Kokyu to junkan. Respiration & circulation
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Diffuse atelectasis often occurs in the dorsal region of the lung of critically ill patients under long term mechanical ventilation. Conventional physical therapies (ex. PEEP, Sigh) have little effect on diffuse dorsal atelectasis. ⋯ It was assumed that the prone position was the factor responsible for the improvement of pulmonary V/Q ratio, the change of movement pattern of the diaphragm, and the ease of postural drainage of sputum. There were no complications. We conclude that prone position respiratory care has high utility for critically ill patients with diffuse dorsal atelectasis.
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In this report, we evaluated and discussed the accuracy and the clinical problems involved in measurements of extravascular lung water volume (EVLW), using the thermal-sodium double indicator dilution technique. We measured EVLW in 2 groups, group I (normal cardiac function group) consisting of 20 patients with esophageal cancer, and group II (low cardiac function group) consisting of 27 patients with heart valvular disease. No significant difference was found between the two groups in the reproducibility (SDM/Average X 100) of measurements of Cardiac output (CO), MTT (Mean Transient Time), and EVLW. ⋯ We thought that EVLW should be calculated using the CO measured with Swan-Ganz catheter in cases of low cardiac function. Infection, thromboembolism and bleeding after the insertion of the catheter, overload of water and sodium due to the injection of the indicator were thought to be complications of measurement of EVLW. But in our clinical cases there was no such complication.
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The influences of intra-aortic balloon pumping (IABP) on peripheral dynamics were assessed by Doppler echocardiography. The subjects were 20 patients requiring IABP support, postoperatively, to control low cardiac output state. The flow velocity integral in systole (Int S) and that in diastole (Int D) were measured from left common carotid, superior mesenteric, and terminal aortic flow pattern, and the sum of Int S and Int D (Int S + Int D) was calculated with and without balloon pumping. 1) IABP increased cardiac output significantly (p less than 0.01). 2) Common carotid flow: IABP increased Int S significantly (p less than 0.01), but neither Int S nor Int S + Int D changed significantly with IABP. 3) Superior mesenteric flow: IABP increased Int D significantly (p less than 0.01), but both Int S and Int S + Int D remained unchanged with IABP. 4) Terminal aortic flow: None of Int S, Int D and Int S + Int D changed significantly with IABP. These results suggest that the carotid area can receive much of the increase in cardiac output in systole with IABP, and that the superior mesenteric area can receive much of the volume of blood displaced in the aorta by balloon inflation in diastole.