Critical care medicine
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Critical care medicine · Jan 1985
Postextubation hypoxemia treated with a continuous positive airway pressure mask.
Twenty-seven surgical patients who developed post-extubation hypoxemia unresponsive to routine respiration therapy (incentive spirometry and chest physical therapy) received continuous positive airway pressure (CPAP) delivered through a mask at an inspired oxygen fraction (FIO2) of 0.45. All patients responded with an increased PaO2 and achieved a PaO2/FIO2 ratio of at least 300 with a mean CPAP of 8.3 +/- 2.8 cm H2O. ⋯ Two (7%) patients required reintubation, one for control of excessive secretions and the other for persistent Pseudomonas pneumonia. Mask CPAP was an effective treatment for postextubation hypoxemia in this group of surgical patients.
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Chylous leakage from the thoracic duct into the pleural space may occur after any type of thoracic surgery; however, there are few reports of this condition after coronary artery bypass grafting. A case of chylothorax after combined coronary bypass and mitral valve replacement is reported to illustrate a discussion of its pathologic basis, diagnosis and management.
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Critical care medicine · Dec 1984
Availability of critical care personnel, facilities, and services in the United States.
This survey of 1474 special care units in the United States found that smaller hospitals tended to have only one ICU. The number of ICUs increased with overall hospital size; when a hospital had two ICUs, the second unit was usually for coronary care. Internists directed most of the ICUs, followed in decreasing order by surgeons, family practitioners, anesthesiologists, and pediatricians. ⋯ The number of house officers varied widely according to hospital size, as did the numbers of subspecialty fellows and nonphysician professional and paraprofessional personnel. The availability of services in hospitals also varied according to hospital size, particularly for intra-aortic balloon counterpulsation, CT scanning, and intracranial pressure monitoring. Urban setting more significantly affected size and available services than did geographic region.(ABSTRACT TRUNCATED AT 250 WORDS)
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Critical care medicine · Dec 1984
Correlation of changes in oxygenation, lung water and hemodynamics after oleic acid-induced acute lung injury in dogs.
Changes in oxygenation after oleic acid (OA)-induced acute lung injury were correlated to changes in extravascular lung water (EVLW) and hemodynamics in 19 mongrel dogs. Three patterns seemed apparent. In group 1 (seven dogs) EVLW increased by 88% from control values but PaO2 fell only 15%. ⋯ Cardiac index fell in all three groups. A small but significant increase in PvO2 partially explains the improvement in oxygenation in group 2. We conclude that changes in oxygenation are a poor index of injury during this model of acute lung injury and that the course of oxygenation is directly related to measured changes in EVLW and hemodynamics.