Resuscitation
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A lethal case of Adult Respiratory Distress Syndrome (ARDS) consequent to meningococcal septicemia is clinically and physiologically described. Very high levels of eosinophil cationic protein and lactoferrin in bronchoalveolar lavage were observed in spite of peripheral eosinopenia and neutropenia. These findings provide support for the hypothesis that activated granulocytes are involved in the pathogenesis of septic-induced ARDS.
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This study examined the effect of carbon dioxide, lidoflazine and deferoxamine therapy upon the 10-day survival incidence and subsequent neurologic function of rats subjected to 7 min of cardiorespiratory arrest with resuscitation. Cardiac arrest (asystole) was induced at time zero by injection of cold, 1% KCl into the left ventricle of ketamine-anesthetized rats pretreated with succinylcholine. Positive pressure ventilation was discontinued at time zero. ⋯ At 2 days postresuscitation, 75% of treated rats vs. 25% of control rats were alive (CHI2 = 10.0, d.f. = 1, P less than 0.01), and at 10 days, 60% of treated rats vs. 25% of control rats were alive (CHI2 = 5.01, d.f. = 1, P less than 0.05). There was no detectable neurologic deficit among survivors in either group at 15 days. The combination of carbon dioxide, lidoflazine and deferoxamine, administered after return of spontaneous circulation, is a simple and easily administered treatment regimen that improves the survival incidence without neurologic deficits in this animal model of cardiorespiratory arrest and CPR.
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Case Reports Comparative Study
A double-crossover study comparing conventional ventilation with high frequency ventilation in a patient with tracheoesophageal fistula.
Respiratory distress, from severe gastric aspiration pneumonitis and abdominal distention in the patient with tracheoesophageal fistula frequently requires mechanical ventilatory support. Bulk flow ventilation can lead to enlargement of the fistulous tract, elevation of gastric intraluminal pressures, raised airway pressures with hemodynamic instability, and retained secretions. We report a case of tracheoesophageal fistula, secondary to perforation of a squamous cell carcinoma of the esophagus, with temporary improvement in gas exchange on high frequency ventilation after failing on a conventional ventilator. ⋯ We were unable to provide life-sustaining ventilation and oxygenation with either an Engstrom ventilator at 13 l/-minute ventilation or an MA-1 ventilator (Puritan-Bennett, Kansas City, MO) at a tidal volume of 800 cc and a ventilator rate of 30. Terminal respiratory failure occurred. Based on the period of improvement using high frequency jet ventilation, we believe this mode of ventilatory support is beneficial in the management of tracheoesophageal fistula.
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The buffering capacities of common colloid and crystalloid resuscitation solutions were compared in vitro. An equal volume of each resuscitation solution was titrated above and below its initial pH with 0.14 N sodium hydroxide or 0.11 N hydrochloric acid. ⋯ With the method of this in vitro study, human fresh frozen plasma was 25-50 times better as an acid buffer than the crystalloid solutions and approx. 5 times better than human serum albumin (HSA). On an equal volume basis, it was the superior resuscitation solution as a buffer, probably because of combined bicarbonate and protein content.
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The endotracheal route for drug administration provides a rapid means of accessing the systemic circulation when intravenous routes cannot be established in emergent situations. This route is relatively free of significant complications and has been documented as being successful numerous times in various clinical settings. Currently, the following drugs have been studied by this route: epinephrine, atropine, lidocaine, naloxone, bretylium, and diazepam. The paper reviews the current state of the art of endotracheal drug administration.