摘要:

Continuous Svo2measurement using a triple-lumen flow-directed pulmonary artery catheter with fiberoptic filaments has been described. The purpose of this study was to identify whether the availability of Svo2as a continuously monitored signal could have altered patient management decisions made by the medical staff on the basis of clinical and laboratory data and signals currently used in Id's. Subjects for this study were 15 critically ill patients requiring arterial cannulation and insertion of a pulmonary artery catheter. The central processor of the device was placed in a specially constructed wooden box in such a way as to conceal the digital display of the signal. The folded paper used for a continuous 72-h recording of the signal was also not available to the personnel managing the patient. In detailed and repeated assessments of the patient's status, the medical team managing the patient entered on a special form all clinical and laboratory data as well as medical decisions made. At the end of each study the Svo2value recorded at each assessment was entered on the form. The investigators then determined whether knowledge of Svo2would have changed the clinical decision actually made. The Svo2signal was continuously recorded for a total of 1065 h and 173 individual assessments. The Svo2signal as measured by the Oximetrix device was compatible with decisions made on the basis of standard measurements used in the ICU in a majority of cases. We could not document any incident in which awareness of Svo2would have resulted in a different yet more appropriate line of management than that based on the currently available data.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The Servo 150 hygroscopic condenser-humidifier was evaluated during use to determine if the inner foam core became contaminated and if a bacteria-laden aerosol was produced during the inspiratory cycle of the patient's mechanical ventilator. Cultures from the core and of inspired gas were obtained from seven patients with known culture-positive sputum, after 4, 8, 12 and 24 h of humidifier use. In each case, the inner foam core was grossly contaminated after 4 h of use and colony counts increased during the 24-h testing period. The bacteria recovered were the same as those cultured from sputum. Despite the core's heavy bacterial growth, a bacteria-laden aerosol occurred in only 43% of the samples obtained during humidifier use. The Servo humidifier does not appear to increase the risk of airway exposure to airborne bacteria during mechanical ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A miniaturized Fiberoptic Pco2probe permits direct measurement of tissue Pco2on nonkeratinized tissue surfaces without the heating effects produced by transcutaneous Pco2sensors. This study of anesthetized dogs compared Pco2measured at the palpebral conjunctiva (Pcjco2) with Paco2and mixed venous (Pvco2) measurements during normovolemic normotension and hypovolemic hypotension. During the control period, the average Pcjco2was 3 ± 1 (SEM) torr greater than Paco2(r = 0.98) when the latter ranged from 20 to 80 torr. There was a close association (r = 0.94) between Pcjco2and Paco2when the cardiac index (CI) was greater than 2.0 L/minm2. However, as CI decreased below this value, PCjCo2and Paco2were less well correlated (r = 0.69). Pcjco2was closely associated with Pvco2at all stages of the experiment, both above (r = 0.95) and below (r = 0.82) a CI of 2 L/min m2. Fiberoptic conjunctival Pco2monitoring seems promising as a noninvasive measure of physiologic status.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A T-piece injector assembly delivers a blended oxygen/air mixture proximally via the side-arm of the T-piece, while continuous positive airway pressure (CPAP) is independently regulated by an injector adapted distally to the open end of the reservoir tubing. The system can provide different CPAP levels without significant fluctuations in the airway pressure and/or the inspired oxygen concentrations, and it maintains the original simplicity and safety of the T-piece.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We analyzed 35 samples of fresh frozen plasma (FFP), finding mean concentrations of 535 mg/dl glucose, 172 mEq/L sodium, 73 mEq/L chloride, 3.5 mEq/L potassium, 15 mEq/L bicarbonate, and 5.5 g/dl protein with 60% albumin. Thus, FFP is a hyperosmolar hyperglycemic, hypernatremic, and hypochloremic solution which may be a less effective volume expander than other albumin-containing solutions, due to its lower albumin content.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Stroma-free hemoglobin (SFH) solution is an acellular oxygen carrier under development as a temporary red blood cell (rbc) substitute. SFH will be of value if it contributes to oxygen loading (delivery) and unloading (consumption). If there is no interaction between red cell hemoglobin and SFH, then the composite oxygen dissociation curve for whole blood (WB) can be written as: SWB= r SSFH+ (1 - r) Srhc, where S is the fractional saturation, and r is the SFH/WB hemoglobin ratio. This composite whole-blood curve was compared with the calculated curve, and the root mean square difference was 0.9%. Direct and indirect methods of measuring oxygen concentration ([O2]) of whole blood or plasma were compared. The regression line was [O2]indirect.= 0.995 [O2]direct+ 0.07 (r = 0.995, N = 16,p< .01). The adequacy of anaerobic separation of plasma was evaluated by measuring the changes in Po2and Pco2. The Po2increased by less than 2 torr and the Pco2decreased by less than 1 torr during in vitro tests. Both the direct and indirect methodology yielded consistent [02] values for each carrier.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Blind insertion of a weighted nasoenteric tube (NET) has a low chance of immediate duodenal intubation and may cause serious complications. This study used fluoroscopic assistance to facilitate the passage of an NET to the duodenum. The success rate and complications were compared to those for NET insertion without fluoroscopy. Blind passage of a weighted feeding tube was associated with a 15% success rate in 13 patients; by contrast, fluoroscopic assistance allowed 95% of 20 patients to be intubated successfully in an average of 14 ±12 min. Although blind insertion caused intrabron-chial intubation in two patients, there were no complications associated with fluoroscopy.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The relationship between the arterial-alveolar oxygen partial pressure ratio (PaO2/PAO2) and different fractions of inspired oxygen (FiO2) was studied using a bicompartmental computer model. Pao2/PAO2 was found to be less stable than in previous clinical works probably because the venous admixture varied with changes in the FiO2.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

An obese patient with sleep apnea and chronic obstructive pulmonary disease was difficult to sedate and ventilate after tracheostomy. High peak inspiratory pressures and severe patient agitation persisted despite sedation with lorazepam, and threatened security of the tracheostomy. The use of a ketamine infusion sedated the patient and allowed weaning to progress uneventfully.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID