Critical care medicine
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Critical care medicine · Nov 1987
A technique for the administration of ribavirin to mechanically ventilated infants with severe respiratory syncytial virus infection.
Fifteen infants with respiratory syncytial virus pulmonary infection admitted to our pediatric ICU from December 1, 1985 through April 30, 1986, required mechanical ventilation. These patients were placed on an open trial of ribavirin therapy. We describe a technique for the safe delivery of aerosolized ribavirin to these infants while on the ventilator. ⋯ The highest positive inspiratory pressure generated was 42 +/- 9.5 (SD) cm H2O, the highest PEEP was 5.9 +/- 3.2 cm H2O, the duration of ventilation was 10.7 +/- 8.5 days, and exposure to fraction of inspired oxygen was greater than or equal to 0.6 for 55.3 h. Ribavirin levels were measurable in two patients, thereby demonstrating that the drug was in fact delivered and absorbed. Our preliminary results demonstrate that ribavirin can be delivered to the patients with respiratory syncytial viral infections who require mechanical ventilation; however, further studies are indicated to evaluate the efficacy and dose responsiveness, alterations in pulmonary dynamics, and safety of ribavirin in delivery to infants requiring ventilation.
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Critical care medicine · Oct 1987
End-tidal carbon dioxide as a noninvasive monitor of circulatory status during cardiopulmonary resuscitation: a preliminary clinical study.
In four postoperative cardiac patients during controlled ventilation, acute circulatory failure was associated with decreases in end-tidal CO2 (PetCO2) and cardiac index. Closed cardiac compression caused an increase in both PetCO2 and cardiac index, with complete restoration to baseline values after successful CPR. Our data indicate that PetCO2 measurements during controlled ventilation in acute circulatory failure patients may be used as an indirect noninvasive tool to monitor the patient's hemodynamic status during CPR.
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Critical care medicine · Oct 1987
Case ReportsEmergency airway clot removal in acute hemorrhagic respiratory failure.
Three cases of respiratory failure and severe hypoxemia caused by blood clot obscuring the central airway are described. A technique to clear the airway using a no. 6 Fogarty balloon-tip embolectomy catheter inserted through a flexible fiberoptic bronchoscope was used in all three cases. Marked improvement and stabilization occurred while definitive therapy was undertaken.