Critical care medicine
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Critical care medicine · Apr 1984
Use of the anterior cricoid split operation in infants with acquired subglottic stenosis.
Ten infants with acquired subglottic stenosis were treated successfully using the anterior cricoid split operation. Eight had been preterm infants who required endotracheal intubation and assisted ventilation for the respiratory distress syndrome. Two had been born at term; 1 required mechanical ventilation for aspiration of meconium and the other intubation for obstructive apnea. ⋯ All were extubated at the end of this period without evidence of stridor or obstructive apnea. One patient developed a subglottic granuloma at the level of the cricoid cartilage 4 months after the operation; this was successfully excised with the carbon dioxide laser. The other 9 patients remain asymptomatic 1 month to 1 yr after the surgical repair.
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Critical care medicine · Apr 1984
Effects of aerosolized lidocaine on circulatory responses to laryngoscopy and tracheal intubation.
Topical anesthesia of oropharynx with lidocaine aerosol (6 ml of 4% for 5 min) prevented hypertension and tachycardia during laryngoscopy and tracheal intubation. In the control group (saline aerosol), systolic and mean BP as well as heart rate (HR) significantly increased during laryngoscopy and intubation. ⋯ The pressor response and tachycardia observed during laryngoscopy and tracheal intubation were, thus, successfully prevented by lidocaine aerosolization. This simple technique for oropharyngeal anesthesia before laryngoscopy intubation may be considered, particularly in patients with intracranial pathology and/or decreased myocardial reserve.
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Critical care medicine · Apr 1984
Pulmonary ventilation by continuous flow using a modified Carlen's tube.
Carlen's tubes were modified by introducing a manometer line into each lumen to allow both bronchi to be insufflated continuously. During such continuous-flow ventilation (CFV) with a gas flow of 1 L/kg body weight X min in 6 anesthetized dogs, both CO2 and O2 homeostasis were maintained. ⋯ The mean PaO2 was stable at 80 torr and 451 torr using air and oxygen, respectively, as the insufflating gas. When the CFV was reduced to 0.75 L/kg X min, there was a rise in mean PaCO2 from 34 to 53 torr in 12 min; PaCO2 was then reduced to 40 torr when 4 breath/min was introduced with a mean tidal volume of 375 ml.
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Critical care medicine · Feb 1984
Results, charges, and benefits of intensive care for critically ill patients: update 1983.
Objective and quantitative methods were used to measure severity of illness and outcome of intensive care in critically ill patients, in terms of success or failure of therapy within the ICU, survival or death at 1 yr, quality of life in survivors, and utilization of resources. One hundred ninety-nine consecutive Class IV critically ill surgical patients hospitalized between 1977 and 1978 at the Massachusetts General Hospital comprised the study population. Although the mortality rate of 69% was close to the 73% rate we recorded for 1972-1973, the survivors' quality of life was significantly better. ⋯ Survival rates and quality of life in survivors did not vary with age. The disease process for which the patient was hospitalized was an important determinant of outcome. Intensive care medicine for critically ill surgical patients does prolong life and enable some patients to return to a productive lifestyle; however, the costs of these benefits are extremely high.
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Critical care medicine · Feb 1984
Case ReportsHemodynamic pattern in anaphylactic shock with cardiac arrest.
A 41-yr-old man developed anaphylactic or anaphylactoid shock 9 min after infusion of a modified fluid gelatin. The hemodynamic effects of shock from its onset were studied: fall in mean arterial pressure (MAP) and systemic vascular resistance index (SVRI), increase in cardiac index (CI) and stroke index (SI). When the infusion was stopped, a few min after the onset of shock, wedge pressure (WP) fell sharply and the patient experienced cardiac arrest without previous arrhythmia or other ECG anomaly, thus demonstrating the importance of maintaining the left ventricular filling pressure at a normal level in the course of anaphylactic shock.