Biomedical subjects

M Subirana

Publications and source records attributed to M Subirana.

13 recordsLinked to original sources

PubMed1994

Volume-controlled ventilation and pressure-controlled inverse ratio ventilation: a comparison of their effects in ARDS patients.

Volume-controlled ventilation with positive end-expiratory pressure (PEEP) (CPPV) is the conventional ventilatory approach in adult respiratory distress syndrome (ARDS) patients, but some reports suggest that pressure-controlled ventilation with an inverse inspiratory to expiratory ratio (PCIRV) may improve gas exchange in these patients. We analysed the acute effects on gas exchange, lung mechanics and haemodynamics induced by CPPV and PCIRV in ARDS patients. CPPV and PCIRV were applied randomly in ARDS patients. During CPPV, external PEEP was titrated according to the initial inflection point in the static pressure-volume (P-V) curve of the respiratory system, or it was 10 cmH2O when there was no inflection. During PCIRV, external PEEP was not applied, and inspiratory to expiratory (I/E) ratio was inversed until total PEEP was equal to the inflection point in the P-V curve, or it was 10 cmH2O. Respiratory rate, fractional inspiratory oxygen (FIO2), and tidal volume (VT) were kept constant in both modes. Eight ARDS patients were studied prospectively and admitted to a general Intensive Care Unit (ICU) of a University Hospital. Haemodynamic measurements, airflow (V), airway pressure (Paw) and VT were obtained using standard methods. We did not observe any significant change between CPPV and PCIRV with respect to: arterial oxygen tension (PaO2) 117 +/- 12 vs 107 +/- 15 mmHg (16 +/- 2 vs 14 +/- 2 kPa), arterial carbon dioxide tension (PaCO2) 40 +/- 2 vs 39 +/- 2 mmHg (6 +/- 0.3 vs 5 +/- 0.3 kPa), intrapulmonary shunt function (QS/QT) 36 +/- 3 vs 38 +/- 4%, cardiac output (CO) 7.1 +/- 0.7 vs 7 +/- 0.8 l.min-1, and total PEEP 9.7 +/- 0.6 vs 9 +/- 0.3 cmH2O. Oxygen transport and total respiratory system compliance remained unchanged in both modes. Mean Paw was slightly lower during CPPV (17 +/- 1 cmH2O) than during PCIRV (19 +/- 1 cmH2O). PCIRV does not appear to have clinical advantages over CPPV in terms of gas exchange, haemodynamics, or static lung mechanics when using the same total PEEP and minute ventilation.

Adult↗

PubMed1984

[Plasma levels of antiepileptic agents in the treatment of epilepsy].

From a total of 560 different epileptics visited during 16 months, we have practiced 140 plasmatic dosifications of antiepileptic drugs according to EMIT technic. The antiepileptic drugs studied were: PB, DPH, PRM, VPA, CBZ and ESM. In this study only the 70 patients treated with PB in monotherapy or combined with DPH, CBZ, VPA and PRM are considered. From the 70 patients, 45 have been controlled; from them 21 (46,5%) did not reach efficient levels from anyone of the used antiepileptics. From the 70 patients 25 have been partially or bad controlled, 20 of them (80%) had PB in efficient levels, 13 (52%) had the other antiepileptic in efficient levels, 12 (47%) had both antiepileptics in efficient levels and 4 (16%) had no antiepileptic drug in efficient levels in spite of using the efficient dose in mg/Kg/day. The conclusions of this results are: we reached a good effect by using PB alone or combined under the considered efficient levels in a 46.5% of the patients; the bad controlled patients, kept on being bad controlled in spite of having 80% of them PB, the other antiepileptic or both in efficient levels.

Adolescent↗

PubMed1980