Intensive care medicine
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Intensive care medicine · Jan 1991
Case ReportsPersistent left superior vena cava--an unusual location of central venous catheters in children.
The incidence of central venous catheters inadvertently placed in a persistent left superior vena cava (PLSVC) was found to be 1.0% in a pediatric population requiring central venous catheterisation. Two well documented cases are presented and the possible association of PLSVC with other non-cardiovascular malformations is suggested.
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Intensive care medicine · Jan 1991
Comparative Study Clinical Trial Controlled Clinical TrialLow molecular weight hydroxyethyl starch 6% compared to albumin 4% during intentional hemodilution.
Intentional normovolemic hemodilution was chosen as the model to compare a 6% low molecular weight hydroxyethyl starch (LMW HES) to 4% albumin. The study ran over the plasma exchange period for 24 h. Nine patients, scheduled for abdominal aortic surgery, were included in each group. ⋯ After hemodilution, despite a significant decrease in arterial oxygen O2 content, systemic oxygen transport did not significantly vary until 24 h in relation to the increased cardiac index. An increase in O2 extraction was observed after the exchange but no further increase was observed until the 24 h. No significant changes either in global O2 consumption or in lactate concentration were detected.(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1991
Subclavian vein catheterization in critically ill children: analysis of 322 cannulations.
Complications in 322 percutaneous subclavian vein catheters placed in 272 children by the infraclavicular approach were investigated prospectively. Ages ranged from 4 days to 15 years. Incidents during catheter introduction occurred in 13 cases, and were more common when insertion was on the right side (p less than 0.01). ⋯ Staph. epidermidis isolation and duration of cannula use were statistically related (p less than 0.01). No catheter-related deaths occurred. We conclude that subclavian vein catheterization is a simple and useful procedure that entails relatively few serious complications when performed by experienced pediatricians.
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Intensive care medicine · Jan 1991
Influence of SIMV plus inspiratory pressure support on VA/Q distributions during postoperative weaning.
Since the introduction of synchronized intermittent mandatory ventilation (SIMV) several advantages have been attributed to this ventilatory mode, one of them being a more homogeneous distribution of ventilation and perfusion than during controlled mechanical ventilation (CMV). Up to now no data are available to confirm whether this is true when SIMV is used in combination with inspiratory pressure support (IPS). Therefore, we compared the influence of CMV and SIMV + IPS on the distributions of ventilation and perfusion in 9 patients undergoing weaning from postoperative mechanical ventilation. ⋯ This result was underscored by the unchanged dispersion of the perfusion distribution (log SDQ). The increased VD/VT was caused by increased inert gas dead space (from 22.0 +/- 9.6 to 26.8 +/- 8.7%) which was accompanied by increased ventilation of lung regions with high VA/Q ratios (10 less than VA/Q less than 100) in 3 patients. These results show that in our group of patients partial removal of CMV together with pressure support assistance of spontaneous ventilation did not induce a clinically significant loss of the efficiency of the breathing pattern.(ABSTRACT TRUNCATED AT 250 WORDS)