Critical care medicine
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A 53-yr-old woman with mediastinitis after thymectomy for myasthenia gravis was successfully mechanically ventilated with airway pressure release ventilation (APRV), which was started when the patient was intubated and continued by mask for 2 days after extubation. Mask APRV allowed efficient mechanical ventilation.
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Critical care medicine · Dec 1988
Unreliability of oxygen tension-based indices in reflecting intrapulmonary shunting in critically ill patients.
Measurement of intrapulmonary shunting (Qsp/Qt), a widely used method for monitoring disturbances of pulmonary oxygen transfer in critically ill patients, involves calculation of arterial and mixed venous oxygen contents. In circumstances where mixed venous blood samples are not readily available, oxygen tension-based indices such as the alveolar to arterial oxygen tension differences (P[A-a]O2), arterial oxygen tension to alveolar oxygen tension ratio (PaO2/PAO2), PaO2 to FIO2 ratio (PaO2/FIO2) and respiratory index (RI) are widely utilized to reflect Qsp/Qt. Oxygen content-based indices such as the estimated shunt are not as widely utilized as the oxygen tension indices. ⋯ Correlations between Qsp/Qt and estimated shunt were good (r = .94) and poor for the P(A-a)O2 (r = .62), PaO2/PAO2 (r = .72), PaO2/FIO2 (r = .71), and RI (r = .74). We conclude that there are no real substitutes for venous oxygen contents in critically ill patients. When pulmonary artery blood is not available for analysis, oxygen tension-based indices are unreliable reflectors of Qsp/Qt while the estimated shunt, an oxygen content-based index, provides a more reliable reflection of Qsp/Qt.
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Critical care medicine · Dec 1988
Comparative StudyContinuous monitoring of tissue oxygen tension during hyperoxia and hypoxia: relation of subcutaneous, transcutaneous, and conjunctival oxygen tension to hemodynamic variables.
Subcutaneous, transcutaneous, and conjunctival oxygen tensions (PscO2, PtcO2, and PcjO2, respectively) were measured in anesthetized dogs subjected sequentially to normoxia, hyperoxia, and hypoxia. Intravascular pressure, hemodynamic and oxygen transport variables were measured simultaneously. PtcO2 and PcjO2 closely paralleled PaO2 during normoxia, hyperoxia, and hypoxia over a wide range of arterial oxygen tensions. ⋯ Oxygen delivery and oxygen consumption were maintained or only slightly changed during hypoxia. All three continuous measurements of oxygen tension are reliable indices of PaO2 over a wide range under normovolemic conditions. The instruments for measuring PscO2 and PcjO2 are unheated and therefore may have advantages for human application.