Critical care medicine
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Critical care medicine · Jan 1984
Case ReportsSevere hypoxemia without evidence of tissue hypoxia in adult respiratory distress syndrome.
A patient with severe arterial hypoxemia in adult respiratory distress syndrome (ARDS) secondary to a fractured femur is reported. A marked discrepancy between the clinical condition and laboratory findings was observed. At one point, PaO2 was below 4 kPa (30 mm Hg) on F1O2 0.21 without signs of tissue hypoxia. This patient illustrates beneficial effects of a leftward shift of the oxyhemoglobin dissociation curve.
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Critical care medicine · Jan 1984
Case ReportsLocal lung ventilation in critically ill patients using nonradioactive xenon-enhanced transmission computed tomography.
Nonradioactive xenon is sufficiently radiodense to increase the density of gas-containing lung as seen in a computed tomography (CT) scan. Subtraction of a baseline CT scan from the xenon-enhanced CT scan can accentuate gas space differences by subtracting fixed tissue densities. ⋯ The xenon CT scan, thus, provides more precise information about distribution of ventilation than planar radiogas techniques. The technical aspects of application to a critically ill patient and the mathematical basis of the technique are presented.
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Critical care medicine · Jan 1984
Comparative StudyPercutaneous transtracheal jet ventilation for cardiopulmonary resuscitation: evaluation of a new jet ventilator.
This study compared percutaneous transtracheal jet ventilation (PTJV) at a frequency (f) of 20/min, with high-frequency positive-pressure ventilation (HFPPV) at f of 60/min, and endotracheal intubation and intermittent positive-pressure ventilation (ET IPPV) at f of 10/min in apneic dogs. Fifty-four emergency medicine trainees (EMTs) attempted PTJV via a 14-gauge Angiocath attached to a hand-held jet ventilator, f of 20/min, and ET IPPV using an Ambu bag, f of 10/min. Twenty-nine other EMTs attempted cricothyrotomy using a prototype nonkinkable catheter (Arrow) and a new jet ventilator, Bronchovent, f of 60/min, equipped with a pressure sensor which stops ventilation at pressures greater than 20 cm H2O. ⋯ There was a higher equipment failure rate (catheter kinking and dislodgment) in the PTJV group. In the HFPPV group, the Bronchovent's pressure-limiting sensor stopped ventilation when the catheter was kinked or out of position, reducing the extent of subcutaneous emphysema and barotrauma. With further catheter improvements, HFPPV Bronchovent may offer a safe and reliable method of ventilating patients during CPR in the field.