Critical care medicine
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Critical care medicine · May 1989
Volume monitor for mechanical ventilation in the hyperbaric chamber.
Treatment of critically ill patients requiring ventilatory support and hemodynamic monitoring in the hyperbaric medicine department is a frequent occurrence. We provide mechanical ventilation principally with the Penlon Oxford ventilator; however, its simple design lacks volume, rate, and disconnect monitors. ⋯ To our knowledge, this is the only battery-driven monitor on the market that provides rate, volume, apnea, and minute ventilation within the same unit. It should be used as an adjunct to the Penlon Oxford ventilator in the hyperbaric chamber.
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Critical care medicine · May 1989
Intravenous lipids in newborn lungs: thromboxane-mediated effects.
Lipid infusions can interfere with oxygenation and cause pulmonary hypertension. We studied the effects of iv lipid infusions on pulmonary hemodynamics and oxygen transport to investigate whether the vasoconstrictor, thromboxane (Tx), mediates resulting changes. Newborn piglets were instrumented to observe cardiopulmonary hemodynamics, blood gases, and oxygen contents. ⋯ TxB2 increased in all animals with iv lipid (276 +/- 295 to 1481 +/- 716 in PL; 228 +/- 110 to 1402 +/- 580 in SQ), and fell with intervention in the SQ animals only (2632 +/- 1236 vs. 964 +/- 305, respectively; p less than .02). In conclusion, interference with DO2 associated with pulmonary hypertension and increased TxB2 occurred with iv lipid infusion in piglets. Tx antagonism ameliorated these changes.
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Critical care medicine · Apr 1989
Comparative StudyHigh-frequency percussive ventilation compared with conventional mechanical ventilation.
In seven patients with severe respiratory distress, conventional mechanical ventilation and PEEP were used initially for respiratory support, which was changed to high-frequency percussive ventilation (HFPV) at the same level of airway pressure and FIO2. During both modes of ventilation, patients could breathe spontaneously via a low-threshold demand valve. With HFPV, PaO2 improved significantly (p less than .01) compared with PaO2 during conventional methods. Cardiac output was unaffected by the change to HFPV.
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Critical care medicine · Apr 1989
Randomized Controlled Trial Clinical TrialTrendelenburg position and passive leg raising do not significantly improve cardiopulmonary performance in the anesthetized patient with coronary artery disease.
The effects of the Trendelenburg (TREND) position and passive straight leg raising (PLR) on cardiopulmonary performance in 18 anesthetized patients undergoing myocardial revascularization were studied with a two-dimensional transesophageal echocardiography probe and a thermodilution right ventricular ejection fraction (RVEF) pulmonary artery catheter. The TREND position (at 20 degrees) and PLR (at 60 degrees) were studied in relation to the level-supine position in random order. ⋯ PLR had similar effects as the TREND position, except CI did not change significantly. Thus, the TREND and PLR resulted in minor hemodynamic improvement with right ventricular dilation, decreased RVEF, and impaired oxygenation in the anesthetized cardiac surgical patient.
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Multiple rewarming methods have been recommended for the treatment of hypothermia in the ED. Because the hypothermic patient population is heterogenous, a method for stratifying mortality risk when comparing therapies is desired. ⋯ Prehospital cardiac arrest, a low or absent presenting BP, elevated BUN, and the need for either tracheal intubation or NG tube placement in the ED were found to be significant predictors of patient demise in a large database (n = 428). The likelihood ratio was used to develop and validate an empiric hypothermia outcome score that can be used in future hypothermia treatment studies to account for differences of patient presentation.