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Biomedical subjects

L Blanch

Publications and source records attributed to L Blanch.

At least 73 records · Page 4Linked to original sources
PubMed1990

Intrinsic PEEP on static pressure-volume curves.

The static pressure volume (PV) curve of the total respiratory system is a well established method to assess pulmonary mechanics during respiratory failure. We have tested the impact of auto-PEEP on the PV curve determination in 16 COPD patients. An isovolumic pressure increment (IPI) was found at the beginning of the curve and a close correlation between IPI and auto-PEEP level (r = 0.962) p less than 0.001) was observed. The regression equation was not significantly different from the identity line. We conclude that the appearance of IPI in PV curves is largely determined by auto-PEEP and it is a good estimate of the existing auto PEEP level.

Aged↗
PubMed1990

Endotracheal tube cuff pressure assessment: pitfalls of finger estimation and need for objective measurement.

Estimation of endotracheal (ET) cuff pressure by finger palpation is one of the methods currently used in the clinical setting. We compared the accuracy of this method with instrumental intracuff pressure measurement in tracheal model tests by 20 members of our ICU team. Four different ET tubes at three different pressure levels were examined. Accuracy for the estimated method by finger palpation was 69% for high pressures, 58% for normal pressures, and 73% for low pressures. We observed differences in terms of sensitivity, specificity, and positive predictive power between different tubes reflecting differences in tube characteristics and interobserver variability. We conclude that precise intracuff pressure measurement is mandatory to prevent complications of over- or underinflation.

Clinical Competence↗
PubMed1988

Intrinsic PEEP: a cause of inspiratory muscle ineffectivity.

Intrinsic PEEP has been described as an inspiratory threshold load to the inspiratory muscles that could increase the work of breathing. We report a patient who presented ineffective inspiratory efforts to trigger the ventilator; when we applied PEEP in similar amounts of measured intrinsic PEEP, his inspiratory efforts became able to trigger the ventilator, suggesting that the inspiratory load was alleviated.

Aged↗
PubMed1988

Accuracy of an indirect carbon dioxide Fick method in determination of the cardiac output in critically ill mechanically ventilated patients.

We evaluated the accuracy of an indirect CO2 Fick method for measuring cardiac output in 30 critically ill mechanically ventilated patients. When the Fick principle was applied to CO2 using estimated PaCO2, the cardiac output obtained underestimated the thermodilution technique showing a lack of accuracy. However, there was a significant correlation between thermodilution and CO2 rebreathing methods using measured (r = 0.92; p less than 0.001) and estimated (r = 0.60; p less than 0.01) arterial PCO2. The regression equation using measured arterial PCO2 was y = 0.59 + 0.91x, and for estimated arterial PCO2 was y = 1.7 + 0.33x. The results suggest that the CO2 rebreathing method using measured arterial PCO2 may be useful to determine cardiac output in those seriously ill patients on artificial ventilation not requiring right heart catheterization.

Adult↗
PubMed1987

Whole pelvic osteomyelitis: unusual finding in staphylococcal sepsis.

We describe an infrequent case of combined infection of bone, articulation and lung by Staphylococcus aureus, with affectation of all pelvic bones. Studies with 99m Tc pyrophosphate were repeatedly negative, becoming positive following the appearance of radiological signs.

Adolescent↗
PubMed1987

Effect of PEEP on the arterial minus end-tidal carbon dioxide gradient.

The effect of PEEP on the arterial minus end-tidal carbon dioxide gradient (PaCO2-PetCO2) was evaluated in 13 adult patients with acute respiratory failure. The morphologic study of the pressure-volume (P-V) curves allowed separation of the patients into two groups: group 1 (n = 7) with initial inflection point in the (P-V) curve, and group 2 without inflection point. We hypothesized that the profile of the PaCO2-PetCO2 gradient would indicate an appropriate PEEP level only in patients with recruitable air spaces. We ventilated group 1 patients with zero end expiratory pressure (ZEEP), PEEP corresponding to inflection point pressure (PEEPPi) and PEEP5 cm H2O above PEEPPi, and group 2 patients with ZEEP, 6 cm H2O PEEP and 12 cm H2O PEEP. The PaCO2-PetCO2 gradient changed significantly in group 1 (ZEEP: 13.59 mm Hg; PEEPPi: 8.33 mm Hg; PEEPPi + 5 cm H2O: 10.54 mm Hg), but not in group 2 (ZEEP: 14.15 mm Hg; PEEP 6 cm H2O: 14.20 mm Hg; PEEP 12 cm H2O: 16.53 mm Hg). Our results show that the PaCO2-PetCO2 gradient may be useful in selecting a PEEP level which produces alveolar recruitment, but only in those patients with initial inflection point in the P-V curve.

Adult↗
PubMed1986

Post-neurosurgical and spontaneous gram-negative bacillary meningitis in adults.

In order to evaluate the clinical aspects of gram-negative bacillary meningitis (GNBM) we reviewed the charts of 20 adult patients with the discharge diagnosis of meningitis caused by gram-negative bacilli (bacteriologically proved) seen between 1973 and 1984. Nine patients had post-neurosurgical (post-NS) GNBM and 11 patients spontaneous (S) GNBM; the mean age of the former was 42 +/- 16 years and of the latter 56 +/- 14 years (p less than 0.05). The overall mortality rate was 50% (33% in the post-NS group and 64% in the S group). The glucose levels in CSF were significantly lower in the patients who died. Patients treated with combined aminoglycoside therapy presented a lower mortality rate than those treated with intravenous aminoglycoside only (25% versus 70%). We suggest that if aminoglycoside therapy is employed, these antibiotics must be administered both intravenously and directly into CNS.

Adult↗