Critical care medicine
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Critical care medicine · Jun 1983
Case ReportsUse of transcutaneous O2 monitoring in the intraoperative management of severe peripheral vascular disease.
Transcutaneous O2 (PtcO2) and CO2 (PtcCO2) monitoring has been used in infants, in critically ill adults, and more recently, in peripheral vascular disease. The present report compares values of centrally placed chest (PtcO2 and PtcCO2) sensors with values of peripherally placed calf (Ptc'O2 and Ptc'CO2) sensors in a patient with severe peripheral vascular disease during performance of an axillofemoral bypass graft. ⋯ The ratio reflects local tissue perfusion in the face of fluctuating PaO2 and central PtcO2 values. The data demonstrate that PtcO2 sensors reflect tissue blood flow and oxygenation and, therefore, are useful measures of tissue perfusion, especially during limb revascularization.
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Critical care medicine · Jun 1983
Prolonged mechanical ventilation for respiratory failure: a cost-benefit analysis.
To define the costs and benefits associated with prolonged mechanical ventilation, we studied retrospectively the records of 137 consecutive patients who required at least 48 h of ventilator support. The patients were physiologically unstable and required intensive care. Causes of respiratory failure included pulmonary diseases, post-operative complications, neuromuscular diseases, cardiac dysfunction, and GI disease. ⋯ These costs varied from +460/yr of extended life for patients with respiratory failure complicating asthma to +8026/yr for patients with cardiac dysfunction. The cost-benefit ratio increased sharply for men older than 56 yr and for women older than 75 yr. These data document the importance of the basic disease process and the patient's age in the cost-benefit relationship.
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We evaluated 95 extubated neonates to determine if certain risk factors could predict the development of laryngeal injury. Risk factors were recorded prospectively during the intubation period and correlated with laryngeal injury determined by laryngoscopy after extubation. Duration of intubation greater than or equal to 7 days and 3 or more intubations significantly predicted injury.
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Critical care medicine · Jun 1983
Comparative StudyPostural variations in pulmonary resistance, dynamic compliance, and esophageal pressure in neonates.
In order to determine effect of posture and to assess the reliability of the esophageal balloon method for measuring esophageal pressure changes (delta Pes) under clinical conditions, lung mechanics were measured in 13 term and preterm babies in each of 3 postures: supine, right, and left lateral. The pulmonary resistance (Rp) was significantly lower and the dynamic compliance (Cdyn) higher in the right lateral than in the supine position. ⋯ It is concluded that the (right) lateral posture is mechanically less demanding than the supine posture and that delta Pes can be measured accurately in the supine posture. Absolute values of PesEE have no physiologic meaning and should not be used for patient management or for the calculation of lung mechanics.
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Rapid changes in technology have forced many hospitals to consider changes in the size of their ICUs. One method of predicting intensive care bed needs creates a mathematical model of the unit which simulates the unit's operation. This report describes a model that provided information to a physician group charge with deciding how many beds to include in a proposed expansion of one hospital's ICU. ⋯ Based on the results, the group chose to leave the unit's size unchanged at 11 beds. The immediate result was to facilitate planning by providing quantitative estimates of the consequences of different choices. The long-term result was an ICU whose size accommodated patient needs despite changing demand for services.