摘要:

Routine measurement of pressure-volume curves of the lungs and thorax in seven patients treated with continuous mechanical ventilation provided supportive evidence for the presence or absence of cardiogenic pulmonary edema, noncardiogenic pulmonary edema, pneumonia, bronchospasm, mucous plugging, intubation of mainstem bronchus, atelectasis, and results of subsequent therapy. Those conditions associated with predominantly airway disease altered dynamic more than static pressure-volume measurements. Those conditions associated with parenchymal lung disease or loss of lung volume generally altered both dynamic and static pressure-volume measurements. The effectiveness of treatment of these diseases could be monitored by their effect on the pressure-volume curve. The determination of pressure-volume measurements are simple, noninvasive, and can be accomplished within minutes. The routine use of these measurements should be one of the monitoring procedures performed in patients treated with mechanical ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

There is a special form of pulmonary dysfunction which most often occurs following massive tissue damage, such as major fractures accompanied by hypovolemia. This syndrome may be appropriately called post-traumatic pulmonary microembolism to distinguish it from other causes of respiratory failure. We believe that pathophysiology is initiated at the time of trauma and consists of platelet aggregation and fibrin deposition in the pulmonary microcirculation caused by release of tissue-thromboplastin products. Whether this acute traumatic pulmonary microembolism will progress to a fully developed post-traumatic pulmonary microembolism with respiratory symptoms depends upon the magnitude and duration of tissue-thromboplastin release and the efficiency of the fibrinolytic system to clear the lungs. The early microembolic effects on the lungs consist mainly of ventilatory derangements with a low ventilation/perfusion ratio; not until a later stage does true shunting of mixed venous blood across fluid-filled alveoli and small airways occur. Frequently determinations of Pao2and AaDO2during air breathing (“air-test”) to reveal a low ventilation/perfusion ratio is, therefore, preferable to true shunt determinations in patients who may develop this syndrome; caution must be exercised in giving room air to critically ill patients. These ventilatory variables, combined with frequent platelet counts, allow early recognition of post-traumatic pulmonary microembolism.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

We report an evaluation of the effect of positive-end-expiratory-pressure (PEEP) on improving pulmonary oxygenating capacity in the adult respiratory distress syndrome (ARDS), when the latter is associated with generalized gram-negative sepsis. Fifty-seven cases treated in our RICU with PEEP ventilation (April 1972 to January 1975) were retrospectively reviewed. Oxygenating capacity improvement was evaluated in terms of the changes in Pao2/Fio2and AaDO2(Fio2= 1.0). Both the short term (2–3 hours from the initiation of PEEP) and the overall effects of PEEP were evaluated.A mean PEEP of 5.6 cm H2O initially increased Pao2/Fio2by a mean of 94 torr and decreased AaDO2(Fio2= 1.0) by 105 torr in the 28 nonseptic patients. In the 29 septic patients, 5.1 cm H2O PEEP initially increased Pao2/Fio2by 32 torr and decreased AaDO2(Fio2= 1.0) by 38 torr. The differences between the septic and nonseptic patients were statistically significant (P< 0.001). Likewise, the long-term effect of similar levels of PEEP was in increasing Pao2/Fio2by 142 torr and by 75 torr in the nonseptic and septic patients, respectively. The final reduction in AaDO2(Fio2= 1.0) was 163 torr and 87 torr in the nonseptic and septic patients, respectively. These differences between patient groups were also statistically significant (P< 0.02).Mortality during PEEP was 15/29 and 3/28 in the septic and nonseptic patients, respectively. Overall mortality in the septic and nonseptic groups was 18/29 and 5/28, respectively.We conclude that ARDS with sepsis constitutes a more severe pulmonary insult than ARDS without sepsis, and/or that generalized sepsis creates a more prolonged pulmonary insult that makes it less amenable to PEEP. Thus, high levels of PEEP may be needed to treat ARDS associated with sepsis.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Fourteen patients with acute nonoliguric renal failure have been studied during the past 3 years. The mortality rate was 7% and the complication rate was 21%. Early recognition of the nonoliguric state and its maintenance with adequate volume replacement should decrease the mortality rate in postoperative acute renal failure. Reasons for the decrease in septic complications among this group of patients are not clear, but the absence of septic complications appears to be the major reason for the decreased morbidity and mortality in these patients.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Preliminary studies on muscle tissue metabolism were made in a series of 18 patients treated in an intensive care unit.In acutely ill patients with circulatory or respiratory insufficiency, there was an increase in muscle lactate content, a decrease in the phosphorylcreatine stores as well as decreases in adenosine triphosphate (ATP) and total adenine (TA) contents. These findings could partly be explained by a relative hypoxia in the muscle but acute hypoxia alone would not account for the decrease in ATP or TA.These changes in the adenylate pool were still more pronounced in patients with prolonged diseases. In this series the ATP content was only 50% of the normal, despite normal lactate content.The reason for the low adenine nucleotide level in muscle tissue is thought to be due primarily to an increased formation and deamination of adenosine monophosphate during hypoxia in combination with a decreased rate of purine synthesis in the liver and/or a decreased capacity for “purine salvage” in the muscle. This itself might, in turn, be mediated by a low energy state in muscle or liver or be due to other metabolic disturbances or tissue damage.It was found that prolonged immobilization without metabolic disturbances did not change the TA content in muscle, while short-lasting severe metabolic acidosis decreased the TA content. A correction of the metabolic disturbance immediately increased the TA content in muscle.A low energy charge potential was found in patients with prolonged diseases, possibly being the cellular expression for the concept of the post-traumatic catabolic state.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Axillary arterial catheterization for intraoperative and postoperative monitoring was successful in 90% of 87 attempts. Complications occurred in nine patients; there were eight hematomas, one of which was extensive. In the ninth patient, radial pulsations disappeared but returned after the catheter was withdrawn. There were no sequelae in any of these patients.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

摘要:

Long-term endotracheal intubation in seriously ill patients is frequently complicated by nosocomial infection of the tracheobronchial tree, especially with aerobic gram negative bacilli. A further complication is drying of pulmonary secretions unless the medical gases given are humidified.The performance characteristics of a humidifying system used in spontaneously breathing, intubated patients is described. This system possesses the potential to decrease infection, provides physiologic humidification without nebulization, and, by avoiding air dilution, allows the administration of a precisely regulated Fio2.

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1976

数据来源: OVID