Critical care medicine
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Critical care medicine · Feb 1980
Case ReportsUse of volume loading to obtain preferred levels of PEEP. A preliminary study.
Hemodynamic and oxygen transport measurements were made with successive increments of positive end-expiratory pressure (PEEP) in 14 episodes of ARDS in 11 patients who had normal or slightly increased blood volumes. "Preferred" or optimal PEEP was defined as the PEEP value associated with the greatest VO2 that did not compromise pulmonary function as determined by shunting (Qs/Qt). The preferred PEEP averaged 10.7 +/- 2.7 (SD) cm H2O in the patients who had appreciable reduction in cardiac index (CI) by the time this level of PEEP was reached. ⋯ The final preferred PEEP in these patients averaged 14.1 +/- 3.6 (SD) cm H2O. The authors conclude that the titration of PEEP as well as fluid therapy may be used to maximize VO2 in patients with early shock lung.
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Although the Kistner tracheostomy tube was introduced 20 years ago, it has never been formally evaluated. This tube is an appliance used to maintain a tracheostomy stoma when there is some doubt as to the patient's ability to maintain his airway without a tracheostomy tube. The Kistner tube is a short tube that occupies only the distance from the skin to the inside of the tracheal wall. ⋯ Proper placement of the tube is of outstanding importance ot prevent protrusion of the tube into the tracheal lumen causing obstruction of the airway. Recommended maneuvers for prevention of complications along with advantages and shortcomings of the tube are discussed. With proper selection of the patient, use of the Kistner tracheostomy tube provides a safe and effective method to remove retained secretions and to wean from tracheostomy.