Articles: critical-care.
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Acta Anaesthesiol Scand · Oct 1982
Regional differences in lung function during anaesthesia and intensive care: clinical implications.
Anaesthesia and most frequently acute respiratory failure are accompanied by a lowered functional residual capacity (FRC). This lowering promotes airway closure in dependent lung units and forces ventilation to non-dependent regions. Perfusion, on the other hand, is forced towards dependent lung units. ⋯ Improved matching of ventilation and perfusion can be achieved by: (1) positioning the subject in the lateral posture; (2) ventilating each lung separately in proportion to its perfusion (differential ventilation); and (3) applying PEEP only to the dependent lung (selective PEEP). Because of less overall intrathoracic pressure and lung expansion, interference with the total lung blood flow and the danger of barotrauma should be less than with general PEEP. Improved gas exchange with a 50-100% increase in PaO2 has been observed in a limited number of patients with acute bilateral lung disease studied so far during differential ventilation and selective PEEP.
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Clinical pediatrics · Sep 1982
Interaction of health-care professionals with critically ill children and their parents.
The stress imposed on the emotional equilibrium of a team of health-care professionals by the serious illness of a child can disrupt communication among the team, the child, and the parents. Such stresses may be so severe as to interfere with the ability to the adults to meet the child's needs. Although the feelings and attitudes of critically ill children and their parents are well described in the medical literature, very little has been written about the psychosocial interaction among those responsible for the patient's care. ⋯ The purpose of this article is to review available information, as well as experience at St. Jude Children's Research Hospital, on the psychosocial interaction of the health-care team with critically ill children and their parents. An awareness of the difficulties of caring for such patients is essential in overcoming communication barriers, in reducing any interprofessional tensions that might arise during treatment, and in ensuring high-quality medical care.