Critical care medicine
-
Critical care medicine · Sep 1993
Randomized Controlled Trial Clinical TrialPerfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome: a prospective, randomized, controlled study.
To determine the efficacy of perfluorocarbon-associated gas exchange (partial liquid ventilation) in respiratory distress syndrome. ⋯ We conclude that perfluorocarbon-associated gas exchange, which employs liquid functional residual capacity and gas tidal volumes delivered by a conventional ventilator, can facilitate oxygenation and CO2 removal, and dramatically improve lung mechanics in the premature lamb with respiratory distress syndrome.
-
Critical care medicine · Sep 1993
Decreasing imposed work of the breathing apparatus to zero using pressure-support ventilation.
To apply pressure-support ventilation with the goal of decreasing the imposed work of the breathing apparatus (endotracheal tube, breathing circuit tubing, and the ventilator's demand-flow system) to zero and to evaluate a clinical method of measuring the imposed work of breathing. ⋯ Ideally, the imposed work of the breathing apparatus should be zero to decrease the afterload on the ventilatory muscles and, thus, the patient's work of breathing. Eliminating the imposed work is achieved using appropriate levels of pressure-support ventilation. We describe an easily applied, practical method of measuring imposed work using a commercially available, portable, bedside respiratory monitor. We recommend that all patients diagnosed with respiratory failure and compromised pulmonary mechanics and who are intubated and breathing spontaneously, receive at least a minimal level of pressure-support ventilation that results in zero breathing apparatus-imposed work of breathing.
-
Critical care medicine · Sep 1993
Comparative StudyReal-time gas-exchange measurement of oxygen consumption in neonates and infants after cardiac surgery.
The purposes of this study were: a) to measure oxygen consumption (VO2) in ventilated neonates and infants after cardiac surgery, utilizing a real-time gas exchange system; and b) to assess this new method by comparing the measured VO2 with calculated VO2 (using the Fick equation and simultaneously determined thermodilution cardiac output, measured hemoglobin, and measured mixed venous and arterial saturations). ⋯ Measured VO2 using a gas-exchange system compared favorably with calculated VO2 values using the Fick equation and simultaneously obtained thermodilution cardiac output and arterial and venous oxygen concentrations. By employing this breath-by-breath gas-exchange system, real-time VO2 measurement in ventilated neonates and infants is now feasible.
-
Critical care medicine · Sep 1993
An exploratory analysis of medication utilization in a medical intensive care unit.
To evaluate patterns of medication use in a medical intensive care unit (ICU) and to explore relationships between drug use, patient age, admitting diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE II) scores, length of stay, and survival. ⋯ Patients admitted to the medical ICU receive multiple medications from a variety of pharmacologic classes. Prolonged length of stay, certain admitting diagnoses, and death are associated with increased medication administration. Age, certain admitting diagnoses, and APACHE II scores are significantly related to survival.