Critical care medicine
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Critical care medicine · Nov 1982
Flexible fiberoptic bronchoscopy and laryngoscopy in children under 2 years of age: diagnostic and therapeutic applications of a new pediatric flexible fiberoptic bronchoscope.
The new flexible fiberoptic bronchoscope (Olympus BF Type 3C4, Tokyo, Japan) was employed for diagnostic and therapeutic purposes in 96 children below 2 yr of age. Sixty-two laryngoscopies and 34 bronchoscopies were performed without any mortality or significant morbidity. The bronchoscope was helpful in establishing diagnosis and also served as a tool for aspirating secretions and resolving atelectasis. It is concluded that flexible fiberoptic bronchoscopy and laryngoscopy in children 2 yr or younger is a safe procedure and may aid in the diagnosis and therapy of disorders of the respiratory tract in this age group.
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Critical care medicine · Nov 1982
Catheter colonization and bacteremia with pulmonary and arterial catheters.
We prospectively studied the incidence of catheter-related sepsis in 51 critically ill patients who underwent 52 arterial and 37 pulmonary artery catheterizations over a period of 3 months. Daily cultures of blood and catheter insertion site were done and the catheters were cultured semiquantitatively at the time of removal. Catheter colonization defined as growth of 15 or more colonies was observed with 9 (10%) catheters and bacteremia with 4 (4.5%) catheters. ⋯ Femoral arterial catheterization appeared to be more often associated with colonization than radial catheters. It appears that the arterial and pulmonary artery catheter colonization occurs in about 10% of catheters and predisposes to catheter-related sepsis. Semiquantitative cultures of the catheter may aid in better documentation of catheter-induced sepsis.
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Critical care medicine · Nov 1982
Comparative StudyMechanical ventilation in fiberoptic-bronchoscopy: comparison between high frequency positive pressure ventilation and normal frequency positive pressure ventilation.
High frequency positive pressure ventilation (HFPPV) was compared with normal frequency positive pressure ventilation (NFPPV) during diagnostic fiberoptic-bronchoscopy. HFPPV was achieved by a simple modification of the Minivent, and gave satisfactory alveolar ventilation and oxygenation. In all 11 patients and over periods of at least 40 min, HFPPV gave normal PaCO2 and high levels of PAO2. Arterial blood pressures were higher and the airway pressures were lower than during NFPPV.
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Critical care medicine · Nov 1982
Transcutaneous O2 and CO2 monitoring of high risk surgical patients during the perioperative period.
The usefulness of noninvasive transcutaneous oxygen (PtcO2) and carbon dioxide (PtcCO2) sensors as well as invasive monitoring of flow and oxygen transport were evaluated in the perioperative period of a small series of high risk surgical patients. We used the pattern of physiological events preceding intraoperative death as the criteria for evaluation of the relative usefulness of these variables. Cardiac output (CO), oxygen delivery (DO2), and O2 consumption (VO2) provided the earliest warning of impending circulatory deterioration and were most useful during critical nonlethal circulatory episodes; these were closely paralleled by the PtcO2 index (PtcO2/PaO2); the PtcCO2 was less sensitive. Heart rate (HR) and mean arterial pressure (MAP) were highly variable with frequent changes unrelated to change in flow and O2 transport.