Intensive care medicine
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Intensive care medicine · Mar 1982
Epidural analgesia or mechanical ventilation for multiple Rib fractures?
A protocol for treating thoracic trauma is proposed. Severe pulmonary lesion with increased venous admixture (e.g. contusio, atelectasis, aspiration) is treated by mechanical ventilation. Rib fractures with minor pulmonary lesion and therefore with only moderately abnormal gas exchange but with remarkably reduced vital capacity (even with flail chest) are controlled by thoracic epidural analgesia following vital capacity, tidal volume and respiratory rate. ⋯ The indication for a mechanical ventilation or for spontaneous breathing with thoracic epidural analgesia is therefore deducted more from functional variables than from morphological facts. The course of a consecutive series of 283 patients is presented. 155 patients were treated with primary ventilation and 112 patients with primary epidural analgesia, while 16 patients could be managed with general analgesia. The duration of treatment morbidity and mortality show this protocol to be very useful.
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Intensive care medicine · Mar 1982
The influence of PEEP ventilation on organ blood flow and peripheral oxygen delivery.
In an experimental study including 10 dogs with intact lungs (group I) and 10 dogs with oleic acid-induced pulmonary edema (group II), the effects of PEEP 10 and 20 (cm H20) on central hemodynamics, lung function, organ blood flow and tissue PO2 (liver and skeletal muscle) were examined. In both groups, PEEP resulted in a significant fall of cardiac output (CO) despite volume substitution. ⋯ Animals with pulmonary edema and consequently lower absolute values of CO showed a more uniform reduction of organ perfusion sparing only brain and heart PEEP 10 led to a marginal improvement of tissue oxygenation, whereas PEEP 20 resulted in a deterioration of local PO2 associated with a decrease in O2 transport. It is concluded that whenever PEEP is applied, a reduction and redistribution of CO may occur possibly jeopardizing tissue oxygenation and thus interfering with organ function.
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Intensive care medicine · Jan 1982
Randomized Controlled Trial Comparative Study Clinical TrialThe significance of colloid osmotic pressure measurement after crystalloid and colloid infusions.
Colloid osmotic pressure (COP) was followed postoperatively in 55 randomized patients. After minor operations and short-term infusion therapy only small changes of the COP could be observed and it was concluded that after such operations COP measurement is unnecessary. After major surgical interventions, however, COP measurement gave valuable hints. ⋯ The same applied also to preoperative hemodilution. It was unnecessary to substitute the withdrawn blood with a colloid solution. In addition, COP measurement helped to avoid expensive albumin administrations, and indicated colloid overload in cases of pulmonary edema.
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Intensive care medicine · Jan 1982
Normal values of functional residual capacity in the sitting and supine positions.
The measurement of functional residual capacity (FRC) has assumed new importance in the diagnosis of acute respiratory failure. However few reference values exist for FRC in supine positions for both sexes. We measured the FRC in 100 healthy subjects with the helium dilution closed circuit method in the sitting and supine positions. ⋯ The FRC always decreased when the subject changed from the sitting to supine position. In this study, the correlation coefficients between FRC and height were statistically significant for both sexes, the influence of age and weight on FRC being negligible. Our results provide useful reference values for FRC in the supine position.