Critical care medicine
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The authors studied the use of CPAP by face mask in 44 patients with mild to moderate acute respiratory insufficiency (mean PaO2/FIO2 = 171 +/- 42 (SD). All patients improved their oxygenation (mean PaO2/FIO2 = 300 +/- 68 (SD) after the application of CPAP (mean 9 +/- 3 (SD) cm H2O). ⋯ No other significant complications or adverse side effects occurred. The authors conclude that CPAP by face mask in a select group of patients will improve lung function and arterial oxygenation without the use of tracheal intubation and mechanical ventilation.
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The cerebral function monitor (CFM) (Devices Unlimited) is a single-channel, bipolar ECG device modified for continuous recording of cortical electrical activity. We have found the CFM useful in the Pediatric Intensive Care Unit (PICU), particularly in seizure patients, patients with increased intracranial pressure, and after cardiorespiratory arrest. The device and our experience with its use in the PICU are described in this paper.
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The authors have developed a new method for independent lung ventilation (ILV). After lung isolation with a double-lumen endotracheal tube, one ventilator with two subunits controls independent lung tidal volume (VT) and PEEP to each lung. ⋯ This ventilator has been successfully used to treat patients with severe unilateral disease. Desirable qualities include simplicity of operation, availability of parts, and low cost.
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Critical care medicine · Jul 1980
Continuous transcutaneous oxygen monitoring during respiratory failure, cardiac decompensation, cardiac arrest, and CPR. Transcutaneous oxygen monitoring during arrest and CPR.
The transcutaneous oxygen sensor (PtcO2), which has been used to predict PaO2 in neonates, recently has been shown to follow changes in oxygen delivery, rather than PaO2 during shock and hypoxia in dogs. Six preterminal patients were continuously monitored with PtcO2 and monitored hemodynamically at frequent intervals during cardiac decompensation, arrest, and cardiopulmonary resuscitation (CPR). The weighted mean correlation coefficients between PtcO2 and O2 delivery as well as between PtcO2 and cardiac output were 0.94 and 0.96, respectively. ⋯ The mean VO2 was 142 +/- 24 ml/min x M2 for PtcO2 values > torr, and 75 +/- 15 ml/min x M2 for PtcO2 < 25 torr (p < 0.01). A PtcO2 of > 40 torr corresponded to normal cardiac index, O2 delivery, VO2, PvO2, and arterial pH (pHa) while a PtcO2, of < 25 torr corresponded to large reductions of these variables. A PtcO2 of < 25 torr preceded cardiac arrest by 43 +/- 28 min.
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Critical care medicine · Jun 1980
Complications of airway intrusion in 100 consecutive cases in a pediatric ICU.
One-hundred consecutive patients who underwent orotracheal intubation (OT), nasotracheal intubation (NT), or tracheostomy in the pediatric ICU were evaluated for complications of these airway invasions. Twelve patients had major complications as a result of airway intervention. The mortality for patients requiring mechanical ventilation was 17% as compared with a total overall mortality of 8.3% for patients in the pediatric ICU. ⋯ Laryngotracheobronchitis (croup) was the primary diagnosis associated with the highest rate of complications. An association was found between the occurrence of seizures or hypoperfusion state (shock) while intubated and the occurrence of major complications of airway intrusion. Acquired infections of the respiratory tract with Hemophilus influenzae, Pseudomonas, Klebsiella, and Candida albicans were also associated with a high rate of complications.