摘要:

Ten neonates with respiratory distress requiring mechanical ventilation and supplemental oxygen were studied during a continuous 24-h period to determine the value of continuous transcutaneous oxygen (PtcO2) monitoring. All 10 infants were continuously monitored during the study with a Clark-type skin electrode (Litton) and 5 of the 10 also had a catheter-tip oxygen electrode in place in the umbilical artery to measure umbilical artery O2(PuaO2). The results of these two forms of monitoring were not available for the care of the infant during the study period. Hypoxia, as defined by a Po2of less than 50 torr, occurred for an average of 237 ± 51 min/24 h from continuous PtcO2monitoring as compared with 146 ± 33 min/24 h by estimation from arterial blood gas (Pao2) (p< 0.05). Hyperoxia, a Po2of greater than 75 torr, occurred 69 ± 16 min/24 h in the continuous group and 113 ± 26 min/24 h from Pao2estimations. Severe hypoxia, a Po2of less than 30 torr, was not observed from Pao2estimations, but was seen for an average 32 ± 15 min/24 h from the PtcO2monitoring. These latter differences were not significant. Correlation between Pao2and PtcO2values (r= 0.93) was greater than the correlation between Pao2and PuaO2(r= 0.81). PtcO2= 19.7 ± 0.74 x PuaO2, and the correlation coefficient between PtcO2and PuaO2was 0.64. Continuous oxygen monitoring revealed significantly longer periods of hypoxia than that observed from blood gas estimations alone and its use in the low birth weight infant should result in more rational ventilatory therapy and in fewer episodes of hypoxia.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

One-hundred consecutive patients who underwent orotracheal intubation (OT), nasotracheal intubation (NT), or tracheostomy in the pediatric ICU were evaluated for complications of these airway invasions. Twelve patients had major complications as a result of airway intervention. The mortality for patients requiring mechanical ventilation was 17% as compared with a total overall mortality of 8.3% for patients in the pediatric ICU. Major complications occurred in 10% of patients who had orotracheal intubation, in 11% of patients who had nasotracheal intubations, and in 26% of patients subjected to tracheostomy. Laryngotracheobronchitis (croup) was the primary diagnosis associated with the highest rate of complications. An association was found between the occurrence of seizures or hypoperfusion state (shock) while intubated and the occurrence of major complications of airway intrusion. Acquired infections of the respiratory tract withHemophilus influenzae, Pseudomonas, Klebsiella, andCandida albiconswere also associated with a high rate of complications.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Fifty-eight consecutive patients admitted to the ICU requiring ventilatory support for respiratory failure were studied. The Therapeutic Intervention Scoring System (TISS) was used daily as an objective measure of the severity of critical illness in each patient. Patients who survived (27 of 58) 8–10 months after admission to the ICU were interviewed in their homes to assess the outcome of their illness. Most survivors were functioning at or above their premorbid level with respect to their activities of self care and community living. Survivors had minimal recall of the pain and anguish of their ICU experience.The financial cost of care was estimated. Of the total ICU cost, 40% was expended on the 27 survivors.The TISS alone could not distinguish survivors from nonsurvivors in this patient population. The major factor determining the outcome of the illness was the age of the patient. More information on the outcome of critical illness in elderly patients is needed.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Assessment of preload and afterload of patients having undergone cardiac surgery is commonly done by the monitoring of mean arterial and left atrial pressures (MAP, LAP). In this ICU, a central computer has been in use to sample routinely the MAP and LAP every 10 min. This computer has been programmed to activate an alarm sequence if a routinely acquired value of MAP or LAP is found to be outside of preset (“trend”) limits. The computer then initiates a repeat mode of sampling of MAP and LAP at 1 min intervals. If three consecutive repeated values of either variable remain outside of the preset limits, then the following occurs: 1) a plot of the trend of MAP and LAP over the preceding 3 h appears on the bedside video monitor, 2) a bedside light and audible chime are activated, and 3) the bedside keyboard is locked out to other functions until the alarm is reset. A study showed that this system can detect adverse trends appropriately, averaging only 1–2 false alarms/patient per 8-h shift.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The choice of mechanical ventilation and other technical measures for positive-pressure ventilation plays a central role in the clinical management of an increasing number of serious conditions. It is a well known fact that the circulatory effects of positive-pressure ventilation are often closely linked to the elevated mean intrathoracic pressure with which it is associated. Thus, a controversy arises between physics and physiology in the designing of ventilators to match the breathing patterns and pulmonary and car-diocirculatory physiology of patients with seriously impaired vital functions.A ventilator system utilizing a pneumatic valve principle for pressure/flow-generated, time-cycled high-frequency positive-pressure ventilation (HFPPV) for use during bronchoscopy and laryngoscopy is described. Bronchoscopic and laryngoscopic HFPPV represent new and clinically established applications of high-frequency ventilation. They may be regarded as unequivocal improvements over previous methods of ventilation during bronchoscopy and laryngoscopy and, in this respect, HFPPV has substantially increased the possibilities of microlaryngeal and tracheal surgery.A prototype of a ventilator system for pressure/flow-generated, time-cycled, volume-controlled ventilation, functionally without a compression volume, has also been developed. In this system for volume-controlled ventilation, inspiratory flow has a decelerating character, intrapulmonary gas distribution is improved in relation to that with use of a conventional ventilator system, and volume is the primary (independent) variable, while pressure becomes a secondary (dependent) variable. Such ventilation set at a high ventilatory frequency would seem to cause less interference with cardiocirculatory functions.The major characteristics of the ventilatory pattern of volume-controlled HFPPV are (1) a ventilatory frequency of about 60–100/min and an inspiration: expiration ratio of less than 0.3, (2) smaller tidal volumes, and thereby lower maximal and mean airway-thus, lower transpulmonary pressures, yet a higher functional residual capacity than in conventional IPPV/CPPV, (3) positive intratracheal and negative intrapleural pressures throughout the ventilatory cycle, (4) less circulatory interference than in conventional IPPV/CPPV, (5) reflex suppression of spontaneous respiratory rhythmicity (under certain conditions) during normoventilation, (6) decelerating inspiratory flow without an end-inspiratory plateau, and (7) more efficient pulmonary gas distribution than in conventional IPPV/CPPV. This means that the conventional opinion of how alveolar ventilation takes place during mechanical ventilation is no longer adequate for explaining how alveolar ventilation occurs during ventilation with low-compressive systems and HFPPV.Although the functional characteristics of volume-controlled HFPPV would appear to have considerable impact on the pulmonary and cardiocirculatory physiology of patients with seriously impaired vital functions, the results of the present and more extensive clinical evaluation in critically ill patients must be awaited before the merits of low-compressive, volume-controlled ventilation of high frequencies can be satisfactorily compared with those of the traditional techniques and ventilatory rates.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID