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

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:

Alternatives to total parenteral nutrition (TPN) can play an invaluable role in the support of the critically ill patient. However, the efficacy of this depends on: (1) early nutritional assessment; (2) sequential nutritional assessment as dictated by the clinical condition of the patient; (3) careful estimation of requirements based on calculated energy expenditure and use of the “stress-index”; (4) early use of enteral feedings in combination with peripheral and central intravenous routes, especially with the use of “feeding modules” to provide patient's specific concentrated diet; (5) use of intravenous fat as an isotonic supplement to dextrose in the presence of carbohydrate intolerance; (6) avoid overfeeding as rigorously as underfeeding; (7) continued clinical trials to determine optimal nutritional/metabolic support of the critically ill

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:

Endotracheal tube resistance may increase upper airway resistance and the work of breathing beyond the normal range in adults or children who are chronically intubated and receiving intermittent mandatory ventilation. The purpose of this study was to measure the resistance of infant endotracheal tubes (IETTs) over the range of normal infant respiratory flows while systematically changing length, diameter, and carrier gas density. Resistance was measured in IETTs of 2.5, 3.0, and 3.5 mm inner diameter at flows increasing from 10–150 ml/sec, using both air and 80% helium 20% oxygen (He-O2) as the carrier gases. Tube length was progressively shortened from full length to 4.8 cm in 2-cm increments, and resistance to both air and He-O2was measured at all lengths. Reynolds' number calculations and the relationship of resistance to flow showed the flow regime in IETTs to be transitional in nature. Increasing tube diameter, decreasing length, or decreasing gas density led to large decreases in IETT flow resistance. Over the range of normal infant flows, IETT resistance is equal to or higher than that of the normal upper airway. IETT resistance might increase the work of breathing in some infants to the point of respiratory failure, and such resistance may be lowered by systematic changes in IETT diameter, length, or carrier gas density.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The neurological recovery and histological changes were studied in monkeys after intermittent postischemic arterial hypertension after 16 min of global brain ischemia. Ischemia was produced with a high pressure (1500 mm Hg) neck tourniquet and systemic arterial hypotension. Intensive care and life support, including monitoring of physiological variables, were provided for 7 days. Postischemia all monkeys were immobilized; ventilation was controlled and mean arterial pressure was maintained between 85–115 mm Hg for the first 48 hours. Immediately postischemia in four monkeys, intermittent arterial hypertension (i.e., 150–190 mm Hg) was induced by norepinephrine infusion for 3–5 min. Hypertensive episodes were repeated at 15, 30, 60, and 120 min postischemia, once every hour for the first 24 hours and once every 2 hours between 24 and 48 hours. Thereafter, the monkeys were allowed to breathe spontaneously. Four control monkeys were similarly treated except that arterial hypertension was not induced. Neurological recovery was evaluated by EEG, intracranial pressure, neurological deficit scoring, and histological examination of the brain after killing on day 7 postischemia. The neurological deficit score (100% = brain death; 50% = vegetative state; 0% = normal) in control monkeys on day 7 was 17.8 ± 1.8 (SEM) % compared to 46.3 ± 6.5% (p< 0.05) in the hypertension group. EEG recovery was delayed and the postischemic increase in intracranial pressure was prolonged in the hypertension group. Histological damage scores in the brain correlated with neurological deficit scores. Severe intermittent hypertension has a deleterious effect on neurological recovery after global brain ischemia.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A case of intravenous Placidyl injection is described which resulted in pulmonary pathophysiology consistent with adult respiratory distress syndrome (ARDS). Concise documentation of pulmonary and hemodynamic function demonstrated the dramatic response to PEEP therapy. Previously reported cases, mechanisms, and similarity to heroin-induced ARDS are discussed.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Fiberoptic bronchoscopy in mechanically ventilated patients has been limited to endotracheal tubes of 8.0–8.5 mm diameter. When performed through smaller tubes, pressures exceeding ventilator limits may occur, alveolar ventilation may become impaired, or progressive hyperinflation from airway obstruction during expiration may result. In this study, the efficacy of a 70% helium-30% oxygen ventilating gas mixture was compared to 30 % oxygen in air in a laboratory mechanical lung analog and during 15 bronchoscopies in 7 intubated patients. One patient with a 7.5 mm tube was studied. With the helium-oxygen mixture, ventilator pressures were not exceeded, alveolar ventilation was uncompromised, and hyperinflation did not occur. Bronchoscopy may be safely performed through endotracheal tubes smaller than 8.0 mm using a helium-oxygen mixture.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID