ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02995.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The original rationale for HFPPV was that under certain conditions adequate alveolar ventilation could be achieved with high ventilatory frequencies and small tidal volumes. It was theorized further that increased ventilatory frequencies and low tidal volumes would decrease the airway pressures, barotrauma, and cardiovascular and other systemic consequences seen with conventional mechanical ventilation. The first clinical applications of HFPPV were in bronchoscopy and laryngoscopy for diagnostic and/or therapeutic purposes. Apart from these endoscopic applications, volume‐controlled HFPPV has been compared with conventional ventilation in upper abdominal surgery and coronary artery bypass grafting. The possible advantages of HFPPV over conventional volume‐controlled ventilation in the intensive care setting are still unclear. Provided that the mean lung volumes are similar, oxygenation in acute respiratory failure is similar with both ventilation methods. Although the role of HFPPV in the management of pulmonary diseases still remains to be clarified, it does provide effective ventilation in selected types of patients needing ventilatory support. New modes of pressure‐controlled ventilation have not resolved all clinical problems in severe ARDS and/or acute respiratory failure. The search for means of optimal ventilatory support with minimal complications must continue, as conventional ventilation does not always offer the best trea

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02996.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In order to evaluate intensive care, all adult patients (980) admitted to a multidisciplinary intensive care unit (ICU) during 1 year were followed prospectively. The ICU mortality was 9,6%. One year after admission the survival was 73.6%. By that time the surviving patients had a further survival that was 96% of that of the general population. Of the 1–year survivors, 22.3% had deteriorated in health status compared to 3 months before the stay in ICU. In the admission groups with high mortality the survivors had a more pronounced deterioration in health status. Increased age and length of stay in the ICU were associated with higher mortality but not with changes in health status. We conclude that the outcome of intensive care can be evaluated by studying only the survival, since the survival rate is correlated to changes in health status among survivors in the different admission groups. One year after admission most of the surviving patients had regained their previous health status and their further survival was almost the same as that of the general populatio

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02850.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb03031.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02997.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

The effects of adenosine–induced hypotension on cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRo2), and cerebral lactate production, together with systemic haemodynamics, were studied in 10 patients undergoing cerebral aneurysm surgery in neurolept anaesthesia with controlled hyperventilation. CBF changes were determined in six of the patients with a retrograde thermodilution technique in the jugular vein. Hypotension was induced with a continuous infusion of adenosine in the superior vena cava. The dose range was 0.06–0.35 mg/kg/min, and this caused a 42% reduction in mean arterial blood pressure (MABP) from 79 × 4 to 46 × 1 raraHg (10.5 × 0.5 to 6.1 × 0.1 kPa) through a profound reduction in systemic vascular resistance (SVR), which amounted to 61%. No significant change occurred in CBF. Whole body AV–difference of oxygen was decreased by 37%, and cerebral AV–difference by 28%, corresponding to reductions in whole body oxygen uptake and CMR02 of 16 and 17%, respectively. Cerebral AV–difference of lactate did not change. In the posthypotensive period MABP was increased by 10%, together with a minor increase in CBF (15%). It is concluded, that adenosine–induced hypotension at MABP levels between 40–50 mmHg (5.3–6.7 kPa) does not affect cerebral oxygenation unfavourably, and may even offer a protective effect by reducing cerebral oxygen demand. The slight CBF increase in the posthypotensive period was probably secondary to an increase in MABP together with a blunted autoregulation, but in no case was this effect considered to be harm

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02852.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02853.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Panting in animals can be expected to represent a naturally occurring physiological counterpart to today's techniques of mechanical high‐frequency ventilation. To analyze the mechanisms underlying the gas exchange inefficiency during ventilation with high frequencies, steady‐state pulmonary gas exchange was studied in seven conscious dogs (32 kg mean body weight) during panting elicited by mild thermal stress. The animals had a chronic tracheostomy and an exteriorized carotid artery loop and were exposed to 27.5°C ambient temperature for 2 h (65% relative humidity). Open‐circuit techniques were used and Po2and Pco2from the tracheostomy tube were continuously monitored by mass spectrometry using a special sample‐hold phase‐locked gas sampling technique. Po2and Pco2were determined in arterial blood collected from the carotid artery. During the exposure, the following variables of steady‐state gas exchange were determined (means ±SD): breathing frequency 313 ±19 min‐1; tidal volume, 167 ± 21 ml; total ventilation, 52 ± 9 1‐min‐1′ effective alveolar ventilation, 5.5± 1.3 1‐min‐1; partial pressures (torr; a, arterial; E', end‐tidal): Pao2, 106.2 ± 5.9; Paco2, 27.2 ± 3.9; (PE'‐Pa)o2, 26.0 ± 5.3; (Pa‐PE')co2, 14.9 ± 2.5. According to the conventional lung model, parallel‐dead space ventilation (ventilation of unperfused lung regions) would account for about 55% of the alveolar ventilation and for 2/3 of the (PE'‐Pa)o2difference. However, the lack of an ‘alveolar plateau’ in the CO2and O2expirograms suggests that incomplete serial mixing in peripheral airways contributes to the enhanced gas exchange inefficiency during panting as reflected in th

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02998.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

In a double–blind, randomized trial, the efficacy and safety of flumazenil, a benzodiazepine antagonist, was evaluated in patients after gastroscopy under midazolam or diazepam sedation. The criteria of efficacy were the degree of sedation and anterograde amnesia. Flumazenil significantly reduced the degree of sedation in both groups without significant intergroup differences. No sign of resedation was found during the observation period of 3 h. The anterograde amnesia was effectively antagonized in both groups. Flumazenil was well tolerated. Flumazenil is a safe and effective benzodiazepine antagonist which makes it possible to reduce the recovery period in outpatients sedated sufficiently with benzodiazepines for gastroscop

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02854.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0001-5172    

DOI:10.1111/j.1399-6576.1989.tb02999.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY