Critical care medicine
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Critical care medicine · Feb 1996
Comparative StudyRegional tracheal blood flow during conventional and high-frequency jet ventilation in suckling pigs.
To determine whether intubation and ventilation with either conventional mechanical ventilation or high-frequency jet ventilation, using dry or humidified gas, could induce regional tracheal ischemia and serve as a basis for the tracheal necrosis observed clinically during ventilation. ⋯ Acute tracheal hyperemia occurred with intubation and ventilation with both conventional mechanical ventilation and high-frequency jet ventilation but no differences were observed between ventilation modes. Hyperemia was further increased with cool, dry inspired gas, using high-frequency jet ventilation but not conventional mechanical ventilation. Although acute tracheal ischemia was not produced by high-frequency jet ventilation or conventional mechanical ventilation, factors which alter the balance between arterial supply and metabolic demand or induce inflammation may contribute to the tracheal necrosis reported during sustained ventilation.
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Severe traumatic brain injuries are extremely heterogeneous. At least seven of the secondary derangements in the brain that have been identified as occurring after most traumatic brain injuries also occur after cardiac arrest. These secondary derangements include posttraumatic brain ischemia. ⋯ Stepwise measures to prevent lethal brain swelling after traumatic brain injury need experimental exploration, based on the multifactorial mechanisms of brain swelling. Novel treatments have so far influenced primarily healthy tissue; future explorations should benefit damaged tissue in the penumbra zones and in remote brain regions. The prehospital arena is unexplored territory for traumatic brain injury research.
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The development of modern cardiopulmonary-cerebral resuscitation (CPCR) has given every person the ability to challenge death anywhere. Despite sparks of knowledge and occasional applications of possibly effective lifesaving efforts since antiquity, the possibility to reverse acute terminal states or clinical death by modern, physiologically sound, and effective measures did not come about until around 1900 inside hospitals, and around 1960 outside hospitals. Additional potentially effective cerebral resuscitation, research since around 1970, may be taken to clinical trials before the year 2000. ⋯ Research challenges concerning brain trauma, uncontrolled hemorrhagic shock, and "suspended animation" for delayed resuscitation have their own histories, and are not covered here. The author apologizes for not having recognized many important contributors to the history of CPCR because of space constraints or lack of knowledge about such contributions. Input on this subject from readers of this paper is hereby invited.
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Critical care medicine · Feb 1996
Clinical diagnostic criteria of the adult respiratory distress syndrome in the intensive care unit.
To determine the use of commonly used diagnostic criteria for adult/acute respiratory distress syndrome (ARDS), evaluate physiologic variables of most value in diagnosing ARDS, and assess the frequency of newly diagnosed ARDS. ⋯ A wide range of diagnostic criteria are utilized by clinicians in the diagnosis of ARDS.
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Critical care medicine · Feb 1996
Comparative StudyTotal liquid ventilation with perfluorocarbons increases pulmonary end-expiratory volume and compliance in the setting of lung atelectasis.
To compare compliance and end-expiratory lung volume during reexpansion of normal and surfactant-deficient ex vivo atelectatic lungs with either gas or total liquid ventilation. ⋯ End-expiratory lung volume and static compliance are increased significantly following attempted reexpansion with total liquid ventilation when compared with gas ventilation in normal and surfactant-deficient, atelectatic lungs. The ability of total liquid ventilation to enhance recruitment of atelectatic lung regions may be an important means by which gas exchange is improved during total liquid ventilation when compared with gas ventilation in the setting of respiratory failure.