Critical care medicine
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Critical care medicine · Nov 1976
Case ReportsPulmonary angiography via an indwelling four-channel Swan-Ganz catheter.
An indwelling Swan-Ganz catheter was utilized for pulmonary angiography in an extremely ill patient without the necessity for a further invasive procedure. The procedure allowed prompt exclusion of pulmonary embolism as a cause of her deteriorating condition, and confirmed the diagnosis of adult respiratory distress syndrome (ARDS).
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Critical care medicine · Nov 1976
The effect of tolazoline on right-to-left shunting via a patent ductus arteriosus in meconium aspiration syndrome.
Since arterial blood oxygen tensions are used in the evaluation of treatment of patients with meconium aspiration syndrome, it is important to recognize the occurrence of significant right-to-left shunting via a patent ductus arteriosus. The clinical findings, evidence of right-to-left ductus shunting, and outcome in eight patients with meconium aspiration syndrome are presented. Administration of tolazoline HCl and curare produced a beneficial effect on their PaO2 values.
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Critical care medicine · Jul 1976
Comparative StudyThe effect of PEEP on oxygenating capacity in acute respiratory failure with sepsis.
We report an evaluation of the effect of postive-end-expiratory-pressure (PEEP) on improving pulmonary oxygenating capacity in the adult respiratory distress syndrome (ARDS), when the latter is associated with generalized gram-negative sepsis. Fifty-seven cases treated in our RICU with PEEP ventilation (April 1972 to January 1975) were retrospectively reviewed. Oxygenating capacity improvement was evaluated in terms of the changes in PaO2/FIO2 and AaDO2 (FIO2 = 1.0). ⋯ Overall mortality in the septic and nonseptic groups was 18/29 and 5/28, respectively. We conclude that ARDS with sepsis constitutes a more severe pulmonary insult than ARDS without sepsis, and/or that generalized sepsis creates a more prolonged pulmonary insult that makes it less amenable to PEEP. Thus, high levels of PEEP may be needed to treat ARDS associated with sepsis.
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Critical care medicine · May 1976
Reduced inspiratory effort during intermittent mandatory ventilation with PEEP.
The use of intermittent mandatory ventilation (IMV) and positive and expiratory pressure (PEEP) may demand the patient mount an inspiratory pressure equivalent to the pressure level of the PEEP for spontaneous breathing. During respiratory failure, ineffective inspiratory muscles may be unable to consistently meet such demands, especially if high levels of PEEP are used. ⋯ Using this technique, isovolume inspiratory time was dramatically reduced and less inspiratory effort was required. This maneuver may assist spontaneous breathing in patients with respiratory failure on high levels of PEEP.
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Critical care medicine · Mar 1976
Fluid resuscitation following injury: rationale for the use of balanced salt solutions.
Initial fluid management of the injured patient involves replacement of fluid lost incident to the trauma as well as prompt recognition and treatment of shock. Prompt fluid replacement based on these concepts will result in a reduction in mortality and prevention of many complications resulting from prolonged inadequate tissue perfusion. In this discussion, an attempt will be made to facilitate this approach by: (1) discussing these fluid changes; (2) presenting a clinically applicable classification of shock; and (3) outlining a rational approach to the early treatment of hemorrhagic shock, the most frequent form of shock occurring early after injury.