Critical care medicine
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Critical care medicine · Mar 1985
Case ReportsChlorpromazine treatment for neurogenic pulmonary edema.
A patient with neurogenic pulmonary edema was successfully treated with the alpha-blocking agent, chlorpromazine. A pathophysiologic basis for this drug's efficacy is discussed.
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Critical care medicine · Mar 1985
Comparative StudyCerebral preservation during cardiopulmonary resuscitation.
Thirty-two dogs subjected to 4 min of ventricular fibrillation were equally divided into four treatment groups: (a) immediate defibrillation (control); or 30 min of (b) standard CPR (SCPR), (c) simultaneous ventilation-compression CPR (SVC-CPR), or (d) open-chest CPR (OCCPR). After 30 min of CPR, restoration of spontaneous circulation was attempted using drug therapy and countershocks and the animals maintained for 24 h or until refractory hypotension occurred. During CPR, OCCPR yielded higher mean arterial and lower central venous pressures than either external method. ⋯ Although circulation was restored in five SVC-CPR dogs, all were brain-dead and none survived 24 h. In the OCCPR group, seven animals survived 24 h and their neurologic deficit scores were not significantly different from control values. We conclude that OCCPR is greatly superior to SCPR and SVC-CPR with respect to preservation of the brain during resuscitation.
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Critical care medicine · Mar 1985
Forward displacement of the larynx for nasogastric tube insertion in intubated patients.
Simple insertion of a nasogastric (NG) tube was successful in only 52 of 100 anesthetized intubated patients. After the larynx was manually pulled forward, the NG tube was successfully inserted in 33 patients. ⋯ The difficulty of NG tube insertion was not correlated with sex, age, weight, or type of endotracheal intubation. Forward displacement of the larynx by manually gripping and lifting the thyroid cartilage is a useful and safe maneuver that facilitates NG tube insertion in anesthetized intubated patients.
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Critical care medicine · Mar 1985
Case ReportsSevere combined respiratory and myocardial failure treated with high-frequency ventilation.
High levels of positive end-expiratory pressure (PEEP) impair cardiac output. The subsequent lowering of mixed venous oxygenation, when coupled with a significant intrapulmonary shunt, may dramatically depress PaO2. We present a patient whose severe myocardial and respiratory insufficiency was unmanageable on conventional ventilation with high levels of PEEP and maximal inotropic support. High-frequency ventilation superimposed on conventional ventilation lowered peak airway pressure and dramatically improved both cardiac and pulmonary function.
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Critical care medicine · Mar 1985
Pathophysiology of adult respiratory distress syndrome after sepsis and surgical operations.
To describe the natural history of adult respiratory distress syndrome (ARDS) from the circulatory viewpoint, we measured hemodynamic and oxygen transport variables in a series of 126 postoperative and 65 septic ARDS patients. All patients had hypoxemia unresponsive to conservative measures and required mechanical ventilation. ⋯ Before the development of ARDS, both postoperative and septic patients exhibited hypovolemia, pulmonary vasoconstriction, suboptimal myocardial performance, and reduced oxygen delivery and consumption relative to the increased needs of the hypercatabolic state. Because these antecedent changes were greater in ARDS patients who died, their early correction (in addition to standard ventilatory support) may prevent the development of ARDS and decrease its mortality.