Critical care medicine
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Critical care medicine · Jun 1989
Discrepancies between transcutaneous and end-tidal carbon dioxide monitoring in the critically ill neonate with respiratory distress syndrome.
PaCO2, transcutaneous PCO2 (PtcCO2), and end-tidal PCO2 (PetCO2) measurements were studied in 12 critically ill neonates. PtcCO2 was measured using a combination CO2/O2 sensor during the routine care of these patients. End-tidal sidestream sampling was performed during blood gas measurement as dictated by the patient's clinical condition. ⋯ The presence or absence of a metabolic acidosis did not have a significant effect on the slopes obtained. PtcCO2 monitoring using combined sensors is a useful and practical means of monitoring in the neonatal ICU, although acidosis affects the ability to correlate transcutaneous and arterial values. End-tidal sidestream measurements are not as clinically useful because they vary due to different ventilation/perfusion relationships in the sick neonate.
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Critical care medicine · Jun 1989
Retracted PublicationInfluence of acute volume loading on right ventricular function after cardiopulmonary bypass.
The influence of acute volume loading on right ventricular function immediately after extracorporeal circulation (ECC) was investigated in 25 patients undergoing elective aortocoronary bypass grafting. In addition to commonly monitored hemodynamic variables, right ventricular (RV) ejection fraction (EF) was measured by thermodilution technique using a new fast-response thermodilution catheter. In eight patients with concomitant severe stenosis (greater than 89%) of the right coronary artery (RCA), volume loading was followed by a decreased RVEF and cardiac output. ⋯ Increased end-diastolic volume and decreased RV contractility index indicated that patients with myocardial ischemia during cardiac surgery procedures sometimes were unable to make the adaptations required. We conclude that cardiocirculatory dysfunction associated with ECC may be caused by depressed RV function. Acute volume loading in this situation may lead to further deterioration of myocardial function due to RV failure, a condition which cannot be diagnosed readily at the bedside with the usual monitoring techniques.
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Critical care medicine · Jun 1989
Case ReportsInverse ratio ventilation in a 6-year-old with severe post-traumatic adult respiratory distress syndrome.
We successfully employed inverse ratio ventilation on a 6-year-old multiple trauma victim with severe adult respiratory distress syndrome after conventional ventilation modes using volume ventilation with high positive peak inspiratory pressure and PEEP had failed to improve oxygenation.
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Critical care medicine · Jun 1989
Comparative StudyComparison of a sidestream and mainstream capnometer in infants.
This study was designed to compare capnograms obtained from a sidestream and mainstream capnometer during rapid mechanical ventilation in infants. Ten infants were studied during elective anesthesia and surgery. ⋯ The recordings obtained with the sidestream machine were grossly distorted, with flattening of the ascending limb (slope 37.3 vs. 153.3 torr/sec, sidestream vs. mainstream, p less than .001) and absence of the alveolar plateau. The mainstream analyzer gives a more accurate representation of the expired CO2 waveform in small children at rapid respiratory rates.