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Biomedical subjects

A Net

Publications and source records attributed to A Net.

At least 55 records · Page 3Linked to original sources
PubMed1988

Intrinsic PEEP: a cause of inspiratory muscle ineffectivity.

Intrinsic PEEP has been described as an inspiratory threshold load to the inspiratory muscles that could increase the work of breathing. We report a patient who presented ineffective inspiratory efforts to trigger the ventilator; when we applied PEEP in similar amounts of measured intrinsic PEEP, his inspiratory efforts became able to trigger the ventilator, suggesting that the inspiratory load was alleviated.

Aged↗
PubMed1988

Inspiratory effort and occlusion pressure in triggered mechanical ventilation.

We have studied eleven patients ventilated in the assisted mode during recovery from acute respiratory failure. We have measured the effort required to trigger the pressure demand valve for 3 different ventilators, and have measured the occlusion pressure as an index of neuromuscular inspiratory drive. We found a delay in the opening of the demand valve, as previously described by other authors. We also found a close correlation between the effort required to open the demand valve and the occlusion pressure. We conclude that the inspiratory effort required to open the demand valve, in the assist mode, is greater than the preset trigger level and that it is well correlated with the neuromuscular inspiratory drive. This inspiratory effort against the closed demand valve, allows the measurement of the occlusion pressure.

Aged↗
PubMed1988

Value of static pulmonary compliance in predicting mortality in patients with acute respiratory failure.

The measurement of static pulmonary compliance by means of pressure-volume curves is an useful tool in the management of patients with acute respiratory failure. On admission to our Intensive Care Unit, we calculated the static pulmonary compliance values from the pressure-volume curve in 55 severe acute respiratory failure patients under mechanical ventilation. A predictive model, based on static pulmonary compliance measured on the deflation of the pressure-volume curve and patients' age, was developed using a function derived by stepwise discriminant analysis. Thirty-six of the 40 patients (90%) in the learning sample and 12 of the 15 patients (80%) in the test sample were correctly classified into survivors or non-survivors. The overall classification demonstrated an accuracy of 88% (48 of 55 patients). We conclude that the value of static pulmonary compliance can be an useful prognostic factor in patients with severe acute respiratory failure.

Adolescent↗
PubMed1988

Accuracy of an indirect carbon dioxide Fick method in determination of the cardiac output in critically ill mechanically ventilated patients.

We evaluated the accuracy of an indirect CO2 Fick method for measuring cardiac output in 30 critically ill mechanically ventilated patients. When the Fick principle was applied to CO2 using estimated PaCO2, the cardiac output obtained underestimated the thermodilution technique showing a lack of accuracy. However, there was a significant correlation between thermodilution and CO2 rebreathing methods using measured (r = 0.92; p less than 0.001) and estimated (r = 0.60; p less than 0.01) arterial PCO2. The regression equation using measured arterial PCO2 was y = 0.59 + 0.91x, and for estimated arterial PCO2 was y = 1.7 + 0.33x. The results suggest that the CO2 rebreathing method using measured arterial PCO2 may be useful to determine cardiac output in those seriously ill patients on artificial ventilation not requiring right heart catheterization.

Adult↗
PubMed1987

The implementation of a quality assurance programme in the Hospital de la Santa Creu i Sant Pau in Barcelona.

The goal of quality assurance is to guarantee quality in medical care through the detection of problems with their subsequent evaluation and study, and through the implementation of corrective measures, when necessary. This article describes the criteria, methods, and results of a programme of quality assurance introduced in the Hospital de la Santa Creu i Sant Pau, Barcelona, Spain, in 1981. The programme covered the following aspects: evaluation of medical care services; process and outcome of medical care; use of available resources; and patient satisfaction. The results obtained over the last two years showed a substantial improvement in those areas which had been influenced by the programme, as well as the development of collective responsibility of the medical staff when faced with the problems of quality that have been detected.

Consumer Behavior↗
PubMed1987

Effect of PEEP on the arterial minus end-tidal carbon dioxide gradient.

The effect of PEEP on the arterial minus end-tidal carbon dioxide gradient (PaCO2-PetCO2) was evaluated in 13 adult patients with acute respiratory failure. The morphologic study of the pressure-volume (P-V) curves allowed separation of the patients into two groups: group 1 (n = 7) with initial inflection point in the (P-V) curve, and group 2 without inflection point. We hypothesized that the profile of the PaCO2-PetCO2 gradient would indicate an appropriate PEEP level only in patients with recruitable air spaces. We ventilated group 1 patients with zero end expiratory pressure (ZEEP), PEEP corresponding to inflection point pressure (PEEPPi) and PEEP5 cm H2O above PEEPPi, and group 2 patients with ZEEP, 6 cm H2O PEEP and 12 cm H2O PEEP. The PaCO2-PetCO2 gradient changed significantly in group 1 (ZEEP: 13.59 mm Hg; PEEPPi: 8.33 mm Hg; PEEPPi + 5 cm H2O: 10.54 mm Hg), but not in group 2 (ZEEP: 14.15 mm Hg; PEEP 6 cm H2O: 14.20 mm Hg; PEEP 12 cm H2O: 16.53 mm Hg). Our results show that the PaCO2-PetCO2 gradient may be useful in selecting a PEEP level which produces alveolar recruitment, but only in those patients with initial inflection point in the P-V curve.

Adult↗