摘要:

Hemodynamic effects of controlled mechanical ventilation (CMV), intermittent mandatory ventilation (IMV), and intermittent mandatory ventilation with 5 cm H2O PEEP (IMV5PEEP) were studied in 20 patients after aortocoronary bypass surgery. Significant increases in cardiac index (CI) and stroke volume index (SI) (p< 0.01) resulted in patients with normal left ventricular end-diastolic pressure (LVEDP) and ejection fraction (EF) changing from CMV to IMV. With a change from IMV to IMVSPEEP, the CI and SI returned to CMV values. However, in patients with increased LVEDP with an EF of less than 0.6, suggesting poor ventricular function and reserve, when the mode of ventilation was changed from CMV to IMV, right atrial pressure (RAP) and pulmonary artery occlusion pressure (PAOP) significantly increased (p< 0.01) with an associated significant decrease in mean arterial pressure (MAP), CI, SI (p< 0.01). When these patients were placed on IMV5PEEP, the hemodynamic variables returned to the values obtained during CMV. We conclude that changing from CMV to IMV has salutory effects on the patient's hemodynamic values with normal left ventricular function. But in patients with failing left ventricle, volume overload of right ventricle which occurs with the institution of spontaneous respiration during IMV has deleterious effects on the hemodynamic variables. These deleterious effects can be effectively negated by the application of IMV5 PEEP.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Pulmonary edema afterEscherichia coli (E. coli)endotoxin administration is characterized by marked pulmonary hypertension and microvascular protein permeability. Conceivably, therapy directed at reducing pulmonary arterial hypertension should improve right ventricular mechanics and potentially may decrease the amount of edema formed. We studied the effect of nitroprusside (NP) on pulmonary hypertension, transvascular fluid filtration rate (reflected in lung lymph flow (QL)) and microvascular protein permeability afterE. coliendotoxin lung injury. Using the unanesthetized sheep lung lymph preparation, we found the initial pulmonary hypertension after endotoxin infusion refractory to NP. One h after endotoxin, NP significantly reduced the pulmonary artery pressure (PPA) compared to the endotoxin control group. During NP infusion, cardiac output increased as PlPAdecreased. We found no difference in QLduring NP infusion compared to the control group. After cessation of NP infusion, QLincreased, whereas protein clearance (QLX lymph protein content) remained constant. We found no beneficial effect of nitroprusside on transvascular fluid flux and microvascular protein permeability afterE. coliendotoxin injury.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

We assessed cardiac function by acute pressure loading with phenylephrine in 7 patients who had hyperdynamic sepsis and in 8 patients who had heart disease. All patients with sepsis had a positive Limulus lysate test, a septic focus, and a cardiac output (CO) greater than 6.0 L/min. Phenylephrine was given iv to elevate systolic arterial pressure by 30 mm Hg. Cardiac index (CI) and stroke index (SI) increased significantly in patients with hyperdynamic sepsis, whereas systemic vascular resistance index (SVRI) showed no change. In patients with heart disease, CI and SI decreased significantly, whereas SVRI increased significantly. The marked differences in response to phenylephrine by the two groups suggest lack of cardiac dysfunction in patients with hyperdynamic sepsis.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Twenty-five mongrel dogs were subjected to isolated cerebral hypoxia or noncerebral systemic hypotention to create the congestive pulmonary lesions of the shock lung syndrome (SLS). Eleven of the experimental dogs were pretreated with 5,5-diphenylhydantoin (DPH). Prophylactic DPH protects the lung from the injury that is a consequence of hypoxic cerebral perfusion in the dog, but does not afford protection from pulmonary damage caused by isolated, noncerebral systemic hypotension. DPH confers this protection on the brain; there is no evidence that DPH exerts this protective effect by an action on the pulmonary parenchyma directly or on other tissue in the body.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In a study of 28 ventilated patients in the ICU, cimetidine was ineffective in maintaining gastric pH above 4. Quantitative and qualitative bacteriological examination of daily gastric aspirates showed that when the pH was above 4, there was rapid colonization with high counts of organisms, predominantly coliforms. Progressive colonization by yeasts, independent of pH, was noted in nearly one-half of the patients. Gastric colonization has possible implications in terms of crossinfection or development of aspiration pneumonia. As these are seriously ill patients with compromised gastrointestinal (GI) barriers and decreased immunity, the large numbers of bacteria or their endotoxins may contribute to the high incidence of septicemia.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The incidence of deep venous thrombosis of the legs (DVT) was studied in 119 critically ill patients by125I-labeled fibrinogen scanning; the efficacy of low-dose heparin prophylaxis was assessed in a randomized, double-blind study. DVT occurred in 29% of control patients and in 13% of patients receiving heparin 5000 U subcutaneously twice daily. DVT was found mainly in men and was associated with circulatory impairment, respiratory failure and recent vascular or cancer surgery. In a comparison study of medical patients, DVT occurred in 10% untreated and 2% treated. In conclusion, the critically ill are at high risk of venous thromboembolism and low-dose heparin prophylaxis is warranted in those who have no hemostatic impairment.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

We present 3 patients who developed empyema of the gallbladder after admission to the medical ICU for diseases unrelated to gallbladder pathology. Empyema of the gallbladder developed during a prolonged stay in the ICU. Modern intensive care practices may predispose the gallbladder to localized, discrete sepsis. Cryptic biliary tract disease should be considered in patients with medical illness, particularly when complicated by recognized predisposing factors and septicemia of unknown origin.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

We evaluated 73 consecutively extubated neonates for evidence of acute laryngeal injury from intubation. Hoarseness and stridor were graded by a clinical scoring system. Direct laryngoscopy with a flexible fiberoptic broncboscope yielded a 44% incidence of moderate or major laryngeal injury. All patients with stridor had moderate or major injury, as did 38% of patients without stridor. Stridor was quite specific for detecting moderate or major injury but did not identify the type of injury.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A simple, safe, and effective system for umbilical artery monitoring controls continuous fluid infusion to prevent fluid overinfusion and keep the catheter from clotting. Accurate and continuous pressure measurements can be recorded simultaneously with fluid infusion. A convenient method for checking dynamic response fidelity is provided. The system is easy to set up and maintain. Because it is a closed system, contamination of the neonate is minimized.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Continuous iv infusions of isoproterenol are frequently used in severe status asthmaticus in children. The dose range and varying weights of patients require accurate calculations to determine the optimal combinations of drug concentration and infusion rate. We present a simple slide rule for determining these factors.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID