Critical care medicine
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Critical care medicine · Nov 1984
Sequential hemofiltration in nonoliguric high capillary permeability pulmonary edema of severe sepsis: preliminary report.
Five patients with nonoliguric adult respiratory distress syndrome (ARDS) secondary to severe sepsis showed improved blood oxygenation after up to 36 h of conventional therapy and mechanical ventilation with optimal positive end-expiratory pressure. However, metabolic acidosis was unchanged, and blood urea had increased. Some patients showed hemodynamic signs of incipient heart failure. ⋯ Patients recovered from ARDS in spite of fluid accumulation. Mechanical ventilation was stopped up to 8.5 h after the last hemofiltration. We postulate that convective ultrafiltration clears the blood of circulating low- and middle-weight vasoactive molecules implicated in the development of high microvascular permeability acute pulmonary edema secondary to sepsis.
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Critical care medicine · Nov 1984
Lateral position improves wedge-left atrial pressure correlation during positive-pressure ventilation.
Because lateral position can be used to locate a pulmonary artery catheter tip in lung regions where venous pressure exceeds alveolar pressure, we studied the effect of lateral position on the correlation between pulmonary artery occlusion pressure (Pw) and left atrial pressure (Pla) at various increments of positive-end expiratory pressure (PEEP). In ten normal anesthetized pigs, catheters were placed in the left atrium and right and left pulmonary arteries; simultaneous measurements of Pla and Pw from both catheters were obtained in the supine, right lateral, and left lateral positions. ⋯ These findings suggest that the lateral position can be useful in measuring Pw during continuous positive-pressure ventilation. However, further studies in humans are needed before this maneuver can be recommended.
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Critical care medicine · Nov 1984
Randomized Controlled Trial Comparative Study Clinical TrialComparison of continuous positive airway pressure, incentive spirometry, and conservative therapy after cardiac operations.
Of 38 patients undergoing median sternotomy for cardiac operations all developed profound restrictive defects in pulmonary function during the first 72 h after tracheal extubation. Although decreased lung volumes were refractory to correction by vigorous, aggressive pulmonary therapy during this period, frequent and supervised treatment may prevent further deterioration in pulmonary function. The overall incidence of pneumonia was only 3% (1/38). Continuous positive airway pressure delivered by mask proved to be a nearly effortless form of postoperative respiratory therapy that was less painful than incentive spirometry or coughing and deep breathing, and therefore may be preferable.
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Critical care medicine · Nov 1984
Pulmonary function before and after prolonged continuous positive airway pressure by mask.
This investigation examined whether prolonged continuous positive airway pressure (CPAP) applied by face mask could sustain an increase in functional residual capacity (FRC). Before median sternotomy, nine adults performed multiple-breath nitrogen washout to determine FRC and spirometry. ⋯ Although CPAP can restore FRC to preoperative values, and did increase FRC in these patients, FRC deteriorates within 10 min after CPAP is removed. Therefore, when a sustained increase in FRC is desired after median sternotomy, CPAP should be applied without interruption.