Biomedical subjects
Publications and source records attributed to J C Gabel.
An appreciation of the "state of the art" of pulmonary capillary pressure and permeability must necessarily form an important part of the basis of a rational choice of fluid therapy. The present state of the understanding of pulmonary transcapillary fluid exchange is developed. Laboratory data are used in conjunction with clinical evidence to construct and support the physiological concepts set forth.
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We used a gravimetric method to determine the ratio (gamma) of pulmonary venous to total pulmonary vascular resistance in intact dog lungs. From this ratio, pulmonary capillary pressure (Pc) can be calculated. The average value of gamma was 0.50 +/- 0.06 (mean +/- SD) in 10 dogs. We found no correlation between gamma and PO2, PCO2, pH, or hematocrit in the narrow ranges of these experiments. Over the capillary pressure range of 22.4--35.2 mmHg we found no correlation between gamma and Pc. The value of gamma found in this study is not significantly different from the value found in isolated perfused lungs.
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The introduction of the concept of intermittent mandatory ventilation (IMV) has meant that for the first time weaning is controlled. The abrupt cessation of ventilatory support, even for short periods, as was obligatory before IMV, is no longer necessary. The frequency of positive pressure inflations can be gradually and progressively decreased as indicated, leading to spontaneous ventilation in a planned, controlled program. The ease with which other artificial ventilation technics may be incorporated into this system adds to its usefulness. IMV should be considered whenever ventilatory support is to be discontinued.
Fifteen postoperative surgical patients, in whom noncardiac pulmonary edema developed were studied. A presumptive diagnosis of left ventricle failure would have been based on historical evidence of heart disease (80%), electrocardiographic changes of ischemia or arrythmia (87%), or cardiogenic shock (20%). (see article) Fig. 6. PAEDP-PCW gradient. Note that arterial oxygen tension had an inverse relationship to this pressure differential. Roentgenographic findings included pulmonary edema (73%), pulmonary vascular congestion (60%), cardiomegaly or congestive heart failure (40%). Mean increase in A-aDO2 was 290 torr. Further cardiovascular investigation seemed to exclude left ventricular failure. Mean cardiac index was 4.1 plus or minus 1.3 L/min/m2; pulmonary capillary wedge pressure 4 plus or minus 2.7 torr, and stroke work was 87 plus or minus 8.7 gm-meters. Possible etiologic agents included elevated pulmonary artery pressure (67%), allergic reactions (27%), peritonitis or multiple system trauma (54%), or multiple transfusions (33%). Forty-seven per cent of the entire group survived. Therapy was directed toward the underlying noncardiogenic suspected etiology. Direct cardiovascular measurements were necessary to correct the erroneous though seemingly well founded suspected diagnosis of left ventricular failure in these patients.
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Successful therapy of unilateral acute lung disease has been infrequent. The marked compliance difference that exists between the acutely diseased and normal lung may make conventional respiratory therapy ineffective in treating the diseased lung. Vigorous attempts at reexpansion of the involved lung including bronchoscopy, continuous positive pressure ventilation, chest physiotherapy, suctioning, and position changes are usually successful in acute lung disease but were ineffective in the case presented. The use of the double lumen endotracheal tube, Carlens tube, and the application of differential ventilation was a safe and effective modality of therapy when conventional measures failed. The method of ventilation and the patient's course are described.
Plasma colloid osmotic pressure was measured each day in 84 intensive care unit patients. Probit analysis demonstrated a direct relationship between colloid osmotic pressure (COP) and survival. The COP associated with a 50% survival rate was 15.0 torr. COP was higher in survivors than in nonsurvivors without respiratory failure and in patients who recovered from respiratory failure. We conclude that lowered COP is associated with an elevated mortality rate. However, the relationship to death is not explained by the relationship to respiratory failure.
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