Surgery
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Comparative Study Clinical Trial Controlled Clinical Trial
Effect of end-expiratory pressure on total oxygen dynamics.
The role of altered end-expiratory pressure on total oxygen dynamics was studied prospectively in 18 patients with injuries and sepsis. Eight patients received high tidal volumes (12 to 18 ml/kg), continuous positive airway pressure, and intermittent mandatory ventilation (CPAP/IMV); 10 patients received low tidal volumes (8 to 10 ml/kg) with zero end-expiratory pressure and assist control mode of ventilation (ZEEP/A-CM). CPAP/IMV patients had better oxygen tension, reduced physiologic shunting in the lung (24% versus 18%), and an improved arterial tension: inspired oxygen concentration ratio. ⋯ Consequently, the total oxygen delivery was reduced for all 3 days following insult and for the cumulative data for all 3 days (266 versus 306 ml/min) in the CPAP/IMV patients. Oxygen consumption was also reduced in the CPAP/IMV patients; this reduction was not significant for each of the first 3 days but was significant when the data for the 3 days were added to the analysis (306 versus 272 ml/min). Future prospective randomized studies are needed to determine the most effective use of ventilatory support on total oxygen dynamics including oxygen delivery and oxygen consumption.
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The clinical course and final outcome were determined for 63 trauma victims who underwent resuscitative thoracotomy (RT) for hypovolemic cardiac arrest in the Department of Emergency Medicine during a 24-month period. The objectives of the study were to determine the efficacy of and indications for RT and to define the prognostic signs for survival. Of 63 patients, six were successfully resuscitated (9.5%), and five of these were discharged from the hospital (7.9%). ⋯ In our experience, RT is most beneficial for victims of penetrating thoracic trauma, especially those with cardiac injuries. However, routine use of this high cost/low benefit procedure cannot be recommended for patients who have cardiac arrest secondary to blunt trauma or severe head injuries. Also, it is not recommended for patients whose pupillary reflexes and respiratory movements are absent.