Heart & lung : the journal of critical care
-
The efficacy of hourly endotracheal tube cuff deflations in minimizing tracheal damage has not been clearly established. Two investigations which specifically address this question arrive at differing conclusions. These investigations fail to report important variables which may have explained the difference in their results. ⋯ Three groups of dogs received either continuous cuff inflation, hourly 5 minute cuff deflations, or a continuous air leak. The air leak group had significanlty less damage than the continuous inflation group (P less than 0.05) and the hourly deflation group (P less than 0.01). There was no significant difference between the continuous inflation group and the 5 minute hourly deflation group.
-
Shock due to or associated with sepsis may present a clinical picture quite different from that usually seen in hypovolemic or cardiogenic shock. Any trend which suggests increasing sepsis should be treated aggressively as if shock were present. The earlier such therapy is begun, the better the results tend to be. Perhaps the greatest errors in the therapy of severe sepsis and septic shock are (1) delayed control of the primary septic process, (2) giving too little fluid in the early phases of therapy (and too much later), and (3) delaying ventilator assistance if the patient's ventilation or blood gases are deteriorating.
-
Historical Article
A brief introduction to sepsis: its importance and some historical notes.
-
Pressure-flow relationships of an artificial airway-mechanical ventilator system were investigated. Endotracheal tubes varying from 7 to 9.5 mm. internal diameter and tracheostomy tubes from 7 to 10 mm. internal diameter were tested over flow-rates from 0.3 to 1.4 L. per second using a tidal volume of 500 ml. The effect of partial obstruction within these airways by suction catheters and the bronchofiberscope was examined. ⋯ H2O and reduced the flow rate to 50 per cent and the tidal volume to 80 per cent of its set value. Attention should be paid to duration of tracheobronchial suction while the patient is removed from the respirator since a high-grade resistance is created by passage of a suction catheter through an endotracheal tube. Bronchofiberscopy should be cautiously performed through cuffed artificial airways with at least 8 mm. internal diameter because the airway may be too comprised even if mechanical ventilatory assistance is employed.