摘要:

In severe Reye's syndrome, with nonspecific intensive supportive therapy, the mortality rate approaches 75%. In many instances, death is due to uncontrolled cerebral edema and elevated intracranial pressure (ICP). Pentobarbital therapy, sufficient to maintain a blood barbiturate level between 2.5 mg% and 4.0 mg%, was used to control ICP in seven patients with metabolic coma complicated by intracranial hypertension (intracranial pressure > 30 mm Hg for 30 min). The nadir of their neurological function was characterized by no response to deep pain, absent or abnormal oculocephalic responses, bilaterally dilated, unreactive pupils, and markedly irregular or absent respirations. Before barbiturate administration hyperventilation, steroids, mannitol, and other supportive therapies commonly used in Reye's syndrome were begun. After institution of pentobarbital therapy, the daily mannitol dose required to maintain the intracranial pressure below 20 mm Hg was significantly reduced (p< 0.001), from 3.7 ± 0.3 to 0.5 ± 0.2 g/kg/day. All the patients survived, and six have no obvious neurological sequelae. Pentobarbital is a useful adjunct for intracranial pressure control in advanced metabolic coma.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Twenty-one small premature infants with clinical features and radiological findings of type II RDS were studied. Correction of blood pH, corresponding with the decrease of blood Paco2, was usually seen in the first eight hours of age. Clinical improvement, as judged by the RDS score, was noted only after 12 hours of age. Complete recovery was the rule although signs of respiratory distress in a few infants lasted for 48–72 hours. The calculated AaDo2and total Qs/Qt were slightly higher (27.8%) than reported in normal infants and remained unchanged until after 48 hours of age when it decreased to 24.5%.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The chest radiographs and charts of 99 surviving neonates treated with positive pressure ventilation for respiratory distress syndrome were reviewed. Forty infants developed alveolar rupture during mechanical ventilation. Of these, 27 (67.5%) developed bronchopulmonary dysplasia (BPD). Only 3 (5.4%) of the remaining 59 infants developed BPD. The relative odds of developing BPD if alveolar rupture occurred increased by a factor of 39 (p< 0.001).Significant associations between BPD and the duration of ventilation with high peak inspiratory pressures (IP) ≥ 40 cm H2O, low peak IP ≤ 39 cm H2O, continuous distending pressure ≥ 5 cm H2O and fractional inspired oxygen concentration (Fio2) ≥ 0.6 were examined. Since these ventilatory parameters had a significant association (p≤ 0.02) with both BPD and alveolar rupture, an attempt was made to identify the independent contributions of these factors to the development of BPD by a stepwise discriminant analysis. Controlling for the most significant associations, FIO2≥ 0.6 and peak IP ≤ 39 cm H2O, subsequent analysis showed no added discriminant power of predicting BPD in the duration of exposure to high peak IP ≥ 40 cm H2O and continuous distending pressure ≥ 5 cm H2O. Alveolar rupture remained overwhelmingly significant (p< 0.001), but it did not account entirely for the development of BPD. Duration of exposure to peak IP ≤ 39 cm H2O and FIO2≥ 0.6 remained significant.These results suggest that pulmonary barotrauma as reflected by the occurrence of alveolar rupture during positive pressure ventilation is intimately related with the subsequent development of BPD.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Twenty-seven infants with respiratory distress and hypoxemia of noncardiac etiology were treated with tolazoline. Thirteen infants had hyaline membrane disease and 14 had respiratory distress attributable to causes other than hyaline membrane disease. An immediate response to tolazoline, a rise in Pao2of 15 torr or more within 15 min, was seen in 11 infants in the hyaline membrane disease group and in eight infants of the other group. Six infants in the hyaline membrane disease group and 11 infants in the second group survived. Tolazoline should be considered as a therapeutic adjunct in the management of hypoxemia which persists after optimal homeostatic and ventilatory support.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Extracorporeal membrane oxygenation has been suggested as an alternative means of support for the patient who is critically ill with acute ventilatory insufficiency. The determination of which patients should receive this therapy has not been clarified to date. Clinical data have revealed overall surviva1of 10 to 13%. Comparison of therapeutic results with those in which “conventional” therapy is employed has yielded little useful information. At present the overall impact of extracorporeal membrane oxygenation in reducing death from ventilatory insufficiency appears to be minimal. The technique requires major commitments of manpower, equipment, and money, and appears to be limited to a relatively small number of major institutions. A truly objective study, which defines patient entry criteria, specific therapy to be used, and end-points to be achieved has yet to be developed or implemented.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The relationships between right atrial mean, pulmonary artery diastolic, mean, and wedge pressures, and stroke index were studied in 100 patients. The various pressures correlated fairly well with one another, but poorly with stroke index. However, this correlation improved when the values of individual patients were analyzed. Infusion of calcium chloride modified the correlation of the various pressures with the stroke index over a short period of time. During anesthesia, when pulmonary vascular resistances, systemic resistances and myocardial contractility were stable, both pulmonary artery mean and wedge pressure correlated significantly with the stroke index.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Critically ill hypoxemic patients without significant radiological changes on the chest x-ray present a diagnostic and therapeutic problem. Three patients with patent foramen ovale and a patient with a spontaneously closed congenital ventricular septal defect which reopened due to ischemic changes in the ventricular septum are presented. In reviewing the literature, we could not find this type of presentation. Their hypoxemia was associated with right-to-left intracardiac shunts demonstrated by dye dilution cardiac output curves. Because of the risk of systemic embolism associated with a right-to-left intracardiac shunt, air bubbles and particulate material in the intravenous infusion should be avoided. Use of anticoagulants may be beneficial. High inspired oxygen concentration may not correct the associated hypoxemia. The detection of these shunts is easily done at the bedside.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Two cases of flow-directed, balloon-tipped catheterizations of the right heart via a persistent left superior vena cava are presented. In both cases, the monitoring catheters assumed similar, atypical configurations on plain chest roentgenograms. Recognition of the characteristic configuration of the course of transvenous catheters through the persistent left superior vena cava allows for plain film diagnosis of this anomaly.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

Pulmonary artery wedge pressure (PAWP) will only reflect left atrial pressure (LAP) if continuity of fluid exists from the catheter tip to the left atrium. Either increased airway pressure or decreased hydrostatic pressure may lead to discontinuity of the fluid column and misinterpretation of PAWP. Simultaneous measurements of PAWP and LAP were made in 19 anesthetized dogs. Placement of the pulmonary artery wedge catheter above the left atrium (West Zone I) in combination with the incremental addition of 5 cm H2O of PEEP caused a 5 mm Hg gradient between PAWP and LAP in the normovolemic animal. Augmenting PEEP further or hypovolemia (i.e., decrease in LAP) increased the gradient. Hypervolemia (increase in LAP) diminished the gradient.Fluid continuity between the PAW catheter and LA is a prerequisite for monitoring LAP with the Swan-Ganz catheter. Increases in PEEP, placement of the catheter above the left atrium and hypovolemia may occlude the fluid column and cause artifacts in the PAWP obtained.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID

摘要:

The psychological stresses evoked by acute critical illness and intensive care in both patient and physician are examined and certain approaches proposed which, in our experience, can alleviate these stresses. Admittedly, these psychological concepts may appear inconsequential at first glance. We have found, however, that such intervention may facilitate the physician's efforts to provide appropriate care for his critically ill patients, including those who must die, without experiencing the psychological reactions—the guilt, shame, anguish, and despair—these patients typically arouse.

ISSN:0090-3493    

出版商:OVID    

年代:1978

数据来源: OVID