Intensive care medicine
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Intensive care medicine · Jan 1992
Comparative StudyContinuous positive airway pressure by face mask or mechanical ventilation in patients with human immunodeficiency virus infection and severe Pneumocystis carinii pneumonia.
We reviewed the records of 44 patients with AIDS who had 45 episodes of severe Pneumocystis carinii pneumonia (PCP). While 9 patients required intubation and mechanical ventilation (MV) on admission, continuous positive airway pressure (CPAP) by face mask was the initial measure in 36 episodes. There were 25 patients managed with CPAP alone, 23 of whom survived. ⋯ The in-hospital mortality for severe PCP in this study was 33% overall, and reached 65% for mechanically ventilated patients. The 1-year survival was 43% (95% confidence interval, 28%-58%). These data confirm the improved prognosis for patients with AIDS and severe PCP, and suggest that mask CPAP may be an adequate mean of ventilatory support in this setting.
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Intensive care medicine · Jan 1992
Case ReportsThe effect of sedation with propofol on postoperative bronchoconstriction in patients with hyperreactive airway disease.
Two patients with chronic obstructive pulmonary disease developed postoperatively bronchospasm after insertion of a prostetic aortic valve. Continuous sedation with propofol infusion was associated with a significant decline in peak inspiratory pressure suggesting that propofol may have bronchodilating properties.
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Intensive care medicine · Jan 1992
Intrathoracic blood volume accurately reflects circulatory volume status in critically ill patients with mechanical ventilation.
Positive pressure ventilation in patients with acute respiratory failure (ARF) may render the interpretation of central venous pressure (CVP) or pulmonary wedge pressure (PCWP) difficult as indicators of circulating volume. The preload component of cardiac (CI) and stroke index (SI) is also influenced by the increased intrathoracic pressures of positive pressure ventilation. Moreover CI and SI do not indicate volume status exclusively but also contractility and afterload. ⋯ All data were collected in intervals of 6 h. There were 224 data sets obtained. Linear regression analysis was performed between absolute values as well as between the 6 changes (prefix delta).(ABSTRACT TRUNCATED AT 250 WORDS)
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Intensive care medicine · Jan 1992
Reestimation of the effects of inorganic phosphates on the equilibrium between oxygen and hemoglobin.
In a previous paper, published in this journal, we showed that the data obtained in patients with severe ketoacidosis suggest that inorganic phosphates (K2HPO4) can increase their P50 and therefore enhance tissue oxygenation without concomitant alteration of the 2,3 diphosphoglycerate (DPG). In order to test the hypothesis that K2HPO4 could influence the oxyhemoglobin dissociation curve (ODC) by a mecanism which was not DPG mediated we have measured the total ODC on whole blood with and without addition of 13-80 mmol/l of inorganic phosphates. On average, the level of DPG remained unchanged when the P50 with K2HPO4 was significantly higher (p greater than 0.001) (P50 = 29.9 +/- 3.7 mmHg) than when phosphates were not administered (P50 = 25.5 +/- 2.8 mmHg). ⋯ Our data are important in two points. First it is useful to add inorganic phosphates to the treatment of patients with severe ketoacidosis in order to enhance their tissue oxygenation. Second they recall that the ODC is not only determined by the classical effects of temperature, pH and DPG but also by inorganic anions, like phosphates as described by Benesh and Benesh in their pioneering work.