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Biomedical subjects

D R Miranda

Publications and source records attributed to D R Miranda.

10 recordsLinked to original sources
PubMed1992

Critically examining intensive care.

The economic recession of the last decade brought intensive care systems under the light of cost-effectiveness analysis, making use of several instruments available in medical practice, and others adapted from for-profit enterprises. The present concept of intensive care, particularly its functional and organizational interactions with traditional specialties, is at the brink of an important revaluation. Studies of the cost-effectiveness of therapeutic actions may be grossly biased if they do not consider the complete process of care (before, during, and after treatment), analyzing even its smallest elements.

Cost-Benefit Analysis↗
PubMed1987

Efficacy of a heat and moisture exchange device during high-frequency jet ventilation.

A hygroscopic condensor humidifier has been tested during high-frequency jet ventilation, in an experimental set up. The influence of various ventilator settings on relative humidity, temperature and water content of the inspiratory and expiratory gases was investigated. The device provides adequate conditioning of the inspired gases with regard to relative humidity, temperature and water content at various ventilator settings.

Gases↗
PubMed1987

Post lobectomy atelectasis: the use of a Servo 900 B as a high-frequency ventilator.

High-frequency ventilation (HFV) has been used with good results in a variety of clinical situations where conventional ventilation has proved ineffective. However, all of the reports so far have involved the use of a specially purchased specifically designed ventilator which tends to be unfamiliar to most medical and nursing staff responsible for its use. A case where HFV was used in combination with differential lung ventilation in the treatment of unilateral pulmonary atelectasis is described using a Servo 900B as the high-frequency ventilator. It serves to demonstrate that the Servo 900B can be used as an occasional high-frequency ventilator as required, thus avoiding the expense of purchasing a specialized ventilator.

Humans↗
PubMed1987

The effect of oropharyngeal decontamination using topical nonabsorbable antibiotics on the incidence of nosocomial respiratory tract infections in multiple trauma patients.

The incidence of respiratory tract infections was determined in 59 multiple trauma patients requiring prolonged intensive care (greater than 5 days) and receiving no antibiotic prophylaxis. Early pneumonia (less than 48 hr) with S. aureus, S. pneumoniae, and/or H. influenzae was found in 44% of patients. Secondary colonization of the oropharynx and respiratory tract with ICU-associated Gram-negative bacilli followed by pneumonia occurred in 12 patients (20%). The overall incidence of respiratory tract infections was 59%. In a prospective open trial three prophylactic antibiotic regimens were compared: 17 patients were treated with intestinal decontamination using nonabsorbable antibiotics (polymyxin E 400 mg, tobramycin 320 mg, amphotericin B 2,000 mg/day). No difference in infection rate was found. Twenty-five patients were treated with intestinal and oropharyngeal decontamination using an ointment containing 2% of the same antibiotics. Secondary colonization and infection of the respiratory tract with Gram-negative bacilli was significantly reduced (p less than 0.001). The incidence of early (Gram-positive) infections, however, was unchanged. Another group of 63 patients was treated with systemic antibiotic prophylaxis during the first days in combination with oropharyngeal and intestinal decontamination. The incidence of early pneumonia was significantly reduced (p less than 0.001). Five patients (8%) developed an infection. Superinfections were not observed.

Administration, Topical↗
PubMed1986

Nosocomial gram-negative pneumonia in critically ill patients. A 3-year experience with a novel therapeutic regimen.

The efficacy of selective decontamination of the oral cavity and GI-tract in the treatment of established gram-negative pneumonia in critically ill patients was evaluated in a prospective open trial. 25 patients with pneumonia caused by Enterobacteriaceae or Pseudomonadaceae were studied. All patients were mechanically ventilated (range 2-60 days). Non-absorbable antibiotics (polymyxin E 100 mg, tobramycin 80 mg, amphotericin B 500 mg) were administered through the nasogastric tube four times a day. The oral cavity was decontaminated with an ointment containing 2% of the same antibiotics, applied to the buccal mucosa four times a day. For systemic therapy a combination of tobramycin (3-6 mg X kg-1) with either cefotaxim (50-100 mg X kg-1) or ceftazidime (100 mg X kg-1) was given both intravenously and by aerosol (50% IV dose/5 ml saline) four times a day. Eradication of pathogens from the respiratory tract was achieved in 24 patients within 9 days (median 5 days). The cure rate was 96%. Two patients had a relapse. Neither recolonization with resistant organisms nor supra-infections were found for the remaining period of mechanical ventilation (up to 60 days), also after systemic/aerosol therapy had been discontinued. Only 3 patients died (12%).

Aerosols↗
PubMed1977

Intermittent mandatory ventilation. A method to expand clinical applications.

The described modification of the Cameco URS-701 ventilator increases the frequency possibilities from zero to 40, without interfering with the ventilator pattern of each cycle and satisfies the required conditions for a classical IMV-system. Moreover it can provide longer periods of controlled ventilation alternating with periods of spontaneous respiration. This adaptation, mainly consisting of the introduction of a timer in the electrical circuit of the machine, provides us with a safe IMV system on our Engstrom 150 type ventilator and leads to a broader concept of IMV.

Humans↗