摘要:

The application of the Starling resistor concept to the lungs during continuous positive pressure ventilation (CPPV) was evaluated. Ventilation and hemodynamics were studied in eight anesthetized and paralyzed dogs before and during the use of CPPV. CPPV resulted in an increase in transpulmonary pressure and functional residual capacity (FRC), and a decrease in arterial pH and mixed venous oxygen tension (PvO2). Cardiac index decreased 32% (p< 0.01) and stroke volume 51% (p< 0.01). Neither right nor left transmural pressures changed but pulmonary vascular resistance increased 189% (p< 0.01).This study supports the concept that the pulmonary vasculature behaves as a Starling resistor during the use of CPPV. The increase in pulmonary vascular resistance must be considered when transpulmonary pressure is raised by CPPV.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

We tested a computer system for routine arrhythmia monitoring in 181 postoperative patients in order to evaluate its practical value. There was no significant difference in the incidence of arrhythmias between patients clinically classified in poor condition and those classified in good condition. Conventional vital signs appeared to have more value than a PVC count or an index of arrhythmias. We found no evidence that continuous electrocardiogram monitoring might provide an early warning signal in these patients monitored.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A safe, simple, reliable technique for sampling uncontaminated peripheral bronchial secretions in patients with endotracheal tubes has been developed. It is easily performed and requires no special training or equipment. This report summarizes the technique's usefulness in providing diagnostic samples of peripheral airway secretions from 20 patients with pneumonic infiltrates. In eight of the patients, a single organism was recovered from the peripheral airway despite polymicrobial colonization of the upper airways. An additional patient had two anaerobes. The recovered organism's role as a pathogen was verified by an appropriate response to specific antibiotic therapy in two patients, isolation from blood or empyema fluid in five, confirmation by bronchoscopy in one, and transtracheal aspiration after extubation in one. Peripheral bronchial secretions were sterile in the remaining 11 patients, even though multiple organisms were isolated from usual tracheal suctionings.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Despite the wide variety of illnesses and operations, we observed a common cardiorespiratory pattern of shock that was different for the survivors and nonsurvivors, although no one variable was capable of predicting outcome. Differences between the patterns of survivors and nonsurvivors were defined by range criteria and by cut-points operationally obtained from the frequency distributions of cardiorespiratory variables. The values of each of the 33 variables obtained, at times remote from therapy during each successive stage in the postoperative course, were used to predict survival and death in a series of 113 patients by the range and cut-point methods. An average of 13.5% of all the available variables gave a correct prediction by the range criteria and 35% by the cut-point method.The mean percentage of Right — Wrong classifications throughout all stages for range and cut-point methods was 80 and 85%, respectively. Using the last available stage, the outcome was correctly predicted by the range criteria in 80% and by the cut-point method in 88% of the patients. The high percentage of correct predictions suggests that these methods may provide a measure of the severity of acute illness as well as early warning of impending death.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

An algorithm for management of pulmonary complications in burn patients on the same basis as in patients with adult respiratory distress syndrome is outlined. Pao2of less than 60 torr (F102, 0.21–0.4), Paco2over 40 torr, pH less than 7.35, respiratory rate over 40/min, and clinical evidence of compromised upper airway were the indications for initiation of aggressive intensive respiratory care. This consisted of nasotracheal intubation, arterial cannulation, pulmonary artery catheterization, and establishment of mechanical ventilation. The algorithm further defines the subsequent management of these patients as far as need for continued mechanical ventilation, fluid and electrolyte balance, hemodynamic stability, and renal function.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Cardiac output and intravascular pressures were monitored in a series of 20 critically ill patients in a community hospital during a 1-year period. Hemodynamic monitoring was very useful in the evaluation of clinical problems; data indicating hypovolemia and cardiac problems were found in 8 and 5 patients, respectively. More importantly, the frequently repeated measurements before and during therapy were extremely helpful in titrating therapy. Reliance on CVP measurements would not have provided the essential information.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The value of prompt assessment of hemodynamic cardiorespiratory function in critically ill medical and surgical patients is widely appreciated. We have presented a system for rapidly computing these variables on real time in the ICU, for a capital outlay of less than $250. In so doing, we hope to extend the benefits of this type of assessment to the smaller community hospital ICU and individual clinicians.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Transportation of patients requiring continuous ventilatory support and increased inspired oxygen concentrations may be cumbersome, inefficient, and dangerous. We evaluated a new time-cycled transport ventilator, which provided simple operation, ample inspired oxygen concentration, and adequate minute ventilation in every patient tested.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Patency of pressure sensing systems can be provided by the Intraflow Continuous Flush System (Sorenson Research Company, Salt Lake City, UT 84115). This device allows continuous flow of flush solution through a regulatory valve while preventing transmission of the high pressure of the flush solution. The case presented describes the recognition of a false elevation of a monitored pressure secondary to the malfunction of the Intraflo regulatory valve. Elimination of the flush solution high pressure during monitoring prevents inappropriate data collection.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID