摘要:

Face mask or bag endotracheal tube manual ventilation of neonates and infants has relied primarily on the use of self-inflating resuscitation devices (SIRs). While SIRs have the advantage of being simple to use and, therefore, require minimal training, recent research has demonstrated significant drawbacks to these devices. These drawbacks have included their large physical size, the tendency of such devices to cause significant hyperventilation, and the extreme variability of pressures necessary to activate the pop-off valve safety feature. This latter problem is especially serious in the infant where large pressure variations may increase the potential for pulmonary barotrauma. In an attempt to minimize the disadvantages of SIRs, we developed a prototype volume-controlled resuscitation device (VCD). We then compared the VCD to the SIRs in a cat model using blinded volunteer health care personnel previously familiar with SIRs only. Ventilation of the cat with the VCD yielded arterial and end-tidal CO2values more closely resembling the physiologic state at a lower mean airway pressure. The data suggest that a human trial of manual ventilation with the prototype VCD is warranted.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

To achieve normocarbia during conventional mechanical ventilation, ventilator settings are determined initially on the basis of body weight. The best ventilator settings for CO2elimination during high-frequency jet ventilation (HFJV) have not been so clearly defined. A recent study has suggested that eucarbia will be obtained with HFJV when tidal volume (VT) per kg of body weight is kept within a narrow, well-defined range. In the same study, a “bench test” demonstrated that VT was directly proportional to the jet ventilator driving pressure (DP). The goal of our study was to confirm this recommended VT/kg to obtain eucarbia and to determine whether the relation observed between VT and DP in the laboratory was true clinically. We studied 14 patients admitted to the ICU for postoperative support. We determined a good correlation between DP and Vr/kg (r = .811,p< .001) for the group as a whole and a good inverse correlation between DP or VT/kg and PacO2for most individual patients; however, there was a poor inverse correlation between DP or VT/kg and Paco2for the group as a whole, due to wide patient-to-patient variation in the efficiency of jet ventilation. We conclude that there is no universal formula for setting jet ventilator DP or VT/kg to affect normocarbia in humans.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We evaluated the use of percutaneous endoscopic gastrostomy in 30 ICU patients. There was a 14% incidence of minor complications, no major complications, and no mortality. We conclude that percutaneous endoscopic gastrostomy is a useful alternative to operative gastrostomy in the ICU patient.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The heart rate variability (HRV) of 82 patients exhibiting sinus rhythm and admitted for possible myocardial infarction (MI) was evaluated. Using a simple information entropy measure to quantify the HRV, patients subsequently diagnosed with MI or experiencing significant dysrhythmia (n = 35) exhibited less entropy (0.28 ± 0.15) within the first 24 h after admission than those patients (n = 45) with no MI (0.36 ± 0.14;p< .01). Although correlations between entropy and age and heart rate (HR) were significant (p< .01), the additional explained variance was minimal. The groups were compared for sex, age, mean HR, past medical history and medications taken and were found to be statistically similar. In our patients without significant dysrhythmias on admission, HRV appeared to be an index for significant cardiac events, and thus may prove to be a useful tool in clinical situations where other objective decision criteria are lacking.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Maintenance of normal plasma ionized calcium concentration forms part of the management of the critically ill patient; it is, therefore, important to measure accurately plasma ionized calcium. We have compared the ionized calcium concentration of blood samples heparinized with a carefully measured amount of heparin with that of blood samples heparinized in the conventional fashion. The amount of heparin in the deadspace of a syringe was demonstrated to artifactually lower the plasma ionized calcium concentration. Samples for plasma ionized calcium measurement should be heparinized with a measured quantity of heparin, since the conventional technique introduces an unknown and probably excessive quantity of heparin into the syringe deadspace.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

There is no one operative treatment for acute pancreatitis. Surgery is indicated to resolve diagnostic uncertainty and perhaps to modify the early course of 1 gallstone pancreatitis. Peritoneal lavage is useful in reversing early-phase systemic circulatory effects mediated by toxins in the ascitic fluid, but does not modify the underlying pancreatitis. When pancreatitis progresses to pancreatic and peripancreatic necrosis, the ultimate outcome is determined by a) the amount of necrosis, b) the extent of extrapancreatic necrosis, and c) bacterial contamination of necrosis. The amount of pancreatic regional necrosis that can be safely observed for healing is unknown; large collections tend to become infected secondarily and thus should be evacuated. Computed tomographic scanning is the best current means of detecting pancreatic necrosis and abscesses. Only percutaneous aspiration can reliably differentiate sterile from infected collections. As sepsis is the most common cause of death in acute pancreatitis, adequate surgical drainage is essential, while antibiotic therapy is only adjunctive. Aggressive treatment directed at the two principal causes of death, early-phase shock and late-phase sepsis, should reduce mortality to about 1% overall and to about 5% in cases complicated by regional necrosis and sepsis.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID