Intensive care medicine
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Intensive care medicine · Jan 1985
Comparative StudyThe acute effects of prostaglandin E1 on the pulmonary circulation and oxygen delivery in patients with the adult respiratory distress syndrome.
Prostaglandin E1 was administered intravenously to 10 patients who had the adult respiratory distress syndrome associated with severe infection in order to investigate its hemodynamic effects. Infusion of PGE1 significantly decreased the mean pulmonary arterial pressure, mean systemic arterial pressure, pulmonary vascular resistance and systemic vascular resistance, and increased the cardiac index, oxygen delivery and oxygen consumption. No significant difference was noted in the intrapulmonary shunt fraction. These results indicate that administration of PGE1 improves pulmonary hemodynamics and tissue oxygenation in patients with acute respiratory distress syndrome, by reducing right ventricular afterload and increasing the cardiac index.
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Intensive care medicine · Jan 1984
Variations of regional lung function in acute respiratory failure and during anaesthesia.
Acute respiratory failure and anaesthesia impede ventilation of dependent lung units and perfusion of non-dependent ones, creating considerable ventilation-perfusion (V/Q) mismatch. General PEEP can improve V/Q but it cannot restore it to normal. To improve matching, ventilation must be distributed in proportion to regional blood flow. ⋯ Using this ventilator setting as a rule of thumb in patients with acute, severe, bilateral lung disease, arterial oxygen tension was improved by an average of 45% compared with that during general PEEP, with no reduction in cardiac output. It is concluded that differential ventilation with selective PEEP can offer considerable improvement in gas exchange in acute, bilateral lung disease. However, long-term studies are required before a final evaluation can be made.
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Intensive care medicine · Jan 1984
Case ReportsUpper airway obstruction caused by massive subcutaneous emphysema.
Acute upper airway obstruction is a potentially life-threatening event. The most common causes include foreign body inhalation, thermal injury, inflammation, angioedema and trauma. Airway obstruction caused by submucosal extension of subcutaneous emphysema has only been previously reported once. We report the case of a patient who suffered a respiratory arrest as a result of hypopharyngeal and laryngeal swelling associated with massive subcutaneous emphysema.
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Intensive care medicine · Jan 1984
Case ReportsRecurrent torsade de pointes type ventricular tachycardia in intracranial hemorrhage.
Two out of 72 cases of intracranial hemorrhage-induced polymorphous ventricular tachycardia with typical Torsade de Pointes morphology are presented. Both patients had marked QTc prolongation more than 550 ms. ⋯ Even though polymorphous Torsade de Pointes type ventricular tachycardia is rare during the clinical course of intracranial hemorrhage, attention should be given to the QT interval. QTc prolongation more than 550 ms may carry a high risk of Torsade de Pointes type ventricular tachycardia and ventricular fibrillation.
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Intensive care medicine · Jan 1984
Case ReportsSevere pulmonary interstitial emphysema of the right lung treated by selective intubation of the left main bronchus.
As an alternative to surgical treatment, we have selectively intubated the left main bronchus in children with severe pulmonary interstitial emphysema (PIE) of the right lung. Within 12-24 h the unilateral hyperinflation disappeared. We propose that when conservative treatment of unilateral PIE fails, contralateral SBI should be tried before surgical intervention, leading to loss of functioning tissue, is undertaken.