Critical care medicine
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Critical care medicine · Sep 1981
Comparative StudyComparison of dopamine, dobutamine, and epinephrine in CPR.
Two new catecholamines, dopamine and dobutamine, have found widespread use for cardiovascular support. The relative efficacy of these drugs in aiding resuscitation from cardiopulmonary arrest is unknown. Dogs were subjected to either asphyxial or fibrillatory cardiac arrest. ⋯ The authors conclude that, in dogs, dopamine is a useful adjunct to CPR because of its alpha-adrenergic stimulating activity at high doses. Dobutamine does not appear to be of value as the initial therapy of cardiac arrest. If the response in man is similar to that in dogs, dopamine may provide an alternative to epinephrine during CPR.
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Critical care medicine · Aug 1981
Case ReportsManagement of upper airway obstruction in the intensive care unit.
Three patients under observation in ICUs developed mechanical upper airway obstruction requiring surgical intervention for airway control. One patient was treated by tracheotomy placed through a vertical midline incision and 2 patients were treated by cricothyroidotomy followed by elective tracheostomy and closure of the cricothyroidotomy. ⋯ The importance of rapid cricothyroidotomy through a small incision in patients unresponsive to less invasive measures is emphasized. The use of a small pediatric endotracheal tube placed through the cricothyroidotomy incision is suggested as a method to increase the speed and safety of the procedure and avoid the potential long-term complication of laryngeal stricture.
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critically ill infants receiving supplemental oxygen for their hypoxemia may become significantly compromised by hypoxemia and bradycardia when supplemental oxygenation is interrupted to carry out laryngoscopy and tracheal intubation. It would, therefore, be desirable to devise a means of maintaining supplemental oxygenation during the procedure. A modified laryngoscope blade achieved this objective simply and efficiently. ⋯ The procedure of intubation was less stressful both to the patient and to the operator. It would seem appropriate to use the modified laryngoscope blade in all situations where hypoxemia threatens. It would seem to have a particular place in intubation of the difficult airway.
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Critical care medicine · Jul 1981
Comparative StudyPerformance of neonatal ventilators: the effects of changes in resistance and compliance.
The authors tested the ability of 6 neonatal ventilators (Baby bird, Bourns BP-200, Veriflo, Bourns LS, ServoVent, SI-75) to deliver a preset tidal volume with minimal pressures when the compliance and resistance of test lung were altered. The authors also studied the effects of gas leaks from the system and the effects of PEEP. ⋯ Under these same conditions (normal compliance, elevated resistance), only 24-46% of the preset tidal volume was delivered. The different ventilators caused the pressure within the test lung to exceed 5, 10, and 15 cm H2O for differing amounts of time (sec)/min.
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Critical care medicine · Jul 1981
Prophylactic intubation and continuous positive airway pressure in the management of inhalation injury in burn victims.
Burn mortality statistics are influenced by age and degree of total surface body burn. The addition of an inhalation injury to a cutaneous burn results in a significant increase in mortality rate. Nine hundred fourteen patients with acute thermal injury were screened for positive history of burn in a closed space, facial or oropharyngeal burn, singed nasal vibrisae, carbonacious sputum, and clinical signs of upper airway involvement. ⋯ In patients with inhalation injury, burn wound sepsis (21.7%) was the main cause of death. These data suggest that prophylactic intubation and CPAP therapy in burn patients with suspected inhalation injury prevent pulmonary related death in early stage of burn. Irrespective of presence of inhalation injury, sepsis originating from the wound or respiratory tract is the main cause of death in the late stage of burn.