Critical care medicine
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Critical care medicine · Jul 1982
Hemodynamic response to changes in ventilatory patterns in patients with normal and poor left ventricular reserve.
Hemodynamic effects of controlled mechanical ventilation (CMV), intermittent mandatory ventilation (IMV), and intermittent mandatory ventilation with 5 cm H20 PEEP (IMV 5 peep) were studied in 20 patients after aortocoronary bypass surgery. Significant increases in cardiac index (CI) and stroke volume index (SI) (p less than 0.01) resulted in patients with normal left ventricular end-diastolic pressure (LVEDP) and ejection fraction (EF) changing from CMV to IMV. With a change from IMV to IMV 5 peep, the CI and SI returned to CMV values. ⋯ We conclude that changing from CMV to IMV has salutory effects on the patient's hemodynamic values with normal left ventricular function. But in patients with failing left ventricle, volume overload of right ventricle which occurs with the institution of spontaneous respiration during IMV has deleterious effects on the hemodynamic variables. These deleterious effects can be effectively negated by the application of IMV 5 peep.
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Critical care medicine · Jul 1982
Predictive value of stridor in detecting laryngeal injury in extubated neonates.
We evaluated 73 consecutively extubated neonates for evidence of acute laryngeal injury from intubation. Hoarseness and stridor were graded by a clinical scoring system. ⋯ All patients with stridor had moderate or major injury, as did 38% of patients without stridor. Stridor was quite specific for detecting moderate or major injury but did not identify the type of injury.
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Critical care medicine · Jul 1982
Comparative StudyCirculatory responses to afterloading with phenylephrine in hyperdynamic sepsis.
We assessed cardiac function by acute pressure loading with phenylephrine in 7 patients who had hyperdynamic sepsis and in 8 patients who had heart disease. All patients with sepsis had a positive Limulus lysate teat, a septic focus, and a cardiac output (CO) greater than 6.0 L/min. ⋯ In patients with heart disease, CI and SI decreased significantly, whereas SVRI increased significantly. The marked differences in response to phenylephrine by the two groups suggest lack of cardiac dysfunction in patients with hyperdynamic sepsis.