Critical care medicine
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This study evaluates the effectiveness of combining mechanical ventilation and 5 cm H2O positive end-expiratory pressure (PEEP) at the onset of adult respiratory distress syndrome (ARDS) in dogs. Five cm H2O PEEP applied at the onset of ARDS in oleic acid injured dogs resulted in a decrease in cardiac output (CO). ⋯ Control group dogs (receiving mechanical ventilation only) showed a less dramatic changing in CO, but demonstrated a dramatic drop in saturation, compromising oxygen transport of the tissues. Thus, despite decrease in CO experienced by the PEEP group, oxygen extraction at the tissue level remained high.
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The administration of albumin in the initial resuscitation of shock remains highly controversial. Impaired coagulation in the critically injured patient has recently been added as an argument against the use of supplemental albumin. This study investigated the hemostatic effects of albumin therapy after hemorrhagic shock. ⋯ Coagulation parameters were measured before bleeding, immediately after resuscitation, and on days 2, 3, and 4. The changes in platelet count, platelet function, and serum fibrinogen were similar in the albumin treated and control animals. Although the prothrombin time and partial thromboplastin time were more prolonged in the albumin group, the changes were not sufficient to produce clinical bleeding.
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Critical care medicine · Jan 1981
Ventilatory management of life-threatening bronchopleural fistulae. A summary.
The loss of a substantial portion of a critically ill patient's inspired tidal volume through a bronchopleural fistula (BPF) may significantly alter the intrapulmonary distribution of ventilation, ventilation-perfusion matching and arterial blood gases. If surgical closure of the fistulous tract is not possible, modifications of traditional ventilatory methods may be necessary to preserve adequate gas exchange. ⋯ Although these techniques might be considered investigational, they can be justified: (1) in the presence of profound hypoxemia and hypercarbia caused by a large BPF, and (2) when reduced gas loss through the fistula is considered an important part of therapy. All the methods discussed below apply in patients requiring endotracheal intubation and mechanical ventilation, whereas some (as indicated in the text) can be used during spontaneous breathing.