Critical care medicine
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Critical care medicine · Jun 1986
Determinants of alveolar ventilation during high-frequency transtracheal jet ventilation in dogs.
The effectiveness of transtracheal jet ventilation is a function of gas delivery pressure (drive pressure), duty cycle (insufflation time/total cycle time), and respiratory frequency. Nine dogs, anesthetized with sodium pentobarbital, were ventilated through a cricothyrotomy cannula using a controller that allowed separate setting of drive pressure, duty cycle, and frequency. PaO2 and PaCO2 were measured after achieving steady-state gas exchange at 15 to 22 different combinations of drive pressure, duty cycle, and frequency in each dog. ⋯ The distribution of air flow between alveolar and physiologic dead space, upper airway leakage, and entrainment was determined for each set of conditions. Changes in alveolar ventilation corresponding to the blood gas changes resulted from interaction of dead-space ventilation and upper airway leakage, which varied with breath duration. Decreases in leakage during short breaths tended to compensate for the increased fractional dead-space ventilation at high frequency, thus minimizing the effects of frequency changes on gas exchange.
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Critical care medicine · Jun 1986
Case ReportsInadvertent gastric balloon inflation within the chest in the management of esophageal varices.
Balloon tamponade of esophageal variceal hemorrhage is palliative therapy which is associated with a certain incidence of morbidity, perhaps mortality. Three cases of intrathoracic inflation of the gastric balloon of such tubes are described. The precise mechanism of thoracic placement remains uncertain. Fluoroscopy or chest x-ray should be used to confirm appropriate tube tip placement.
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As of October 1985, 37 candidates have passed the final examination in intensive care for the Diploma of Fellow of the Faculty of Anaesthetists, Royal Australasian College of Surgeons (FFARACS). In September 1984, 23 of these successful candidates responded to a questionnaire seeking information on their educational experiences during training and the nature of their work since the examination. ⋯ The responses to the questions on training indicated that more intensive care and medical experience were considered desirable. Most felt that their training and the examination were useful in determining long-term employment, satisfactory performance in intensive care, and personal job satisfaction.
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Critical care medicine · Jun 1986
Influence of hypothermia, barbiturate therapy, and intracranial pressure monitoring on morbidity and mortality after near-drowning.
We retrospectively evaluated the clinical and pathologic effects of hypothermia and high-dose barbiturate therapy on hypoxic/ischemic cerebral injury after near-drowning in children. Of 40 near-drowned patients admitted to the ICU, 13 died, seven had permanent cerebral damage, and 20 survived. Twenty-four patients (group 1) were treated with a regime of hyperventilation, hypothermia, and high-dose phenobarbitone while intracranial pressure (ICP) was continuously monitored. ⋯ Hypothermia was associated with a decreased number of circulating PMNs but did not increase the number of neurologically intact survivors. Similarly, although barbiturates may control ICP, their use did not improve outcome. Because severe cerebral edema and herniation after near-drowning is usually associated with irreversible brain damage, measures to control brain swelling such as hypothermia and barbiturates will be of little benefit.(ABSTRACT TRUNCATED AT 250 WORDS)
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An 8.3-Fr modified pigtail catheter has been developed for chronic percutaneous drainage of pericardial effusions. Placement of this catheter using a modified Seldinger technique is virtually atraumatic. To test the safety and efficacy of this catheter for pleural drainage, it was used to manage eight collections of pleural fluid and nine pneumothoraces in a total of 12 infants and children. ⋯ Fluid accumulations were satisfactorily drained in every instance. Pneumothoraces were treated definitively with a single catheter, except when a bronchopleural fistula was present. Percutaneous pigtail drainage of pleura fluid or air is simple, safe, effective, and substantially less traumatic than standard chest-tube placement.