Journal of critical care
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Journal of critical care · Mar 1998
Randomized Controlled Trial Clinical TrialDecelerating flow ventilation effects in acute respiratory failure.
The purpose of this article is to analyze the effect of a pressure-regulated volume-controlled ventilation mode on lung mechanics and gas exchange in patients with acute respiratory failure. ⋯ Pressure-limited ventilation allows mechanical ventilation for the same tidal volume as VC but results in a lower peak inspiratory pressure and a slightly lower PaCO2. The mechanism responsible for this gas exchange effect is unknown but is probably related to a better air distribution of the decelerated flow. The clinical relevance of this phenomenon remains to be established.
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Journal of critical care · Mar 1998
ReviewParacrine regulation of cardiac myocytes in normal and septic heart.
A paracrine pathway for the regulation of cardiac contractile function by nonmuscle cells is documented in the heart. Coronary and endocardial endothelium release several diffusible agents, such as prostaglandins, endothelin-1, and nitric oxide, with an action on cardiac myocyte function. ⋯ In addition to cardiac myocytes, activated microvascular endothelial cells and cardiac endothelial cells may contribute to nitric oxide generation and, ultimately, to the depression of myocardial contractile activity during sepsis. This article reviews the local intercellular communication between cardiac myocytes and endothelial cells in the normal heart and discusses some of the mechanisms potentially claimed to depress heart function in sepsis.
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Journal of critical care · Mar 1998
An approach to the treatment of severe adult respiratory failure.
The purpose of this article is to evaluate outcome in adult patients with severe respiratory failure managed with an approach using (1) limitation of end inspiratory pressure, (2) inverse ratio ventilation, (3) titration of PEEP by SvO2, (4) intermittent prone positioning, (5) limitation of FiO2, (6) diuresis, (7) transfusion, and (8) extracorporeal life support (ECLS) if patients failed to respond. ⋯ An approach that emphasizes lung protection and early implementation of extracorporeal life support is associated with high rates of survival in patients with severe respiratory failure.
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Journal of critical care · Mar 1998
The use of phentolamine in the prevention of dopamine-induced tissue extravasation.
The purpose of this study was to determine whether dopamine-induced tissue extravasation injury could be prevented with phentolamine. ⋯ This study clinically supported the use of phentolamine for the prevention of dopamine-induced extravasation injury.