Critical care medicine
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Critical care medicine · Mar 1982
Colloid osmotic pressure and fluid resuscitation with hetastarch, albumin, and saline solutions.
The effects of fluid resuscitation with 6% hetastarch, 5% albumin, or 0.9% saline solutions on plasma colloid osmotic pressure (COP) were examined in 26 patients with hypovolemic circulatory shock. One liter of hetastarch produced a 36% increase in COP compared to an 11% increase after 1 L of albumin (p less than 0.001). One liter of saline resulted in a 12% decrease in COP (p less than 0.05). ⋯ These changes persisted from 2-5 days after resuscitation. Saline resuscitation required significantly larger amounts of fluid. The authors conclude that fluid resuscitation of circulatory shock with colloid solutions increases COP and requires less volume of resuscitative fluid.
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Critical care medicine · Mar 1982
Comparative StudyTracheal tube forces on the posterior larynx: index of laryngeal loading.
Most tracheal tubes sold today are arcuate in shape while the human airway is S-shaped. In situ, the tubes exert different forces on the posterior larynx, depending on their stiffness. Laryngeal damage after prolonged intubation is recognized as the result of these forces. ⋯ The airway model and test procedure can be utilized by manufactures, designers, and others to provide valuable information on tracheal tube performance and to develop improved tracheal tubes in the future. The results indicate that the polyvinylchloride tubes (PVC) and the silicone rubber tubes had the lowest index of laryngeal loading after long-term conditioning and would be preferable for prolonged intubation. The red rubber tube had the highest index of laryngeal loading after long-term conditioning, yet its stiffness would facilitate intubation.
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The ventilatory response in acute lactic acidosis was assessed in 39 patients. In 18 patients, the acidosis was associated with phenformin ingestion and in 21, with other causes such as shock and sepsis, but not pulmonary edema. ⋯ Only 1 lactic acidotic patient had a triflingly lower CO2 tension. Shock was present in 8 of the 9 lactic acidotic patients whose CO2 tensions were more than 2 torr above the 95% confidence band.
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Critical care medicine · Feb 1982
Comparative StudyVentilatory pattern in respiratory failure arising from acute myocardial infarction. II. PtcO2 and PtcCO2 compared to Pao2 and PaCO2 during IMV4 vs IPPV12 and PEEP0 vs PEEP10.
Transcutaneous oxygen and carbon dioxide tensions (PtcO2 and PtcCO2) were compared with PaO2 and PaCO2 values in 9 patients with pulmonary edema due to acute myocardial infarction (AMI) measured during four experimental interventions: (a) intermittent mandatory ventilation (IMV) 4/min + PEEP0 (cm H2O); (b) intermittent positive pressure ventilation (IPPV)12 + PEEP0; (c) IMV4 + PEEP10; and (d) IPPV12 + PEEP10. PtcO2 responded rapidly to the institution of PEEP, the rise correlating well with that in PaO2 both on IMV4 (r = 0.78) and IPPV12 (r = 0.87). On the other hand, correlations between PtcO2 vs CI and PvO2 were poor (r being 0.45 and 0.24, respectively). ⋯ While PaCO2 remained unchanged, PtcCO2 rose to 73 torr and within some minutes the patient had asystole. PtcCO2 tension generally shows good correlation with PaCO2 and, thus, reflects ventilation. It may also prove to be useful in the early detection of critical low cardiac output states.