Critical care medicine
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Critical care medicine · Oct 1994
Comparative StudyLow mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study.
To evaluate the outcome in patients with severe adult respiratory distress syndrome (ARDS) managed with limitation of peak inspiratory pressure to 30 to 40 cm H2O, low tidal volumes (4 to 7 mL/kg), spontaneous breathing using synchronized intermittent mandatory ventilation from the start of ventilation, and permissive hypercapnia without the use of bicarbonate to buffer acidosis. Also, to compare hospital mortality rate with that predicted by the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the "ventilator score." ⋯ These results lend further support to the hypothesis that limitation of peak inspiratory pressure and reduction of regional lung overdistention by the use of low tidal volumes with permissive hypercapnia may reduce ventilator-induced lung injury and improve outcome in severe ARDS. This hypothesis is supported by a large body of experimental evidence, which also suggests that ventilator-induced lung injury may result in the release of inflammatory mediators, and thus may have the potential to augment the development of multiple organ dysfunction. However, the hypothesis requires testing in a randomized trial as acute hypercapnia could potentially have some adverse as well as beneficial effects.
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Critical care medicine · Oct 1994
Effect of baseline lung compliance on the subsequent response to positive end-expiratory pressure in ventilated piglets with normal lungs.
To determine the pulmonary function and hemodynamic effects of incremental positive end-expiratory pressure in two groups of normal ventilated newborn piglets with different baseline dynamic lung compliance. ⋯ Baseline dynamic lung compliance is an important determinant of the subsequent effect of positive end-expiratory pressure on pulmonary function and hemodynamics in the ventilated piglet with normal lungs.
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Critical care medicine · Oct 1994
Clinical TrialResuscitation of multiple trauma and head injury: role of crystalloid fluids and inotropes.
To determine the hemodynamic responses to blunt trauma with a closed-head injury and to investigate the effect that volume resuscitation has on intracranial pressure. ⋯ Many patients with diffuse blunt trauma closed-head injuries, even when they are normotensive, have evidence of impaired peripheral perfusion. Volume infusion and vasodilating inotropic support improve oxygen transport without increasing intracranial pressure. The observed relationship between intracranial pressure and the serum lactate concentration requires further study.
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Critical care medicine · Oct 1994
Relationships between plasma cytokine concentrations and leukocyte functional antigen expression in patients with sepsis.
To determine the relationships between cytokine concentrations and alterations in leukocyte functional antigen expression in sepsis. ⋯ These findings suggest that the expression of specific functional molecules on peripheral blood leukocytes is variably related to the net production of certain monokines in sepsis.
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Critical care medicine · Oct 1994
Extracorporeal membrane oxygenation for pediatric respiratory failure: five-year experience at the University of Pittsburgh.
To describe the etiology, respiratory severity of illness, and outcome in patients with pediatric respiratory failure who were treated with extracorporeal membrane oxygenation (ECMO). To identify predictors of death, and to compare our morbidity and mortality rates with those rates of a previously reported series of patients with pediatric respiratory failure managed conventionally. ⋯ ECMO appears to be a rational therapy for patients with pediatric respiratory failure who are likely to die with continued conventional management. Recovery of lung function by the end of the first week of ECMO may be a favorable prognostic indicator. Persistent airleak may be a nonfavorable prognostic indicator.