Search PubMed⌕ Search

Biomedical subjects

R D Branson

Publications and source records attributed to R D Branson.

62 records · Page 4Linked to original sources
PubMed1985

Postextubation hypoxemia treated with a continuous positive airway pressure mask.

Twenty-seven surgical patients who developed post-extubation hypoxemia unresponsive to routine respiration therapy (incentive spirometry and chest physical therapy) received continuous positive airway pressure (CPAP) delivered through a mask at an inspired oxygen fraction (FIO2) of 0.45. All patients responded with an increased PaO2 and achieved a PaO2/FIO2 ratio of at least 300 with a mean CPAP of 8.3 +/- 2.8 cm H2O. Mean duration of treatment was 23 +/- 14 h. Two (7%) patients required reintubation, one for control of excessive secretions and the other for persistent Pseudomonas pneumonia. Mask CPAP was an effective treatment for postextubation hypoxemia in this group of surgical patients.

Adolescent↗
PubMed1985

Comparison of conventional mechanical ventilation and synchronous independent lung ventilation (SILV) in the treatment of unilateral lung injury.

Eight patients presenting with severe unilateral pulmonary injury responded poorly to conventional mechanical ventilation. Synchronous independent lung ventilation (SILV) was employed to provide support of ventilation and oxygenation without creating the ventilation/perfusion (V/Q) mismatch observed during conventional ventilation. All patients demonstrated improved oxygenation (mean increase, 80 torr) during SILV with the FIO2 unchanged from previous therapy. Invasive hemodynamic monitoring in five of eight patients showed no difference in the commonly measured cardiopulmonary parameters with the two forms of mechanical ventilation. Peak inspiratory pressure (PIP), continuous positive airway pressure (CPAP), and pressure change secondary to tidal volume delivery to the uninvolved lung were significantly less during SILV. SILV is an effective method of improving oxygenation in patients with severe unilateral pulmonary injury.

Adolescent↗
PubMed1985

Mask CPAP: state of the art.

Mask CPAP is a safe and effective method of alleviating hypoxemia and reducing the work of breathing in selected patients with mild-to-moderate respiratory failure (PaO2/FIO2 less than 300). When mask-CPAP therapy is applied continuously, it is also effective in the treatment of atelectasis. Other applications of mask CPAP, such as those involving the treatment of asthma, require further investigation.

Humans↗
PubMed1985

Use of CPAP mask as the sole mode of ventilatory support in trauma patients with mild to moderate respiratory insufficiency.

Thirty-three trauma patients presenting with hypoxemia and normo- or hypocarbia were treated with continuous positive airway pressure (CPAP) via a snug-fitting face mask. All patients had demonstrated continued hypoxemia despite supplemental oxygen administration before institution of CPAP therapy as the primary mode of ventilatory support. Therapeutic end-point of PaO2/FIO2 greater than 300 was achieved in 32 of 33 patients. Duration of CPAP treatment was 28 +/- 19 hours. Two patients (6%) required intubation, but neither for elevation in PaCO2. CPAP mask appears an effective means of support for mild to moderate post-traumatic respiratory insufficiency.

Adolescent↗
PubMedDate not supplied

Effects of body temperature on accuracy of continuous cardiac output measurements.

Intermittent measurement of cardiac output is routine in the critically ill surgical patient. A new catheter allows real-time continuous measurement of cardiac output. This study evaluated the impact of body temperature variation on the accuracy of these measurements compared to standard intermittent bolus thermodilution technique. This prospective study in a university hospital surgical intensive care unit included 20 consecutive trauma patients. Data were collected with pulmonary artery catheters, which allowed both continuous (COC) and bolus (COB) thermodilution measurements. The catheter was placed through either the subclavian or internal jugular vein. Measurements for COB were performed using a bolus (10 cm3) of ice-cold saline with a closed-injectate delivery system at end-expiration. Computer-generated curves were created on a bedside monitor, and the average of three measurements within 10% of one another was used as COB. COC was determined as the average of the displayed CO before and after thermodilution CO measurements. Body temperature was measured from the pulmonary artery catheter and was grouped as < or =36.5 degrees C, 36.6-38.4 degrees C, and > or =38.5 degrees C. COB and COC were compared for agreement by plotting the mean of the differences (COB - COC) between the methods. The differences were plotted against the average of each pair and analyzed with linear regression. One hundred seventy-eight paired measurements were made over a period of 1 to 3 days. CO ranged from 3.7 to 15.5 L/min. Eighty-one percent of measurements were at a temperature of 36.5-38.4 degrees C. Approximately 7% of measurements were at a temperature below 36.5 degrees C and 11.2% were in patients with a core temperature above 38.5 degrees C. Correlation between the two techniques was 0.96, 0.91, and 0.82 for temperatures of < or =36.5 degrees C, 36.6-38.4 degrees C, and > or = 38.5 degrees C, respectively. In conclusion, the COC measurements correlate well with COB in trauma patients with a core temperature < or =38.5 degrees C. The accuracy degraded at higher temperatures, which may be related to the smaller signal-to-noise ratio at elevated body temperatures.

Adult↗
PubMedDate not supplied

Prehospital use of continuous positive airway pressure (CPAP) for presumed pulmonary edema: a preliminary case series.

OBJECTIVE: To describe the prehospital use of a continuous positive airway pressure (CPAP) system for the treatment of acute respiratory failure presumed to be due to cardiogenic pulmonary edema. METHODS: Prospective case-series analysis. Paramedics administered CPAP via face mask at 10 cm H2O to patients believed to be in cardiogenic pulmonary edema and in imminent need of endotracheal intubation (ETI). Data from run sheets and hospital records were analyzed for treatment intervals, vital signs, complications, admitting diagnoses, need for ETI, and mortality. RESULTS: Nineteen patients received prehospital CPAP therapy. Mean duration of therapy was 15.5 minutes. Pre- and post-therapy pulse oximetry was available for 15 patients and demonstrated an increase from a mean of 83.3% to a mean of 95.4%. None of the patients were intubated in the field. Two patients who did not tolerate the CPAP mask required ETI upon arrival in the emergency department (ED); an additional five patients required ETI within 24 hours. There was one death in the series and two additional adverse events (one aspiration pneumonia, one pneumothorax); none of these were attributable to the use of CPAP. The diagnosis of cardiogenic pulmonary edema was corroborated by the ED or in-hospital physician in 13 patients (68%). Paramedics reported no technical difficulties with the CPAP system. CONCLUSION: For patients with acute respiratory failure and presumed pulmonary edema, the prehospital use of CPAP is feasible and may avert the need for ETI. Future controlled studies are needed to assess the utility and cost-effectiveness of prehospital CPAP systems.

Aged↗