Critical care medicine
-
Critical care medicine · Apr 1983
Comparative StudyCompared effects of selected colloids on extravascular lung water in dogs after oleic acid-induced lung injury and severe hemorrhage.
While the hemodynamic effects of hydroxyethyl starch (HES) have been reported, the effect of this material upon extravascular lung water (EVLW) has not been investigated. Twenty mongrel dogs were subjected to both an oleic acid-induced lung injury and a 2-h period of hemorrhagic shock (MAP = 40 mm Hg). After reinfusion of shed blood, 5 dogs in each of 4 groups were given either 0.5 L of lactated Ringer's solution or 0.5 L of 5% albumin, 6% dextran 75, or 6% HES. ⋯ EVLW was 25.5 +/- 3 ml/kg in the HES dogs, and 29.5 +/- 2 ml/kg in the group given albumin. Differences between albumin and lactated Ringer's solution and between the HES and lactated Ringer's groups were significant (p less than 0.02 and p less than 0.05). Measurements of oxygen, ventilation, CI, and oxygen delivery were not significantly different between the albumin and HES subjects.
-
Critical care medicine · Apr 1983
Comparative StudyCentral venous versus esophageal pressure changes for calculation of lung compliance during mechanical ventilation.
Esophageal and CVP changes were measured simultaneously during mechanical ventilation in 12 patients with acute respiratory failure (ARF). The results of these measurements were different and showed no correlation. Values of transpulmonary pressure changes and calculated lung compliances correlated well, because of the higher airway pressure changes. ⋯ Clinical awareness of factors influencing thoracic cage compliance is important. The difference in transpulmonary and transthoracic pressure relationships during mechanical ventilation and during spontaneous breathing is emphasized. In spontaneous breathing, intrapleural pressure changes are determined primarily by the elastic properties of the lungs; in mechanical ventilation, on the other hand, by the elastic properties of the thoracic cage.
-
Critical care medicine · Apr 1983
Intraesophageal pressure monitoring in infants with respiratory disorders.
Intrapleural (Ppl) and intraesophageal pressure (Pes) measurements were compared during spontaneous respiration in sick infants. The Pes, measured with a water-filled catheter, indicates pressure variations in the esophagus to be about 4.5% smaller than in the pleural cavity. ⋯ Air in the pleural cavity causes marked diminution in Pes fluctuation. Continuous monitoring of Pes may be useful in the early detection of pulmonary air leak in neonates with respiratory disorders.
-
Critical care medicine · Apr 1983
Diaphragmatic paralysis after pediatric cardiac surgery: a retrospective analysis of 34 cases.
Thirty-four cases of diaphragmatic paralysis after pediatric cardiac surgery are reviewed. Differences between pediatric and adult pulmonary physiology account for the increased severity of respiratory distress seen in children with this condition. ⋯ This finding is consistent with the development of sufficient chest wall stability to compensate for paralysis of the hemidiaphragm. Patients under 3 yr of age, without complicating heart failure, who still required intubation and CPAP 3-4 wk after injury to the phrenic nerve should consider operative plication.