摘要:

This study was performed to determine if particulate material within the pulmonary vascular bed could be sampled by aspirating blood from a wedged pulmonary artery catheter.99mTechnetium-labeled albumin microspheres (20 μm) were injected and embolized into the precapillary pulmonary vasculature of 6 critically ill and 4 routine diagnostic catheterization patients. Recovery of the particulates was demonstrated by comparing the gamma radioactivity of the wedge blood sample obtained to that of mixed venous blood. The degree of success in the recovery corresponded to the height of the oxygen tension of the wedge blood sample (PWO2). This suggests that the PWO2may be a useful marker of successful sampling of the pulmonary microvascular bed during wedge aspiration. In wedge samples obtained serially, peak yield of the microspheres was obtained within the first 10 ml whereas peak oxygen tension was obtained at 20 ml of total aspiration volume. Wedge aspiration has promise as a sampling method for microembolized particulates in the investigation of acute pulmonary microvascular diseases.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Four cases of acute life-threatening tracheal obstruction due to intrathoracic goiter are reported. Acute respiratory insufficiency caused by an upper airway obstruction in patients with intrathoracic goiter is exceptional. In 3 of 4 cases reported, the histologic study showed multiple foci of recent hemorrhage, the mechanism probably responsible for these episodes.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

While the hemodynamic effects of hydroxyethyl starch (HES) have been reported, the effect of this material upon extravascular lung water (EVLW) has not been investigated. Twenty mongrel dogs were subjected to both an oleic acid-induced lung injury and a 2-h period of hemorrhagic shock (MAP = 40 mm Hg). After reinfusion of shed blood, 5 dogs in each of 4 groups were given either 0.5 L of lactated Ringer's solution or 0.5 L of 5% albumin, 6% dextran 75, or 6% HES. Lactated Ringer's solution was then given in sufficient quantity to keep the wedge pressure (WP) at 12–15 mm Hg and Pao2, P(A-a)O2, cardiac index (CI) and oxygen delivery were determined. EVLW was measured by thermal-green dye double-indicator technique with an Edwards Lung Water Computer (American Edwards Laboratories, Santa Ana, CA). Mean baseline EVLW was 6.9 ± 0.3 ml/kg. Mean EVLW rose to 11.5 ± 1.9 ml/kg after oleic acid. One h after reinfusion, EVLW increased to 40.5 ± .4 ml/kg in the dogs given only lactated Ringer's solution and to 39.5 ± 1.5 ml/kg in the dextran group. EVLW was 25.5 ± 3 ml/kg in the HES dogs, and 29.5 ± 2 ml/kg in the group given albumin. Differences between albumin and lactated Ringer's solution and between the HES and lactated Ringer's groups were significant (p< 0.02 andp< 0.05). Measurements of oxygen, ventilation, CI, and oxygen delivery were not significantly different between the albumin and HES subjects.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Esophageal and CVP changes were measured simultaneously during mechanical ventilation in 12 patients with acute respiratory failure (ARF). The results of these measurements were different and showed no correlation. Values of transpulmonary pressure changes and calculated lung compliances correlated well, because of the higher airway pressure changes. It is concluded, therefore, that measurements of esophageal and CVP changes are equally well suited for these calculations.For practical purposes, there is no need to measure a representant of intrapleural pressure changes, because during mechanical ventilation total static compliance calculations can be used to monitor changes in lung compliance, provided the thoracic cage compliance is not reduced substantially and does not change during the course of the studies. Clinical awareness of factors influencing thoracic cage compliance is important.The difference in transpulmonary and transthoracic pressure relationships during mechanical ventilation and during spontaneous breathing is emphasized. In spontaneous breathing, intrapleural pressure changes are determined primarily by the elastic properties of the lungs; in mechanical ventilation, on the other hand, by the elastic properties of the thoracic cage.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Intrapleural (Ppl) and intraesophageal pressure (Pes) measurements were compared during spontaneous respiration in sick infants. The Pes, measured with a water-filled catheter, indicates pressure variations in the esophagus to be about 4.5% smaller than in the pleural cavity. However, there is a highly significant linear correlation (r = 0.96,p< 0.001) between pressure variations in the pleural cavity and in the esophagus during spontaneous respiration; i.e., Pesmonitoring will indicate Pplvariations. Air in the pleural cavity causes marked diminution in Pesfluctuation. Continuous monitoring of Pesmay be useful in the early detection of pulmonary air leak in neonates with respiratory disorders.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Thirty-four cases of diaphragmatic paralysis after pediatric cardiac surgery are reviewed. Differences between pediatric and adult pulmonary physiology account for the increased severity of respiratory distress seen in children with this condition. The efficacy of treatment with endotracheal intubation and continuous positive airway pressure (CPAP) is confirmed. No patient over 3 yr of age required intubation for longer than 2 wk. This finding is consistent with the development of sufficient chest wall stability to compensate for paralysis of the hemidiaphragm. Patients under 3 yr of age, without complicating heart failure, who still required intubation and CPAP 3–4 wk after injury to the phrenic nerve should consider operative plication.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

No reliable tool has been available thus far to quantitate tracheal damage indirectly immediately after endotracheal intubation. We chose hoarseness as an early indicator of tracheal damage and attempted to quantitate its measurement by using linear prediction analysis. Results were compared with those of a qualitative auditory test.Fourteen males who underwent general anesthesia were divided into 2 groups: 7 were intubated with high-pressure cuffed tubes, and the others with low-pressure cuffed tubes. Mean cuff pressure was 74.1 ± 2.87 mm Hg in the former (group A) and 15.4 ± 0.34 mm Hg in the latter (group B). All patients were asked to sound “a‘’ preoperatively, and on the 1st and 3rd postoperative days. This recorded sound was dubbed at random, transcribed, and scored by 12 physicians blindly following a 3-step scale (0: normal, 1: some hoarseness, 2: obvious hoarseness). Scores were summed in each group and the totals for each postoperative day compared statistically to preoperative values by the Student'st-test for paired data, with a significance ofp< 0.05. Linear prediction analysis was applied to the speech sounds by computing the normalized energy of residue for each recorded sound at a sample interval of 64 msec. Total auditory scores between preoperative and first postoperative days were significantly different (p< 0.05) in group A but not in group B. Differences in normalized energy of residue measured preoperatively and first postoperatively were statistically significant (p< 0.05) in group A but not in group B. These results indicate that linear prediction of the speech wave can be a useful tool for quantitative, indirect analysis of hoarseness after endotracheal intubation.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Sphygmomanometric indirect blood pressure readings on the arm were compared to direct blood pressure readings from the radial and pedal arteries in pediatric patients. The direct systolic pressure in the pedal arteries was significantly (p< 0.001) greater (25.1 ± 12.3 mm Hg) than the indirect arm systolic pressure. The direct systolic pressure from the radial artery was identical to the indirect systolic arm pressure. Although there were no statistical differences between direct and indirect diastolic pressures, correlations for diastolic pressures were relatively poor.These data indicate that (1) there is a significant and unpredictable amplification of systolic pressure in the pedal arteries which may result in erroneous diagnosis of hypertension or jeopardize early detection of circulatory shock, (2) indirect blood pressure measurement with the recommended cuff width (125% of arm diameter or 40% of arm circumference) accurately reflects direct systolic pressure in the radial artery, and (3) indirect blood pressure measurement gives a relatively poor prediction of direct diastolic pressures.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In 12 cases of closed head injury without fracture or hematoma, but with clinical signs of increased intracranial pressure (ICP) and brain stem compression and with computed tomographic (CT) scan evidence of cerebral edema and contusion, subgaleal shunts were inserted for immediate decompression of the ventricular system and continuous drainage of hemorrhagic cerebrospinal fluid (CSF). Three patients with fixed dilated pupils and no reflexes or spontaneous respiration on admission did not improve and expired within 72 h. Nine patients who manifested Cushing's triad (bradycardia, bradypnea, and hypertension) shortly after admission made significant recovery and underwent catheter removal 1 wk later; 8 were able to be discharged home after extended periods of physiotherapy. No complications, postoperative hemorrhage or infection, were recorded.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Estimations of blood glucose in the range 0–80 mg/dl were performed using the Chemstrip bG and StatTek Glucose Low Level test strips. Estimations of glucose levels closely approximated values obtained by a quantitative, enzymatic reference method; both appear to be excellent screening tests for hypoglycemia. There were no false-negatives, the tests were 100% sensitive and predicted the absence of hypoglycemia, as defined by a plasma glucose value of less than 30 mg/dl, in every case. Therefore, significant hypoglycemia should not be missed. Both give some false positives; in the usual neonatal intensive care population, about 4 of 10 Chemstrip readings of

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID