Swiss medical weekly
-
Swiss medical weekly · Apr 1986
[The effect of positive end-expiratory pressure (PEEP) on extravascular lung water in intensive care patients].
The use of positive end-expiratory pressure (PEEP) has been highly recommended because of its favourable effects on pulmonary gas exchange and circulation. It was the aim of this study to investigate the influence of PEEP on extravascular lung water (EVLW), which was estimated by the thermal-dye technique. In 12 intensive care patients PEEP was changed every 30 minutes from 0 to 5, 10, 15 and 0 cm H2O, thereby causing a non-significant increase in EVLW of 2, 10, 7 and 1%. ⋯ Therefore, shorttime application of PEEP did not affect EVLW. Patients with normal EVLW were more prone to show increased EVLW during PEEP than patients with elevated EVLW. PEEP-induced improvement of gas exchange and pulmonary shunt were not accompanied by changes in EVLW.
-
Swiss medical weekly · Apr 1986
[Work of breathing in spontaneous respiration with continuous positive airway pressure].
In postoperative respiratory failure continuous positive airway pressure (CPAP), besides improving pulmonary gas exchange, influences respiratory mechanics. Elastic and flowresistive components of respiratory work were measured in intensive care patients being weaned from the respirator. Measured values during breathing with a continuous-flow CPAP system with elastic reservoir were compared with those for O2 breathing via T-tube. ⋯ Compliance, tidal volume and respiratory frequency did not change significantly. The reduction in respiratory work was primarily due to decreased nonelastic work associated with a decrease in resistance. Thus, on weaning from mechanical ventilation using a reservoir-CPAP system, the respiratory work was reduced in comparison to O2 breathing via T-tube.
-
Mortality in blunt hepatic trauma is still high, death being most frequently caused by hemorrhage. Associated injuries are present in nearly all cases. A variety of possible surgical procedures allow treatment tailored to fit the individual situation. Even the sophisticated intensive care required by the frequent posttraumatic complications is not a substitute for adequate surgery.
-
Cardiac contusion is frequently seen after blunt chest trauma; it is often missed, and can cause serious complications. The incidence, features and outcome of cardiac contusion are described.