face-mask for 4 h after surgery and the other, consisting of 11 patients serving as control. The patients were all given intravenous anesthesia and were manually ventilated during anesthesia without using PEEP. ⋯ The study showed that both groups had a reduction in VC and PaO2 and a high percentage of them developed chest X-ray changes. In none of the variables mentioned was there any significant difference between the groups after surgery. Hypoxemia after abdominal surgery can thus not be prevented by only using CPAP for 4 h postoperatively.
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A retrospective review was undertaken of 169 patients admitted to an Intensive Therapy Unit with a major chest injury to determine the incidence, clinical features and outcome of patients with myocardial contusion. This injury occurred in 29 (17%) patients, of whom 24 (83%) had significant cardiovascular complications and five died as a direct result of the injury. The interval between injury and diagnosis was 3.2 +/- 2.3 days (mean +/- SD) from injury and in six patients the diagnosis was made only at necropsy. Increased awareness of myocardial contusion is required for earlier diagnosis and prevention of complications.