American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Jan 1995
NHLBI Task Force summary. Task Force on Research in Cardiopulmonary Dysfunction in Critical Care Medicine.
Research accomplishments during the past decade have led to a much greater understanding of molecular, cellular, and pathophysiological derangements occurring in the lung and other organ systems during critical illness. Despite this progress, care of critically ill patients with cardiopulmonary dysfunction remains a major health challenge. ⋯ Key observations gained through clinical and epidemiological studies must be tested in the basic science laboratory. Increased and coordinated efforts in epidemiology, clinical, and basic research are essential for future progress.
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Am. J. Respir. Crit. Care Med. · Dec 1994
Comparative StudyComparative evaluation of diaphragmatic activity during pressure support ventilation and intermittent mandatory ventilation in animal model.
The aim of the present study is a comparative evaluation of the effects of pressure support ventilation (PSV) and intermittent mandatory ventilation (IMV) on diaphragmatic activity in rabbit model of neonate. The animals were divided into a PSV group and an IMV group. In the IMV group, spontaneous breathing and four kinds of IMV rate (5, 10, 15, and 20/min) were applied (Ventilator: Bear BP200, peak inspiratory pressure [PIP]: 12 cm H2O, inspiratory time: 0.6 s). ⋯ Diaphragmatic activity disappeared at IMV20/min. In contrast, PSV reduced Edi and Pes linearly according to support level. In conclusion, diaphragmatic activity could be reduced more gradually with PSV than IMV by altering ventilatory support level.
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Am. J. Respir. Crit. Care Med. · Dec 1994
Comparative StudyCardiopulmonary resuscitation by precordial compression but without mechanical ventilation.
It is widely held that mechanical ventilation is essential for cardiopulmonary resuscitation (CPR). However, cardiac output and therefore pulmonary blood flow is reduced to less than one-third of normal during CPR. We therefore reasoned that ventilatory requirements are correspondingly reduced and postulated that gas exchange may be maintained during precordial compression with oxygen passively delivered to the airway in the absence of mechanical ventilation. ⋯ Postresuscitation myocardial contractility, reflected in the maximally generated dP/dt40, was also not adversely affected. In the unventilated group, only resuscitated animals developed spontaneous gaspings at an average frequency of 17 +/- 2/min-1. The current emphasis on mechanical ventilation as the highest priority for cardiopulmonary resuscitation is therefore not fully supported under the experimental conditions of this study.
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Am. J. Respir. Crit. Care Med. · Dec 1994
Comparative StudyVentilator-associated pneumonia by Staphylococcus aureus. Comparison of methicillin-resistant and methicillin-sensitive episodes.
All episodes of ventilator-associated pneumonia (VAP) caused by Staphylococcus aureus were prospectively analyzed for a 30-mo period. Methicillin-sensitive S. aureus (MSSA) was isolated in 38 episodes and methicillin-resistant S. aureus (MRSA) in 11 others. The two groups were similar regarding sex, severity of underlying diseases, prior surgery, and presence of renal failure, diabetes, cardiopathy, and coma. ⋯ Finally, mortality directly related to pneumonia was significantly higher among patients with MRSA episodes (RR = 20.72, 95% CI = 2.78-154.35). This analysis was repeated for monomicrobial episodes, and the difference remained statistically significant. We conclude that MRSA and MSSA strains infect patients with different demographic profiles; previous antibiotic therapy is the most important risk factor for developing MRSA infection.(ABSTRACT TRUNCATED AT 250 WORDS)