摘要:

To quantify the influence of continuous positive pressure ventilation (CPPV) on hepatic plasma flow (HPF) in 8 critically ill patients submitted to controlled ventilation, we measured simultaneously HPF by the indocyanine green dye (IGD) clearance and cardiac output (CO) by the thermodilution technique, while increasing PEEP from 0–20 cm H2O.CPPV induced a significant decrease in HPF which was related to the level of PEEP. A linear correlation was documented between HPF and CO; HPF remained a constant fraction of CO during CPPV. These results suggest that the decrease in CO is the most likely mechanism of the fall in HPF during CPPV.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The hemodynamic effects of PEEP ventilation were studied in 16 patients with adult respiratory distress syndrome (ARDS). Cardiac index (CI), blood pressure (BP), heart rate (HR), left cardiac work index (LCWI), and left ventricular stroke work index (LVSWI) were evaluated in each patient at 0, 5, 10, 15, and 20 cm H2O of PEEP. All patients were able to tolerate even the highest level of PEEP without evident clinical sequelae. BP did not change significantly. HR fell significantly at 20 cm H2O of PEEP. LCWI and CI fell at 20 cm H2O of PEEP but the mean fall in CI was only 6% (from 3.47 to 3.27 L/min M2). LVSWI did not change significantly.PEEP did not produce clinically significant hemodynamic changes. We believe that the avoidance of hypovolemia, limited use of sedative and paralytic drugs, and use of assisted ventilation in the management of our patients contributed substantially to these results though other possible factors cannot be excluded.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The polymorphonuclear leukocyte (PMN) plays an integral role in the development of permeability pulmonary edema associated with the adult respiratory distress syndrome (ARDS). This report describes 3 patients with ARDS secondary to systemic sepsis who demonstrated an abnormal diffuse accumulation of Indium (111In)-labeled PMNs in their lungs, without concomitant clinical or laboratory evidence of a primary chest infection. In one patient, the accumulation of the pulmonary activity during an initial pass suggested that this observation was related to diffuse leukoaggregation within the pulmonary microvasculature. A 4th patient with ARDS was on high-dose corticosteroids at the time of a similar study, and showed no pulmonary accumulation of PMNs, suggesting a possible reason for the reported beneficial effect of corticosteroids in human ARDS.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In closed chested, pentobarbitol anesthetized dogs, we studied the relationship between pulmonary vascular resistance index (PVRI) and progressively increasing positive end-expiratory pressure (PEEP) in both normal and abnormal lungs; we correlated these PEEP-induced PVRI changes with those in other pulmonary vascular and airway dynamic function indices. We continuously measured cardiac output (Qt) and pulmonary artery, left atrial, airway, and pleural pressures and intermittently measured arterial and mixed venous blood gas tensions and static and dynamic compliance (Csta, Cdyn) with an 18 ml/kg test inflation. Normal lung was converted to abnormal lung by the administration of oleic acid intravenously plus HCl intratracheally. We found that PVRI was a “U”- or “J”-shaped function of increasing PEEP in both normal and abnormal lungs. PVRI correlated inversely with cardiac index and systemic oxygen transport index and positively with the difference between pulmonary artery diastolic and left atrial pressures in both normal and abnormal lungs as well as inversely with Csta in normal lungs. The various maxima and minima correlates of minimal PVRI occurred at PEEP of 5 cm H2O in normal lungs and PEEP of 10 cm H2O in abnormal lungs. These latter findings support the hypothesis that there is one lung volume in both normal and abnormal lungs which is optimal for ventilation, blood flow, and transport of oxygen to the tissues. These findings suggest that clinical studies should be undertaken to examine whether minimal PVRI may be used as another variable by which to titrate the application of PEEP in humans.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

High frequency positive pressure ventilation (HFPPV) was compared with normal frequency positive pressure ventilation (NFPPV) during diagnostic fiberoptic-bronchoscopy. HFPPV was achieved by a simple modification of the Minivent, and gave satisfactory alveolar ventilation and oxygenation. In all 11 patients and over periods of at least 40 min, HFPPV gave normal Paco2and high levels of Pao2. Arterial blood pressures were higher and the airway pressures were lower than during NFPPV.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

We prospectively studied the incidence of catheter-related sepsis in 51 critically ill patients who underwent 52 arterial and 37 pulmonary artery catheterizations over a period of 3 months. Daily cultures of blood and catheter insertion site were done and the catheters were cultured semiquantitatively at the time of removal. Catheter colonization defined as growth of 15 or more colonies was observed with 9 (10%) catheters and bacteremia with 4 (4.5%) catheters. The skin cultures were positive in 56% of the colonized catheters compared with 11% of sterile catheters (p< 0.01). The mean duration of catheterization of 3.8 days in colonized catheters was not different than 3.3 days in noncolonized catheters. Presence of concurrent infection and use of antibiotic did not change the rate of catheter colonization. Often, microorganisms other than those colonizing the catheter were recovered from blood. Femoral arterial catheterization appeared to be more often associated with colonization than radial catheters.It appears that the arterial and pulmonary artery catheter colonization occurs in about 10% of catheters and predisposes to catheter-related sepsis. Semiquantitative cultures of the catheter may aid in better documentation of catheter-induced sepsis.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The rate of removal of Intralipid was studied in 2 groups of intensive care patients by analysis of the fractional removal rate after a single iv dose and by analysis of the removal rate during a constant infusion of Intralipid which immediately followed. The patients in group 1 were moderately ill after uncomplicated surgery whereas group 2 patients were critically ill and had a mortality of 44%. The fractional removal rate was 2-fold greater in group 1 than group 2 and controls; the 2 latter groups had similar rates of removal. During the constant infusion of Intralipid, 0.42 g/min for 3 h, group 1 patients were found to have a first order removal rate with a constant plasma concentration of Intralipid. The rate constants were not different during the entire infusion from those obtained by the single injection. In all of the group 2 patients, a zero order removal rate was present as the concentration of Intralipid particles increased linearly with time. Group 2 patients had cleared all Intralipid within 6 h after the end of the infusion. Some patients were treated with heparin and/or insulin for clinical reasons. The removal rates were not influenced in either group by these drugs. Thus, moderately traumatized patients were found to clear plasma from Intralipid at recommended infusion rates. However, in critically ill patients, the infusion rate of Intralipid may have to be adjusted below the maximal elimination capacity to avoid Intralipid accumulation in plasma.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Changes in plasma potassium in the first 10 min after alterations in PaCO2in anesthetized greyhounds were monitored continuously in vivo with potassium-selective electrode catheters. Elevation of PaCO2resulted in a small transient fall in plasma potassium whereas reduction in PaCO2resulted in a small transient rise in plasma potassium. Maximum changes occurred at approximately 5 min after alterations in PaCO2with levels tending to return to control thereafter. Changes of similar magnitude in normal man would not be expected to have an adverse effect on cardiac function, but they may have greater significance in subjects with pre-existing abnormal potassium levels, during concurrent treatment with digoxin, and after sudden alterations in PaCO2in chronic hypo- or hypercapnic conditions.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID