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Biomedical subjects

D Rivara

Publications and source records attributed to D Rivara.

10 recordsLinked to original sources
PubMed2001

Gastric intramucosal pH and intraluminal PCO2 during weaning from mechanical ventilation.

OBJECTIVE: To study the value of gastric intramucosal pH and gastric intraluminal PCO2 measurements to predict weaning outcome from mechanical ventilation. DESIGN: Prospective clinical study. SETTING: Intensive care medicine department of a university hospital. PATIENTS: Nineteen adult critically ill patients who were mechanically ventilated because of acute respiratory failure and were considered ready to be weaned. INTERVENTIONS: The patients were weaned with: synchronized intermittent mandatory ventilation plus positive end-expiratory pressure (SIMV+PEEP) or continuous positive airway pressure with pressure support ventilation (CPAP+PSV). A gastric tonometer was placed in all the patients. Tonometric, respiratory, and hemodynamic variables were measured during the weaning process. MEASUREMENTS: Hemodynamic variables, respiratory mechanics, pulmonary gas exchange, respiratory muscle force, spontaneous pattern of breathing, and the central control of breathing were recorded. Simultaneously, the intramucosal pH and gastric intraluminal PCO2 were measured. MAIN RESULTS: Eleven patients were successfully extubated and eight failed. The patients who failed showed higher values of mouth occlusion pressure, respiratory rate, and effective inspiratory impedance (mouth occlusion pressure/mean inspiratory flow). The intramucosal pH was initially 7.19 +/- 0.22 and decreased to 7.10 +/- 0.16 during the weaning process in patients who failed (p < .05). At the same time, the intramucosal pH showed a nonsignificant change from 7.36 +/- 0.07 to 7.32 +/- 0.07 in the patients who were successfully extubated. The intramucosal pH was statistically different when both groups were compared during the initial and the final evaluations (p < .05). For the initial evaluation, the sensitivity and specificity to predict weaning failure when the intramucosal pH was < or =7.30 were 0.88 (95% confidence interval [CI], 0.66-1) and 0.82 (95% CI, 0.59-1), respectively. The gastric intraluminal PCO2 was higher in patients who failed (p < .05). When gastric intraluminal PCO2 was . or =40 torr during the initial evaluation, weaning failure occurred with a sensitivity of 1 (95% CI, 0.31-1) and a specificity of 0.55 (95% CI, 0.26-0.84). CONCLUSIONS: Weaning failure was associated with gastric intramucosal acidosis. The intramucosal pH and gastric intraluminal PCO2 may be helpful to predict weaning outcome. Further controlled clinical trials in a larger group of patients are needed.

Adolescent↗
PubMed1991

Heat and moisture exchanger vs heated humidifier during long-term mechanical ventilation. A prospective randomized study.

Adequate humidification of inspired gases with HMEs during long-term MV remains controversial. In this study, a comparison is made between tracheal secretions during long-term MV either with HME or conventional HH. Both the HME and HH groups were similar with respect to age, sex, diagnosis, duration of MV, SAPS and mortality. Temperature of gases in the tracheal tube was lower and the amount of tracheal instillations was greater in the HME group than in the HH group. Tracheal secretions became thicker between day 1 (control) and day 5, in the HME group than in the HH group. Four and two tube occlusions occurred in HME and HH groups, respectively. Tracheal bacterial colonization was similar in the two groups. Given the advantages of HME (reduced nurses' work and financial cost), HME could be routinely used under cautious surveillance and replaced by HH if difficulty in suctioning occurs.

Female↗
PubMed1990

Acute myocardiotoxicity during 5-fluorouracil therapy.

A 38-year-old man with a colonic carcinoma experienced cardiogenic shock during continuous intravenous treatment with 5-fluorouracil (5-FU), without clinical or electrical signs of coronary insufficiency and with a normal coronary angiogram. His symptoms resolved after eight days of inotropic and vasodilator therapy. Because of the severity of the shock, rechallenge was not performed. This is the first case of acute cardiac failure without coronary ischemia, associated with 5-FU monotherapy. Experimental studies suggest that this adverse effect could be due to myocardial accumulation of 5-FU leading to depletion of high energy phosphate compounds. This might also explain the more frequently seen acute coronary insufficiency due to 5-FU.

Adult↗
PubMed1984

Positional hypoxemia during artificial ventilation.

The effect of body position was studied in 8 patients with predominantly unilateral lung disease, who were admitted to an ICU and placed under artificial ventilation. Significant changes in PaO2 were observed when body position was changed from supine to lateral decubitus. PaO2 increased from 149 to 227 torr when the sick lung was up (p less than .01), but decreased to 106 torr when the sick lung was down (p less than .02). Both differences were statistically significant. The values were not different for right vs. left lung disease.

Adult↗
PubMed1979

Differential ventilation in unilateral lung disease: effects on respiratory mechanics and gas exchange.

Conventional PEEP ventilation has been recently reported to be deleterious in some cases of ARF with unilateral pneumonia. In such respect, two cases of unilateral bacterial pneumonia were intubated with a Carlens tracheal tube. Measurement of tidal volume, static compliance, and functional residual capacity of each lung showed marked inequality. Subsequently, both patients were ventilated with a selective distribution circuit, allowing the introduction of a PEEP valve in the expiratory line of the diseased lung. Evident improvement in blood gases was obtained within 24 hours, as tidal volume, static compliance, and FRC of the diseased lung were markedly improved. In one case equalisation of V/Q ratio was documented using the 81m Kr method. Final recovery was obtained in one case.

Adult↗