Critical Care Medicine

LINDNER, WILLIAM J.

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The effect of positive-pressure ventilation (PPV) with PEEP on the release of α-atrial natriuretic peptide (ANP) was investigated in both humans and an experimental model. In the human study, systemic artery blood samples from 22 critically ill patients were analyzed for ANP. Seventeen of these patients received PPV with different levels of PEEP (5 to 15 cm H

WEIGLE, CARL G. M.

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BERTOLINI, ALFIO

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The ability of ACTH-(1–24) to prolong survival and to extend the deadline for effective blood reinfusion has been studied in a model of lethal hypovolemic shock in the rat. Anesthetized rats were bled to a mean arterial pressure of 18 to 25 mm Hg and then subjected to one of the following iv treatments: a) saline; b) ACTH-(1–24), 160 μg/kg; c) blood reinfusion; d) ACTH-(I-24), 160 μg/kg followed by blood reinfusion. All rats treated with saline 5 min after bleeding died within 0.5 h. On the other hand, the treatment with ACTH-(1–24) induced an almost complete and sustained recovery of cardiovascular and respiratory functions associated with a survival time of 44 ± 18 h, while four of six rats reinfused with the withdrawn blood were still alive 15 days later. The time-lapse between bleeding and treatment was of crucial importance, and neither ACTH-(1–24) injection nor blood reinfusion had any effect if performed 25 min after bleeding. However, treatment with ACTH-(I-24) shortly after bleeding (5 min) greatly improved the effect of a later blood reinfusion. These data indicate that ACTH-(l-24) can prolong survival and permit the time-lapse between blood loss and blood reinfusion to be extended.

CACERES, MANUEL J.

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RUPP, ELLEN

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It is now customary practice to couple separately metered infusions via a manifold to a common catheter that enters the patient. Nitroprusside, however, is considered incompatible with all other medications. Critically ill patients who require multiple infusions of vasoactive and inotropic medications would benefit if physicians had additional information regarding compatibility of nitroprusside with other commonly used infusions. Utilizing high-performance liquid chromatography, the authors investigated the physical and chemical compatibility of nitroprusside, dobutamine, and nitroglycerin in solutions of 5% dextrose or 0.9% NaCl at clinically relevant concentrations. AH drugs were present within the guidelines of the U.S. Pharmacopeia (±10%) over 24 h in NaCl, but nitroglycerin degraded over 24 h when the three drugs were mixed in dextrose. We recommend diluting these medicines in NaCl when mixtures of them would exist for ≥ h.

LAYMAN, LISA K.

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Ionized Ca (Ca

SILVERMAN, MICHAEL

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The use of nebulizers in neonatal ventilator circuits offers a new and relatively uncharted route of therapy for infants in respiratory failure. We used a model lung to investigate and compare different nebulizer types and therapeutic agents and to make practical observations. Five different nebulizers (Ultravent, Acorn, MAD2, Small Particle Aerosol Generator, and Pulmosonic) were compared for efficiency of delivery of an amino-phylline aerosol to the model lung, and the particle size of aerosol produced by them was measured. A Nebulizer Efficiency Index (NEI) was created, representing the deposition rate of the original solution as aerosol upon the model lung filter. The Acorn (2.8–10 When a suspension of budesonide was nebulized, minimal amounts of drug were recovered from the filter when the nebulizer producing the smallest particle size (Ultravent) was studied, suggesting that suspensions of drugs behave differently from solutions. Significant changes need to be made to a conventional circuit when jet nebulizers are used; most of these are obviated by the use of an ultrasonic nebulizer, which also avoids the potential problem of marked cooling of the gas flow produced by jet nebulizers.

OBERLADSTATTER, MICHAEL

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The sequence of lung microvascular permeability (LMVP) changes in early direct posttraumatic and late indirect pancreatitis-induced adult respiratory distress syndrome (ARDS) was studied and compared with that of a control group, as well as non-ARDS ICU patients. A computerized large field of view gamma camera was used to measure LMVP simultaneously over both lungs by In 113m-labeled transferrin and Tc 99m-labeled erythrocytes. The LMVP index (LMVPI) (%/h) was used to quantify LMVP in the dynamic scintigraphic measurement. In the control group the LMVPI was 2.6 ± 2.8%/h for the right and 2.0 ± 2.8%/h for the left lung. Similar values were found in mechanically ventilated ICU patients without ARDS (group A) on admission (right LMVPI 3.2 ± 2.6, left LMVPI 2.6 ± 2.7%/ h) and 4 days later (right LMVPI 3.9 ± 2.6, left LMVPI 2.3 ± 1.8%/h). Interestingly, the initial evaluation of patients with direct early posttraumatic ARDS (lung contusion) (group B) showed significantly (

DELLINGER, R. PHILLIP

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BHARADWAJ, BAIKUNTH

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Pulmonary oxygen transfer, defined by Pao