摘要:

Trauma and shock result in activation of a wide variety of endocrine and metabolic systems.Based upon experimental work demonstrating metabolic deficits, a variety of metabolic therapies have been developed to assist in the treatment of patients with shock or trauma. Evidence to date is inconclusive as to whether this therapy will be of significant benefit to critically ill patients.Some of the senior author's previous research has been analyzed as it relates to important health policy issues.We suggest that a peer review mechanism be set up within organized professional groups to assess major research trends and develop informed opinions on key research subjects within their domain.These peer review assessments must be effectively communicated to Congress and the executive branch of the government, as well as to the general public, if support commensurate with the importance of the research is to be achieved.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The work of breathing was measured in 10 normal subjects and in 28 critically ill patients with acute complications of obstructive pulmonary disease treated with assisted ventilation. The measurement of the work of breathing was found to be a useful objective variable for determining the capability for independent ventilation. Dependence on mechanical ventilation was observed when the respiratory work was ≥1.7 kg · m/min. Patients were ordinarily capable of spontaneous ventilation when the respiratory work was ≤1.0 kg · m/min. Discontinuation of assisted ventilation was likely to be successful in those patients whose respiratory work was ≤ 1.5 kg · m/min if the patient was able to increase and maintain his work capability by a factor of two when breathing against an inspiratory resistance of 5 cm H2O for 10 min. Failure to increase the respiratory work when breathing against an inspiratory resistance indicated limitations in respiratory mechanics and was associated with the need for prolonged assisted ventilation. The measurement of the work of breathing against an inspiratory resistance of 5 cm H2O was useful in the identification and quantification of ventilatory reserve in patients with obstructive pulmonary disease.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

PEEP has become widely used in patients with acute respiratory failure to increase arterial oxygenation. Despite a beneficial effect on the arterial oxygen content, PEEP may result in a substantial decrease in the cardiac output. This study was undertaken to determine the effectiveness of dopamine in correcting a PEEP-induced decreased cardiac output and to determine if, in increasing the cardiac output, the pulmonary shunt is affected. In 12 anesthetized, mechanically ventilated dogs the cardiac output and shunt were determined simultaneously. After control values were obtained, 10 cm of water PEEP was begun and a dopamine infusion was given for 3 hours. The infusion rate was adjusted to maintain the cardiac output near control levels, the average dose being 17.6 μg/kg/min. With the addition of PEEP, there was a decrease in the cardiac output, an increase in the pulmonary vascular resistance, and no change in the shunt. With the infusion of dopamine, the cardiac output returned to control; there was an increase in the shunt and a decrease in the pulmonary vascular resistance. When the dopamine was discontinued, there was a decrease in the cardiac output and the shunt to predopamine levels, but there was no change in pulmonary vascular resistance. On stopping PEEP, there was no change in the shunt but there was an increase in the cardiac output and a decrease in the pulmonary vascular resistance. These studies show that dopamine can correct the reduced cardiac output resulting from PEEP but that in doing so it produces a substantial increase in the pulmonary shunt. The rapid onset of the shunt with dopamine and the equally rapid decrease in the shunt on discontinuing dopamine suggests a redistribution of the increased pulmonary blood flow or the opening of anatomical arteriovenous shunts. Similar hemodynamic effects have been observed in man and it is suggested that those treating critically ill patients be aware of a possible increase in the shunt when dopamine is used to correct a decreased cardiac output in patients receiving PEEP.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Data were collected on the postoperative respiratory courses of two groups of patients following cardiac surgery: one group of 31 patients under typical management for 1973, and a second group of 72 patients from 1975–1976 representing our current management regimen. The patients in the 1973 group were allowed to wake up passively before our seeking extubation criteria. Almost half of these were extubated in the period 15 to 20 hours after admission to the ICU, i.e., the morning after surgery, and 29% were discharged from the ICU within 48 hours of admission.The patients in the 1975–1976 series had pharmacological reversal of muscle relaxants and somnolence following admission to the ICU, when their condition was shown to be stable by clinical and laboratory assessment. Criteria for extubation were then sought. Within 5 hours of ICU admission, 62.5% of the patients were extubated and almost 50% of the patients were discharged from the ICU within 24 hours. No patient in either series required reintubation, and there were no complications due to the early extubation and ICU discharge of patients in the 1975–1976 series. We believe that early extubation of patients whose postoperative course is otherwise uncomplicated following cardiac surgery allows rapid mobilization and progress to the intermediate care areas without introducing undesirable sequelae.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Expense, noise, and bright lighting have been acknowledged disadvantages of ICU's since their establishment. Data are available regarding the first, but not the latter two disadvantages.Background sound levels were measured in four units and found to be comparable to the hospital cafeteria at noon, and only somewhat less noisy than the boiler room. Sound levels generated by numerous components of the environment were measured and related to the total noise level. Noise levels generated by seven different nebulizers, each used at three different settings, were found to show noteworthy differences.High noise levels have been shown to have adverse physiological and psychological effects on patients and on the errorproneness of intensive care personnel. If noise generation is a consideration in selection of equipment, industry can respond appropriately. Further studies can lead to measures that will reduce the noise level in ICU's.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A new device, the Roto-Rest bed, has been used in critically ill patients to effect lateral to lateral position changes and continuous rotation to influence distribution of pulmonary blood flow. Selection of extreme lateral position can be made particularly in cases of respiratory failure with primarily unilateral involvement. Dependent positioning of the uninvolved lung to match ventilation and perfusion can be accomplished simply. Rapid resolution of a large pulmonary contusion serves to illustrate the clinical use of the apparatus.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Percutaneous transtracheal ventilation via a small catheter placed in the trachea and using intermittent jets of oxygen under high pressure has established itself as an important life-support technique. In this study, it was used in a series of 10 experiments performed on dogs at respiratory rates much higher than usually used in clinical practice; i.e., between 20 and 200/min. Tracheal tubes were not used. A 14-gauge Angiocath® was placed percutaneously between the first and second tracheal ring and connected to a fluidic logic-controlled oxygen jet ventilator.At an FIO2= 1, the partial pressure of oxygen and carbon dioxide in arterial blood was maintained at a range of 400–575 torr and 20–25 torr, respectively. Thus, satisfactory alveolar gas exchange up to respiratory rates of 200/min was maintained. The intratracheal pressures were low, not exceeding 8 torr during inspiration. At rates above 160, a slight PEEP effect of 2 torr could be achieved. The experiments were performed on paralyzed animals; but after the muscle relaxants were reversed, no interference with spontaneous ventilation was found. There was no hemodynamic impairment using high frequency ventilation, and cardiac index significantly increased at respiratory rates above 160/min. At high respiratory rates, each jet inflation increased the blood return to the left side of the heart as evidenced by the peaks in pulmonary wedge pressure wave form which reflects the left atrial pressure. However, the mean wedge pressure remained unaltered. At the same time, wave form variations occurred in pulmonary artery pressure showing the effects of pulmonary counterpulsation.The results indicate that it is possible to maintain adequate gas exchange at respiratory rates of up to 200/min at low tidal volumes approaching the dead space volume. It cannot be explained as apneic oxygenation which was used as a control in additional series of experiments. This method led to carbon dioxide accumulation immediately reversible by high frequency jet ventilation.This technique may offer an alternative to conventional artificial ventilation and/or another method of PEEP with less circulatory disturbance. It may allow patients to breathe spontaneously offering a new way of assisting ventilation. Synchronizing the jet ventilation with heart beat in patients during cardiopulmonary resuscitation may influence the cardiac output during resuscitation.

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

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