Critical care medicine
-
Critical care medicine · Sep 1984
Effect of continuous positive airway pressure on lung mechanics during high-frequency jet ventilation.
Six mongrel dogs were studied in a body plethysmograph to ascertain the effects of continuous positive airway pressure (CPAP) during high-frequency jet ventilation (HFJV), using an open system allowing gas entrainment. Increases in CPAP significantly reduced tidal volume. ⋯ At constant CPAP, tidal volume correlated well with the difference between peak airway pressure and CPAP, while the FRC change was correlated with the difference between end-expiratory pressure and CPAP. The relationship between end-expiratory airway pressure and total change in FRC was predictable from lung compliance at all levels of CPAP.
-
Critical care medicine · Sep 1984
Comparative StudyClinical factors influencing the selection of high-frequency jet ventilators.
Criteria for selection of high-frequency ventilators, and in particular high-frequency jet ventilators are not significantly different from those for conventional mechanical ventilators. Selection is based upon the design principles and performance characteristics of the ventilator and successful clinical applications that establish clearly its safety and efficacy. The final choice is also influenced by the physical status of the patient, potential physiologic advantages and disadvantages, the necessary requirements of the clinical situation, and the capability of providing adequate oxygenation and ventilation.
-
Critical care medicine · Aug 1984
Renal hypoxia and lactate metabolism in hemorrhagic shock in dogs.
Central and renal hemodynamics, renal cortical and medullary oxygen tension, and renal lactate metabolism were investigated in hemorrhagic shock in dogs. During graded hemorrhage, renal tissue PO2 decreased in parallel with renal blood flow, whereas renal lactate uptake remained virtually unchanged. ⋯ Reinfusion of shed blood increased renal tissue PO2 above its preshock value but did not restore baseline renal oxygen consumption and lactate uptake levels. These results suggest that renal lactate utilization is not limited by oxygen delivery under moderate hemorrhagic hypotension but decreases linearly with renal tissue PO2 during shock.
-
The ability to recognize symptoms, to make priority decisions, to dispatch suitable ambulance transport and inform the crews, and finally, to initiate first aid via the caller is essential for optimum care of severely injured or ill patients outside the hospital. In Sweden, a special job-related course trains dispatch-center personnel to think in terms of symptoms and evolution of the victim's status, and to assess the level of seriousness.
-
Critical care medicine · Aug 1984
Adult respiratory distress syndrome: hospital charges and outcome according to underlying disease.
We reviewed the hospital charges, underlying diagnoses, and hospital outcomes in 39 patients with adult respiratory distress syndrome (ARDS) admitted to the respiratory ICU of a university hospital between July 1979 and June 1981. Charges per patient ranged from $9263 to $187,893 with a median of $52,894. Median ICU charges were $2430/day. ⋯ Only 1 of 27 patients with underlying hematologic/oncologic diseases survived, compared to 6 of 12 patients with other underlying diseases. Charges and outcomes in this study reflect the underlying patient population and philosophy of care at the study institution. Considering the high costs and poor outcomes in ARDS patients with underlying hematologic/oncologic problems, we recommend that the appropriateness of aggressive treatment be reconsidered.