Articles: respiratory-distress-syndrome.
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Oesophageal pressure measured with an air-filled, thin latex balloon on a 6 French gauge catheter can accurately measure intraoesophageal pressures in ventilated preterm babies. Intraoesophageal pressures and intrapleural pressures are equivalent. ⋯ The largest deflections recorded from the oesophageal trace are from spontaneous inspiratory activity. During paralysis with pancuronium spontaneous respiration is inhibited, peristaltic waves are still recorded, and there is little transmitted pressure from the ventilator to the oesophagus or intercostal drain.
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Comparative Study
Increased neonatal risk from the use of general anesthesia in emergency cesarean section. A retrospective analysis of 374 cases.
Three hundred seventy-four consecutive cases of cesarean section were reviewed retrospectively for differences in neonatal outcome with respect to method of anesthesia used. In 205 elective sections no difference in neonatal outcome was observed irrespective of anesthesia method. ⋯ These preliminary results suggest that general anesthesia may increase the degree of central depression of the fetus already compromised by hypoxia before surgery. An investigation of this question on other sets of data and in a prospective trial should be done.
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Critical care medicine · Oct 1982
Left ventricular contractility using isovolumic phase indices during PEEP in ARDS patients.
The effects of incremental increases in PEEP during mechanical ventilation on left ventricular (LV) contractility before and after intravascular volume expansion (IVE) were studied in 10 patients treated for ARDS. A pulmonary artery (PA) catheter, a LV catheter-tip micromanometer, and an esophageal balloon catheter were inserted in these patients. We measured transmural right atrial and PA pressures, transmural LV end-diastolic and systemic arterial pressures, the first derivative of LV pressure (LV dP/dt), the ratio of LV dP/dt at transmural developed LV pressure (dP/dt/DPt) with DPt = 5, 10, 40 mm Hg, cardiac index (CI) at every level of PEEP and after IVE at the highest PEEP. ⋯ IVE reversed this fall in CI and peak dP/dt. Whereas transmural LV end-diastolic pressure rose markedly. We conclude that the observed fall in LV performance during PEEP is not the result of a depressed LV contractility because PEEP does not induce a decrease in dP/dt/DPt, the least sensitive to change in preload isovolumic phase indices of contractility.