Critical care medicine
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Critical care medicine · Apr 1983
Intraesophageal pressure monitoring in infants with respiratory disorders.
Intrapleural (Ppl) and intraesophageal pressure (Pes) measurements were compared during spontaneous respiration in sick infants. The Pes, measured with a water-filled catheter, indicates pressure variations in the esophagus to be about 4.5% smaller than in the pleural cavity. ⋯ Air in the pleural cavity causes marked diminution in Pes fluctuation. Continuous monitoring of Pes may be useful in the early detection of pulmonary air leak in neonates with respiratory disorders.
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Critical care medicine · Apr 1983
Diaphragmatic paralysis after pediatric cardiac surgery: a retrospective analysis of 34 cases.
Thirty-four cases of diaphragmatic paralysis after pediatric cardiac surgery are reviewed. Differences between pediatric and adult pulmonary physiology account for the increased severity of respiratory distress seen in children with this condition. ⋯ This finding is consistent with the development of sufficient chest wall stability to compensate for paralysis of the hemidiaphragm. Patients under 3 yr of age, without complicating heart failure, who still required intubation and CPAP 3-4 wk after injury to the phrenic nerve should consider operative plication.
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Critical care medicine · Mar 1983
Pressure-time relationships of pressure-limited neonatal ventilators.
A pressure-limited ventilator (Bourns BP-200, Anaheim, CA) and a simple, manually operated constant flow ventilator were studied using a commercially available infant lung simulator (Bourns LS-130, Anaheim, CA). The characteristics of inspiratory pressure-time relationships during ventilation with these ventilators were analyzed. ⋯ Qualitatively similar tracings were obtained with the BP-200 during normal ventilation, with simulated airway obstruction and thoracic restriction. These findings suggest that monitoring pressure-time relationships may be useful in the qualitative assessment of resistance and compliance during pressure-limited ventilation of neonates.
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Critical care medicine · Mar 1983
Optimum left heart filling pressure during fluid resuscitation of patients with hypovolemic and septic shock.
The effect of increasing filling pressures on cardiac performance was examined in 15 patients undergoing fluid resuscitation for hypovolemic and septic shock. The initial significant increase in pulmonary artery wedge pressure (WP) from 7.0 +/- 2.0 to 11.9 +/- 1.6 mm Hg was associated with an increase in stroke volume index (SVI) from 24.2 +/- 9.8 to 34.7 +/- 12.4 ml/M2 (p less than 0.01), left ventricular stroke work index (LVSWI) from 16.9 +/- 7.8 to 28.5 +/- 11.6 g x m/M2 (p less than 0.01) and cardiac index (CI) from 2.25 +/- 0.68 to 3.06 +/- 0.85 L/min x M2 (p less than 0.01). ⋯ The correlation between central venous pressure (CVP) and WP during fluid loading was only fair and the changes in CVP vs WP did not significantly correlate. We suggest that the optimum left heart filling pressure during fluid resuscitation of patients with hypovolemic and septic shock may not exceed a WP of 12 mm Hg.