Critical care medicine
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We evaluated 95 extubated neonates to determine if certain risk factors could predict the development of laryngeal injury. Risk factors were recorded prospectively during the intubation period and correlated with laryngeal injury determined by laryngoscopy after extubation. Duration of intubation greater than or equal to 7 days and 3 or more intubations significantly predicted injury.
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Critical care medicine · Jun 1983
Comparative StudyPostural variations in pulmonary resistance, dynamic compliance, and esophageal pressure in neonates.
In order to determine effect of posture and to assess the reliability of the esophageal balloon method for measuring esophageal pressure changes (delta Pes) under clinical conditions, lung mechanics were measured in 13 term and preterm babies in each of 3 postures: supine, right, and left lateral. The pulmonary resistance (Rp) was significantly lower and the dynamic compliance (Cdyn) higher in the right lateral than in the supine position. ⋯ It is concluded that the (right) lateral posture is mechanically less demanding than the supine posture and that delta Pes can be measured accurately in the supine posture. Absolute values of PesEE have no physiologic meaning and should not be used for patient management or for the calculation of lung mechanics.
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Critical care medicine · Jun 1983
Prolonged mechanical ventilation for respiratory failure: a cost-benefit analysis.
To define the costs and benefits associated with prolonged mechanical ventilation, we studied retrospectively the records of 137 consecutive patients who required at least 48 h of ventilator support. The patients were physiologically unstable and required intensive care. Causes of respiratory failure included pulmonary diseases, post-operative complications, neuromuscular diseases, cardiac dysfunction, and GI disease. ⋯ These costs varied from +460/yr of extended life for patients with respiratory failure complicating asthma to +8026/yr for patients with cardiac dysfunction. The cost-benefit ratio increased sharply for men older than 56 yr and for women older than 75 yr. These data document the importance of the basic disease process and the patient's age in the cost-benefit relationship.
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Anecdotal observations suggest that high frequency jet ventilation (HFJV) is beneficial in major airway disruption. Quantitative evaluation is, however, unavailable. In 12 healthy mongrel dogs, a tracheal window of increasing size, from 0.5 x 1 cm to 1.5 x 2 cm, was opened. ⋯ In all experimental conditions, HFJV delivered with a 1.62-mm injector effectively maintained alveolar ventilation and arterial oxygenation. Gas transport on HFJV is based, in part, on the principles of jet mixing and entrainment; increasingly large tidal volumes can be delivered under conditions of low and constant pressure. Air leaks through pathological openings remain constant even when tidal volume is increased, so that alveolar ventilation can be adequately maintained.
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Critical care medicine · May 1983
Comparative StudyVentilator-induced barotrauma in controlled mechanical ventilation versus intermittent mandatory ventilation.
Retrospective analysis of pulmonary barotrauma incidence in 292 patients ventilated greater than or equal to 24 h was conducted. From 1971-1973, 156 patients with acute respiratory insufficiency were managed with controlled mechanical ventilation (CMV) and PEEP. ⋯ Despite higher mean peak and end-expiratory airway pressure, the IMV-CPAP group exhibited a significantly lower incidence of ventilator-induced barotrauma; 7% vs 22% (p less than 0.01). We suspect the difference is related to fewer mechanical breaths with IMV and not to the level of end-expiratory pressure employed.