摘要:

The possibility that the deleterious renal effects of positive end-expiratory pressure (PEEP) might be avoided by prevention of its attendant cardiovascular effects with increasing intravascular volume was investigated in two groups of anesthetized swine. Group 1 (12 swine) were maintained at a normovolemic state and Group 2 (11 swine) were volume expanded with an infusion of lactated Ringer's solution. In normovolemic swine (Group 1), the addition of PEEP to controlled mechanical ventilation (CMV) caused significant decreases in cardiac output and mean aortic pressure. In addition, decreases in urinary output and osmolar, free water, and creatinine clearance occurred. Change from CMV to CMV + PEEP in Group 1 also produced increases in plasma ADH from 4.6 ± 2.4 to 10.2 ± 7 pg/ml (P< 0.01) and renin from 1.8 ± 1.0 to 4.7 ± 1.6 ng · ml-1· h−1(P< 0.01), epinephrine from 133 ± 23 to 1,060 · 636 pg/ml (P< 0.03) and norepinephrine from 46 ± 15 to 1,427 ± 839 pg/ml (P< 0.03). In hydrated swine (Group 2) addition of PEEP to CMV was not accompanied by any significant change in hemodynamic, renal, or hormonal variables. It is concluded that the short-term renal effects of PEEP are mainly due to hormonal responses that are activated by decrease in perfusion pressure. These responses can be obviated by intravascular volume expansion.

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Using a dog model of prolonged translaryngeal intubation, the authors studied laryngeal injury. Segments of 10.7 mm diameter endotracheal tube were sutured in place in the larynges of anesthetized animals, and the animals were allowed to awaken and the tubes left in place for periods of 24 h to 84 days in a total of 13 dogs. Each animal's larynx was studied endoscopically at weekly intervals and at the time of death. Both endoscopic and postmortem examination revealed erythematous laryngeal mucosa at 24 h and severe mucosal ulceration by 1 week. Microscopic examination revealed mucosal inflammation at 24 h with loss of mucosal architecture by 1 week. In several animals intubated 1 week or longer, inflammatory infiltrates were present in the arytenoid cartilage. While damage was generally severe by 1 week, it did not tend to become more severe after that time. Between week 1 and week 12, there was no significant correlation of the severity of laryngeal injury with the duration of endotracheal intubation. The results suggest that duration alone may not be a factor in laryngeal injury after the first week of intubation.

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0003-3022    

出版商:OVID    

年代:1985

数据来源: OVID