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Ventilatory management, hemodynamics, trauma

Andrea L Lubitz, Lars O Sjoholm, Amy Goldberg, Abhijit Pathak, Thomas Santora, Thomas E Sharp, Markus Wallner, Remus M Berretta, Lauren A Poole, Jichuan Wu, Marla R Wolfson
BACKGROUND: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. Inhaled nitric oxide (iNO) lowers PVR by relaxing pulmonary arterial smooth muscle without remarkable systemic vascular effects. We hypothesized that with hemorrhagic shock and pneumonectomy, iNO can be used to decrease PVR and mitigate right heart failure...
February 2017: Journal of Trauma and Acute Care Surgery
Andrea L Lubitz, Lars O Sjoholm, Amy Goldberg, Abhijit Pathak, Thomas Santora, Thomas E Sharp, Markus Wallner, Remus M Berretta, Lauren A Poole, Jichuan Wu, Marla R Wolfson
BACKGROUND: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. iNO lowers PVR by relaxing pulmonary arterial smooth muscle without remarkable systemic vascular effects. We hypothesized that with hemorrhagic shock and pneumonectomy, iNO can be used to decrease PVR and mitigate right heart failure. METHODS: A hemorrhagic shock and pneumonectomy model was developed using sheep...
November 23, 2016: Journal of Trauma and Acute Care Surgery
Neil G Parry, Bradley Moffat, Kelly Vogt
PURPOSE OF REVIEW: The treatment of blunt thoracic injuries is complex and evolving. The aim of this review is to focus on what is new with ventilation for blunt chest trauma as well as an update on the current management strategies for blunt aortic injury and rib fractures. RECENT FINDINGS: Early use of noninvasive ventilation appears to be well tolerated in select hemodynamically stable blunt trauma patients. For those patients requiring intubation, airway pressure release ventilation is an excellent mode to decrease the risk of posttraumatic acute lung injury...
December 2015: Current Opinion in Critical Care
Bruce Simon, James Ebert, Faran Bokhari, Jeannette Capella, Timothy Emhoff, Thomas Hayward, Aurelio Rodriguez, Lou Smith
BACKGROUND: Despite the prevalence and recognized association of pulmonary contusion and flail chest (PC-FC) as a combined, complex injury pattern with interrelated pathophysiology, the mortality and morbidity of this entity have not improved during the last three decades. The purpose of this updated EAST practice management guideline was to present evidence-based recommendations for the treatment of PC-FC. METHODS: A query was conducted of MEDLINE, Embase, PubMed and Cochrane databases for the period from January 1966 through June 30, 2011...
November 2012: Journal of Trauma and Acute Care Surgery
P Reper, O Wibaux, P Van Laeke, D Vandeenen, L Duinslaeger, A Vanderkelen
Inhalation injury and bacterial pneumonia represent some of the most important causes of mortality in burn patients. Thirty-five severely burned patients were randomised on admission for conventional ventilation (CV; control group) versus high frequency percussive ventilation (HFPV; study group). HFPV is a ventilatory mode, introduced 10 years ago which combines the advantages of CV with some of those of high frequency ventilation. Arterial blood gases, ventilatory and hemodynamic variables were recorded for 5 days at 2h intervals...
August 2002: Burns: Journal of the International Society for Burn Injuries
Gregory Kouraklis, Spiros Spirakos, Andromachi Glinavou
Over the past 20 years, it has gradually become apparent that the results of prolonged and extensive surgical procedures performed on critically injured patients are often poor, even in experienced hands. The triad of hypothermia, coagulopathy, and metabolic acidosis effectively marks the limit of the patient's ability to cope with the physiological consequences of injury, and crossing this limit will frustrate even the most technically successful repair. These observations have led to the development of a new surgical strategy that sacrifices the completeness of immediate repair in order to adequately address the combined physiological impact of trauma and surgery...
2002: Surgery Today
A Sandiumenge Camps, J A Sanchez-Izquierdo Riera, D Toral Vazquez, M Sa Borges, J Peinado Rodriguez, E Alted Lopez
OBJECTIVE: We proposed to compare the efficacy and safety of midazolam and propofol in its new preparation (2% propofol) when used for prolonged, deep sedation in traumatized, critically ill patients. We also retrospectively compared 2% propofol with its original preparation, 1% propofol, used in a previous study in a similar and contemporary set of patients. DESIGN: A prospective, randomized, unblinded trial (midazolam and 2% propofol) and a retrospective, contemporary trial (2% propofol and 1% propofol)...
November 2000: Critical Care Medicine
M McCunn, H N Reynolds, C A Cottingham, T M Scalea, N M Habashi
The objective of this study was to discuss the case of a patient with severe smoke inhalation-related respiratory failure treated with extracorporeal support. The study was set in a 12-bed multi-trauma intensive care unit at a level one trauma center and hyperbaric medicine center. The patient under investigation had carbon monoxide poisoning, and developed acute respiratory distress syndrome and cardiovascular collapse following smoke inhalation. Rapid initiation of extracorporeal support, extreme inverse-ratio ventilation and intermittent prone positioning therapy were carried out...
March 2000: Perfusion
A González Ojeda, A Orozco Mosqueda, L Barrera Zepeda, C Fuentes Orozco, J Avalos González, F Hinojosa Alarcón, C O Paredes Carlo, O Victal Adame
OBJECTIVE: To know the frequency of intraabdominal complications and its impact on survival of patients submitted to cardiopulmonary bypass for common open-heart surgical procedures. BACKGROUND: The gastrointestinal complications after cardiac surgery with cardiopulmonary bypass (CPB) have an incidence of 0.3 to 3% but mortality can exceed 60%. Despite improvements in preoperative, operative and postoperative care it has been the general impression that abdominal complications remain a significant problem...
April 1999: Revista de Gastroenterología de México
G Bugedo, L Castillo, G Hernández
Patients with severe head injury are prone to pulmonary complications that result in hypoxemia or hypercarbia, which could worsen their neurological condition. A rational ventilatory approach requires a good knowledge of respiratory and neurological pathophysiology. Airway management is of prime importance in neurological patients. Prophylactic chronic hyperventilation in head trauma is no longer recommended since it could impair cerebral perfusion, although transient hypocarbia could be of benefit to some patients...
February 1999: Revista Médica de Chile
M Apostle-Mitchell, G MacDonald
Nursing research suggests that pain in critically ill patients is inadequately controlled and has deleterious effects. The critical care nurse must depend on the patient's perception of pain and its expression in physiological and behavioural responses. Ventilatory support, fluctuating levels of consciousness, hemodynamic instability and severity of illness are often barriers to the expression and interpretation of pain. This article includes a review of the nursing literature pertaining to pain management in the critically ill patient...
1997: Official Journal of the Canadian Association of Critical Care Nurses
J A Sanchez-Izquierdo Riera, E Alted, M J Lozano, J L Pérez, A Ambrós, R Caballero
BACKGROUND: The aim of this prospective randomized controlled study was to investigate the effects of continuous venovenous hemofiltration on the hemodynamics and respiratory function of critically ill trauma patients with multiple organ dysfunction syndrome. METHODS: Thirty consecutive critically ill, mechanically ventilated, trauma patients with multiple organ dysfunction syndrome (without kidney failure) who had invasive hemodynamic monitoring for management of hypotension or hypoxemia were randomized to treatment with or without continuous venovenous hemofiltration...
November 1997: Surgery
T Ziegenfuss
Adequate prehospital care of the severely traumatised patient is important to prevent or attenuate early as well as late life threatening complications, such as tissue hypoxia, ischemia/reperfusion injury and finally multiple organ failure. A mismatch of oxygen supply and oxygen demand is a hallmark in the pathophysiology of multiple trauma. Oxygen supply may be diminished by the following factors: shock-related decrease of cardiac output, anemia and hypoxia. On the other hand, oxygen demand may be increased by pain, panic, and agitation...
1996: Zentralblatt Für Chirurgie
P Krafft, H Steltzer, M Hiesmayr, W Klimscha, A F Hammerle
STUDY OBJECTIVE: To investigate the frequency and extent of spontaneous changes ("events") in continuously measured mixed venous oxygen saturation (SvO2) in septic patients and to determine whether attention to individual event-frequency offers additional information for patient management. DESIGN: Nonrandomized prospective study. SETTING: General intensive care unit at a university hospital. PATIENTS: Fifteen patients suffering from septic shock and multiple organ dysfunction syndrome...
March 1993: Chest
J Cruz
OBJECTIVE: To continuously evaluate the relationship between global systemic and cerebral oxygenation during temporary profound hypocapnia, which was attempted for prompt management of posttraumatic intracranial hypertension. DESIGN: Prospective, intervention study. SETTING: Neuroscience intensive care unit of a university hospital. PATIENTS: Young adults (n = 21) with acute brain trauma, undergoing routine monitoring of jugular bulb and pulmonary artery oxyhemoglobin saturations, along with other monitoring...
August 1993: Critical Care Medicine
L M Gentilello, D Anardi, C Mock, C Arreola-Risa, R V Maier
The use of a normal tidal volume in patients with progressive loss of alveolar airspace may increase inspiratory pressure and overdistend remaining functional alveoli. Permissive hypercapnia (PH) is a ventilator management technique that emphasizes control of alveolar pressure, rather than PCO2. The purpose of this study was to determine if the use of PH is associated with an improved outcome from adult respiratory distress syndrome (ARDS). Over a 2-year period, 39 trauma patients were treated for ARDS. Permissive hypercapnia was used in 11, and the remaining patients were treated conventionally...
November 1995: Journal of Trauma
R C Jorden, E E Moore, J A Marx, B Honigman
Percutaneous transtracheal ventilation (PTV) is an active airway management technique that may be an alternative to cricothyroidotomy in critically injured patients. A canine trauma model was devised to compare the ventilatory capacity and hemodynamic effects of PTV to endotracheal intubation. Mongrel dogs (25-37 kg), splenectomized 14 days previously, were anesthetized with pentobarbital and bled to a mean arterial pressure (MAP) of 20 mm Hg. Animals were maintained at this MAP for 1 hour, then resuscitated with simultaneous: a) aortic crossclamping via left thoracotomy, b) Ringer's lactate infusion, and c) active airway support...
October 1985: Journal of Trauma
W C Shoemaker
Physiologic changes that lead to the development of ARDS begin with the precipitating shock syndrome. Hypovolemia, pulmonary vasoconstriction, reduced myocardial performance, and diminished O2 transport typically precede the development of clinical ARDS after hemorrhage, trauma, postoperative conditions, and sepsis. Since shock lung is a complication of shock, it is not surprising that the antecedent clinical and physiologic events that characterize the shock state may be determinants of both the genesis and the outcome of ARDS...
August 1985: Surgical Clinics of North America
M Indeck, S Peterson, J Smith, S Brotman
Prospective evaluation of 103 consecutive transports for diagnostic studies of 56 patients out of the Shock Trauma Unit over a 3-month period was done to document physiologic changes, the cost of each transport, and to assess whether the information gained was utilized to change patient management. Of the 56 patients, 36 (65%) were males and 20 (35%) were females with an age range of 14-82 years (mean, 48 years). The Apache II score ranged from 3-49 (mean, 19.4). There were seven types of diagnostic studies: CT of the head (28), CT of abdomen (35), CT of chest (four), angiography (nine), ventilation/perfusion scan (three), tomography (seven) and miscellaneous studies (15)...
July 1988: Journal of Trauma
E F Hirsch, J R Clarke, H E Gomez-Engler, G H Clowes
The adult pulmonary distress syndrome is a disease of many etiologies and significantly contributes to the post-traumatic and postsurgical mortality and morbidity. Pulmonary insufficiency associated with shock and hemorrhage is characterized by its relatively short duration, less severe alterations of pulmonary functions, and normal pulmonary vascular resistance. The judicious use of fluids and emphasis in the early use of blood during resuscitation will minimize the magnitude of the pulmonary insult. Severe changes in oxygenation and ventilation, increases in pulmonary vascular resistance, the need for long-term respiratory assistance, and an increase in mortality and morbidity are characteristic of the adult pulmonary distress syndrome that follows severe systemic sepsis...
August 1976: Surgical Clinics of North America
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