Critical care medicine
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Critical care medicine · Feb 1982
Randomized Controlled Trial Comparative Study Clinical TrialVentilatory pattern in respiratory failure arising from acute myocardial infarction. I. Respiratory and hemodynamic effects of IMV4 vs IPPV12 and PEEP0 vs PEEP10.
Positive end-expiratory pressure of 10 cm H2O (PEEP10) was compared with zero-end-expiratory pressure (PEEP0), intermittent mandatory ventilation (IMV), 4/min, with intermittent positive pressure ventilation (IPPV), 12/min, in 9 patients with pulmonary edema due to acute myocardial infarction (AMI). Systemic and pulmonary arterial pressures, pulmonary capillary wedge pressure (PCWP) and CVP, cardiac output (CO) and blood gases were measured during these four experimental interventions, and related parameters calculated. PaCO2 was 39.3 +/- 0.9 torr during IMV4 and 36.2 +/- 1.3 torr during IPPV12, and PCWP remained between 20-30 mm Hg throughout the study. ⋯ Both left and right ventricular stroke work (LVSW, RVSW) were higher on IMV4. A moderate PEEP level (up to 10 cm H2O) seems beneficial in post-AMI pulmonary edema and has no significant hemodynamic side effects. The results indicate that of the four alternatives studied, IMV4 with PEEP10 is a ventilatory pattern of choice in the respiratory management of these patients, but each individual patient may require precise titration of each modality to achieve the optimal result.
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Four hundred sixty-one consecutive admissions to the Pediatric Intensive Care Unit (PICU) were evaluated using the Therapeutic Intervention Scoring System (TISS). Patients requiring an increased level of care, defined as TISS points greater than or equal to 10, accounted for 75% of patient days in the ICU. Within this group, the primary reason for admission to the ICU was congenital heart disease, trauma, malignancy, respiratory failure, and sepsis. ⋯ Assuming that the cost of intensive care is related to both seriousness of illness (assessed by TISS) and length of hospitalization, in this pediatric population the cost of hospitalization was not disproportionately high for nonsurvivors compared to survivors. Reduction in mortality rates in a PICU population will be dependent on factors largely uncontrollable buy ICU practitioners. This will come about by reduction in the numbers of congenital malformations and the prevention of childhood trauma.
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Critical care medicine · Dec 1981
Hydroxyethyl starch for resuscitation of patients with hypovolemia and shock.
The authors evaluated the effectiveness of 6% hydroxyethyl starch (hetastarch) solution for treatment of hypovolemia in 46 critically ill patients. Thirty-two of the patients were studied retrospectively and in 14 patients, cardiopulmonary variables were prospectively measured. A total of 29 patients were in shock secondary to hypovolemia (13), sepsis (13), or myocardial infarction (3). ⋯ Immediate survival was 90% in shock patients and 100% in nonshock patients, whereas hospital survival was 65.5% and 88%, respectively. The authors conclude that hetastarch is an effective fluid for resuscitation of hypovolemic patients. This synthetic colloid does not appear to adversely affect pulmonary function.