Critical care medicine
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Critical care medicine · Jan 1983
Comparative StudyComparative studies of IPPV and HFPPV with PEEP in critical care patients. II: Studies on intrapulmonary gas distribution.
The ventilatory patterns of a conventional ventilator for volume-controlled ventilation (SV-900) and a low-compression ventilator utilizing the pneumatic valve principle for pressure/flow-generated, volume-controlled ventilation (system H) were studied in a lung model and in 10 patients with respiratory failure. System H was used at frequencies of 20 (H-20) and 60 (H-60 = high-frequency positive-pressure ventilation [HFPPV]) breath/min, and SV-900 at a frequency of 20 (SV-20) breath/min. With system H, inspiration constituted 22% (no inspiratory pause) and with SV-900, 25% (with 10% inspiratory pause). ⋯ This increased velocity increases gas mixing by increasing turbulence in conducting airways. In the 10 patients with respiratory failure, intrapulmonary gas distribution (measured as the nitrogen washout delay) was improved from 106% during SV-20 to 74% with H-60 (p less than 0.05). H-60 also increased carbon dioxide elimination in the 2 patients with the most severe pulmonary dysfunction.
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Critical care medicine · Jan 1983
Comparative StudyComparative studies of IPPV and HFPPV with PEEP in critical care patients. I: A clinical evaluation.
The effects of the ventilatory patterns of a conventional ventilator (SV-900) and a low-compression ventilator (system H) were studied in 12 patients with respiratory failure (RF). Volume-controlled ventilation at frequencies (f) of 20 breath/min (SV-20) with SV-900, and 20 (H-20) and 60 (H-60 = high-frequency positive-pressure ventilation, HFPPV) breath/min with system H was given. Inspiration constituted 25% (with an inspiratory pause of 10%) of the ventilatory cycle with SV-900 and 22% with system H. ⋯ In the most severely ill patients, long-term HFPPV was uneventful. Airway suctioning during ventilation with oxygen was an important feature of the pneumatic valve principle (system H). The results of this study indicate that volume-controlled HFPPV is as efficient and as well accepted by the patient as conventional ventilation (SV-20).
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Critical care medicine · Jan 1983
Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.
The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. ⋯ No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.
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The primary goal of an interhospital critical care transport program is to provide quality medical care during transit as close as possible to that available in the receiving ICU. Critically ill pediatric patients are transported between hospitals by a variety of transport teams. The skills possessed by physicians, nurses, respiratory therapists, and paramedics overlap. ⋯ Patients were categorized by diagnosis, severity of illness at the time of transport, and the monitoring and life support required during transport. Our data indicate the medical transport team members should have skills required for pediatric critical care diagnosis and management including endotracheal intubation and assisted ventilation; insertion of peripheral, central venous, and arterial catheters; fluid and electrolyte therapy; antibiotic therapy; cardiovascular monitoring; and pharmacological life support. The team members should be chosen based on the particular skills needed for a transport with a goal of providing the patient care required on a consistent basis.
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The Therapeutic Intervention Scoring System (TISS) introduced in 1974 has become a widely accepted method of classifying critically ill patients. In response to requests to update the system because of recent innovations in critical care, some items have been deleted, some have been added, and certain point scores have been adjusted. ⋯ A comparison of the new 1983 system to the old 1974 system in 100 consecutive patients reveals no difference in total point scores. We hope this updated explanation will ease the task of assessing use of intensive care services.