Resuscitation
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We investigated the effects of inversed ratio ventilation by altering the inspiratory:expiratory (I:E) ratio and assessing the time course changes in the intrapulmonary shunting (Qs/Qt) in 14 patients with acute respiratory failure. Stepwise prolongation of the I:E ratio from 1:1.9 to 2:1 and then to 2.6 or 4:1 was applied when PEEP failed to raise the PaO2 above 80 mmHg while breathing oxygen. ⋯ There were no significant changes in hemodynamics, PaCO2, or peak inspiratory pressure during IRV. This ventilatory pattern may be indicated when PEEP fails to improve PaO2, but prolongation of the inspiratory time above an I:E ratio of 2:1 did not produce a greater improvement in Qs/Qt and further increases in PaO2 did not occur after more than 10 h of IRV in our 14 patients.
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Recent studies in swine have suggested that estimating the duration of ventricular fibrillation (VF) could have important implications regarding the selection of the best therapeutic intervention during cardiopulmonary resuscitation (CPR). Successful defibrillation resulting in a pulsatile rhythm is more likely with VF of short duration, whereas VF of longer duration may require interventions designed to augment myocardial blood flow prior to defibrillation. Duration of VF has been estimated in a swine model by modelling the median frequency (FM) of the VF ECG signal. ⋯ The human data revealed an FM which had two peaks with subsequent gradual decline. The data in swine revealed an FM during VF which decreased initially then increased to a peak followed by a gradual decline. Our preliminary results demonstrate that a characteristic median frequency exists in humans which could be used to estimate the duration of VF.
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Comparative Study
A comparison of cardiopulmonary resuscitation with cardiopulmonary bypass after prolonged cardiac arrest in dogs. Reperfusion pressures and neurologic recovery.
Resuscitability and outcome after prolonged cardiac arrest were compared in dogs with standard external cardiopulmonary resuscitation (CPR) vs. closed-chest emergency cardiopulmonary bypass (CPB). Ventricular fibrillation (VF) was with no blood flow from VF 0 min to VF 10 min. Subsequent CPR basic life support (BLS) was from 10 min to VF 15 min. ⋯ Ten dogs in each group followed protocol and survived to 96 h. Five of ten in group I and six of ten in group II were neurologically normal (NS). We conclude that: (1) Reperfusion with CPB yields higher coronary perfusion pressures than reperfusion with CPR-ALS; and (2) even after no blood flow for 10 min, optimized CPR can result in cardiovascular resuscitability and neurologic recovery, similar to those achieved by CPB.
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Randomized Controlled Trial Comparative Study Clinical Trial
The rapid infusion system: a superior method for the resuscitation of hypovolemic trauma patients.
The rapid infusion system (RIS), which can deliver fluids/blood products rapidly at precise rates and normothermic conditions, was compared with conventional fluid administration (CFA) in a randomized study of 36 hypovolemic trauma patients. Admission stratification criteria of the groups were similar relative to age, Glasgow Coma Score (GCS), Injury Severity Score (ISS) and plasma lactate. Despite the lack of difference in blood loss between the 24-h survivors of the two groups, the CFA group required greater total fluids (23.6/20.21), red blood cells (5.5/4.61), fresh frozen plasma (FFP) (2.8/1.91), platelets (523/204 ml), and crystalloids (12.9/10.61). ⋯ The PTT and PT were related to the degree of lactic acidosis (P = 0.0001) and hypothermia (P = 0.001) but not to the amount of FFP given (P = 0.14). The hospital costs, days in the ICU, and days on the ventilator were greater for the CFA group, as was the incidence of pneumonia (0/11 vs. 6/17; P = 0.03). Hypovolemic trauma patients resuscitated with the RIS needed fewer fluid/blood products and had less coagulopathy; more rapid resolution of hypoperfusion acidosis; better temperature preservation; and fewer hospital complications than those resuscitated with conventional methods of fluid/blood product administration.
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Awareness during anesthesia is as old as anesthesia itself. Using muscle relaxing drugs, operations can be done on a relaxed but fully aware patient. ⋯ This article reviews the subject from some aspects including its causes, signs, tests and medico-legal points. Awareness during anesthesia can be looked at as 'the invisible scars of surgery.'