摘要:

In 60 patients in whom Swan-Ganz catheters apparently had been positioned correctly, the balloon was visualized by inflation with radiopaque contrast medium. Sixteen were located peripherally; in 15 of these 16, the balloon inflated eccentrically and in each of these instances, an accurate wedge pressure could not be obtained. One patient in this group had an episode of hemoptysis immediately prior to detection of the peripheral location and eccentric inflation of the balloon.The correct placement and safe use of the Swan-Ganz catheter demand that the catheter tip be located in a large pulmonary artery and that redundant loops of catheter be avoided to prevent subsequent peripheral migration. Identification of peripheral placement and eccentric inflation should be suspected if a pulmonary wedge pressure is obtained with a significantly smaller volume of air than the balloon capacity. The use of a continuous flush system will provide an additional alert by a steady rise in the pseudowedge pressure on attempted balloon inflation.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The major components entering into the inspiratory pattern of various respirators were tested on a model lung which had an abnormally high airway resistance on one side. The tests consisted of simultaneous nitrogen washout curves from each lung separately utilizing two mass spectrometers. The components tested included a constant versus accelerating wave form and the presence, duration or absence of an end-inspiratory pause. Respirators tested included the Bennett MA1, Engström 300 and the Elema Schonander Servo Ventilator 900. The results demonstrated the importance of an end inspiratory pause in improving gas distribution and efficiency of washout. No difference was found between a constant or accelerating air flow. Preliminary results in man appear to confirm the importance of an end inspiratory pause.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Two patients with adult respiratory distress syndrome (ARDS) are described in which the development of localized areas of increased lucency on chest roentgenogram, Westermark's sign, aided in the rapid diagnosis of concurrent pulmonary emboli. Recognition of this radiological sign represents a noninvasive technique for diagnosing this complication.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Cerebral, hepatic, renal cortical, and medullary tissue blood flows of the dog during hemorrhagic shock were measured continuously using the thermoelectrical method. The effects of blood replacement, adrenergic α-stimulator and -blockade and hydrocortisone on the tissue blood flows were studied.After hemorrhage, cerebral blood flow was well maintained while renal cortical blood flow was poorly maintained. Following retransfusion, the blood flow returned rapidly to the brain and slowly to the renal cortex. Norepinephrine, phentolamine, and hydrocortisone were not effective in maintaining the organ blood flows in shock. However, when norepinephrine was given systemically and phentolamine administered to the renal artery simultaneously during shock, both cerebral and renal flows were well maintained. After the blood replacement and administration of α-blockade or hydrocortisone, all the measured blood flows returned to normal levels.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A 3-year experience with 50 acute renal failure patients managed by hemodialysis in a 417-bed community hospital is reviewed. The 58% survival rate was better than that reported in other recent series. Possible reasons for our favorable mortality experience include: (1) Hemodialysis was performed within the ICU facility by the ICU staff. Continuity of total care was thereby maintained and hemodialysis problems, such as maintenance of circulating volume, were managed in the context of continued assessment of the patient's cardiopulmonary status. (2) In contrast to previous reports, the presence of sepsis did not influence recovery rates from acute renal failure. Early administration of specific antibiotics, mainly gentamicin, rapid drainage of abdominal abscesses, and early and frequent dialysis were all utilized in septic patients and may have contributed to their high recovery rate. (3) The use of aggressive dialysis may also have lessened other uremic complications, notably gastrointestinal bleeding. Our dialysis organization and procedures are described.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

In order to evaluate the accuracy of our method of P50determination, we measured P50and 2,3-DPG on different days on several members of our laboratory staff and were surprised to find significant variation. Initially, we indicted our methodology but subsequent data suggest that significant P50variability occurs, not correlated to alterations in 2,3-DPG or red cell pH. The largest variability on different days, 8.5 torr, occurred in a laboratory staff member studied 7 days apart.The P50determinations were made by fixing Po2by tonometry and determining oxyhemoglobin saturation by Van Slyke analysis.In contrast to our in vivo data, serial studies over 5–20 days performed upon 3 samples of stored CPD bank blood demonstrated the expected progressive decline in both 2,3-DPG and P50

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Oxygen availability during cardiopulmonary bypass was assessed in 22 patients under hypothermic and relatively normothermic conditions. The patients were divided into two groups, 17 of whom received ACD blood and 5, CPD blood.The mean P50for all patients fell from a preoperative value of 25.9 ± 2.4 (SD) to 15.6 ± 2.1 during hypothermia confirming a leftward shift of the oxyhemoglobin dissociation curve. Oxygen uptake, calculated from a-&OV0456; oxygen content differences (avDO2) and flow, was significantly lower during hypothermic bypass (65 ± 27 ml/min) than during rewarming (121 ± 41 ml/min). The increase in oxygen affinity during hypothermia was influenced also by changes in acid base and 2,3-DPG concentrations, the changes being similar in both the ACD and CPD groups of patients. During rewarming, however, oxygen availability was increased in the CPD group presumably from significantly increased 2,3-DPG concentrations.A “functional” value of hemoglobin, based upon the effects of the shift of the oxyhemoglobin dissociation curve and, therefore, reflecting the true capacity of hemoglobin to unload oxygen at the tissue level, was calculated. During the hypothermic phase of bypass, this functional hemoglobin was only 4.2 g/100 ml blood, suggesting that, in spite of reduced metabolic demands, oxygenation reserves are minimal.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The educational objectives in use in our Pediatric ICU are described. These have importance for educational programs in critical care medicine, in particular, where patient care needs can easily overwhelm educational needs. It is important not to overlook our role as teachers in the development of proper attitudes and of the more complex areas of thought; skills and rote memory should not be overstressed.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

When suctioning patients with either a tracheostomy or endotracheal tube, the incidence of entry into the left main stem bronchus was recorded at the time of routine AP chest examinations in an ICU. The success rate was 8% with an endotracheal tube and 25% when a tracheostomy tube was present; this was lower than has been reported by others. It could reflect the small size of the series or a more accurate picture.

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