Intensive care medicine
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Intensive care medicine · Jan 1991
Case Reports Clinical TrialCombined use of mask CPAP and minitracheotomy as an alternative to endotracheal intubation. Preliminary observation.
We describe the combined use of mask CPAP (continuous positive airway pressure) and minitracheotomy as an alternative to conventional endotracheal intubation in 3 patients requiring CPAP, secretion removal and diagnostic procedures such as bronchoalveolar lavage and bronchial cultures. These requirements were fulfilled with the combined technique approach, thus preserving glottic function and avoiding the disadvantages of endotracheal intubation of tracheotomy. This approach seems particularly suitable in the treatment of immunocompromised patients because of its reduced invasiveness.
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Intensive care medicine · Jan 1991
Acute carbon monoxide intoxication and hyperbaric oxygen in pregnancy.
Modalities of oxygen therapy for pregnant women intoxicated with carbon monoxide (CO) are ill defined. Hyperbaric oxygen (HBO) is presumed to be hazardous to the pregnancy. On the other hand CO entails anoxic injuries in the mother and fetus. ⋯ Finally 1 elected to undergo abortion for reasons unrelated to the intoxication and 1 gave birth to a baby with Down's syndrome. There is no evidence that HBO was involved with either abortion of our study. We conclude that HBO may be carried out in pregnant women acutely intoxicated with carbon monoxide.
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Hydroxocobalamin is a rapid and powerful antidote in acute cyanide poisoning. The effects of hydroxocobalamin (0.1, 0.3, and 1 mM) on intrinsic myocardial contractility were studied on isolated rat cardiac papillary muscles (n = 10). Whatever the concentration, hydroxocobalamin did not modify the active isometric force and a slight increase in maximum unloaded shortening velocity was noted at 1 mM. ⋯ No changes in contraction-relaxation coupling under heavy load were noted, suggesting the lack of modification of myofilament calcium sensitivity. These results suggest that hydroxocobalamin does not induce noticeable changes in intrinsic myocardial contractility. An indirect mechanism might be involved in the previously reported decrease in cardiac function at supratherapeutic concentrations of hydroxocobalamin.
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Intensive care medicine · Jan 1991
Comment Letter Case ReportsCPAP with a Siemens Servo 900C ventilator during weaning in infants.
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Intensive care medicine · Jan 1991
Comparative StudyHigh frequency jet ventilation in experimental pulmonary emphysema.
The effects of high frequency jet ventilation (HFJV, f = 2 Hz and 8 Hz, I:E = 0.43, FiO2 = 0.4) were studied and compared with intermittent positive pressure ventilation (IPPV, f = 10-14 breaths/min, VT = 15 ml/kg, I:E = 0.5, FiO2 = 0.4) in 8 dogs before and after induction of panlobular emphysema (PLE). PLE increased alveolar-arterial PO2 difference (PA-aO2) during all modes of ventilation, whereas PaCO2 did not change significantly. In both periods of the study, HFJV8 Hz was less effective in terms of CO2-elimination and oxygenation. ⋯ In the PLE-period, FRC and CV increased significantly to 1107 +/- 207 ml and 14.1 +/- 7.0% VC respectively during IPPV (P less than 0.05). Application of HFJV neither increased FRC (HFJV2 Hz: 1153 +/- 433 ml, HFJV8 Hz: 1005 +/- 344 nor CV 14.8 +/- 6.0% VC and 13.9 +/- 8.1% VC, respectively). It is concluded that HFJV induces no alveolar overdistension in dogs with emphysematous lungs.