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For decades, digitalis and diuretics presented as the mainstay of the conventional treatment of heart failure. In the late 1960s, however, the use of positive inotropic agents was reconsidered on account of several studies demonstrating a poor hemodynamic response to digitalis and arrhythmogenic effects in patients with coronary disease. The beneficial effect of diuretics in relieving pulmonary congestion...
Nosocomial pneumonia, or terminal pneumonia as it was formerly called, results from the repetitive microaspiration of contaminated oropharyngeal secretions into the lungs in the presence of impaired host defenses. This pathophysiologic sequence was suggested by the observations of Osler but clarified by the seminal work of Rouby and colleagues. The enormous impact of antimicrobial agents on the organisms...
Continuous positive pressure breathing consisting of a pressure in the airways above the atmospheric level during spontaneous inspiration and expiration was used in the treatment of pulmonary edema and severe pneumonia even before World War II [1]. Positive endexpiratory airway pressure was also very commonly used in the experimental laboratory in any open chest preparation in order to prevent expiratory...
Background: The principal features of elastic pressure-volume curves of lungs or the respiratory system (Pel/V curves) recorded during reexpansion of collapsed lungs and subsequent deflation have been known since the 1950s. In acute respiratory failure and acute respiratory distress syndrome such curves have recently attracted increasing interest because new knowledge can be acquired from...
Background: The “baby lung” concept originated as an offspring of computed tomography examinations which showed in most patients with acute lung injury/acute respiratory distress syndrome that the normally aerated tissue has the dimensions of the lung of a 5- to 6- year-old child (300–500 g aerated tissue). Discussion: The respiratory system compliance is linearly related...
Background: Oxygenation is impaired in almost all subjects during anesthesia, and hypoxemia for shorter or longer periods is a common finding. Moreover, postoperative lung complications occur in 3–10% after elective abdominal surgery and more in emergency operations. Discussion: Rapid collapse of alveoli on induction of anesthesia and more widespread closure of airways seem to explain the...
In the United States sepsis annually affects 700,000 people and accounts for about 210,000 deaths. Respiratory failure has long been known to be a frequent occurrence of this pathological condition and to represent a major contributor to the high associated mortality [1]. This contribution discusses of the effects of sepsis and septic shock on respiratory muscle function and focuses on some of the...
Around 1980 several intensivists decided to score the severity of ICU patients in order to compare the populations and evaluate the results. The outcome of intensive care depends on several factors present on the first day in the ICU and on the patient’s course under ICU therapy. The severity scores comprise usually two parts: the score itself and a probability model. The score itself is a number...
Most cellular activities require energy in the form of oxygen, primarily obtained from the degradation of adenosine triphosphate (ATP) and other high-energy compounds. Oxygen must be present in sufficient amounts in the mitochondria to maintain effective concentrations of ATP in the electron transport system. Cells have to perform a series of activities essential for survival, including membrane transport,...
Background: Multiple organ dysfunction syndrome is the commonest reason for sepsis-associated mortality. Discussion: In the 40 years since it was first described understanding of its pathophysiology has improved, and novel methodologies for monitoring and severity of illness scoring have emerged. These, together with the development of systematic strategies for managing organ dysfunction...
Once upon a time the existence of ventilator-induced lung injury (VILI) was debated. After all, most patients with lung dysfunction requiring mechanical ventilation had other potential causes of lung injury, and many patients appeared to tolerate mechanical ventilation for prolonged periods without any adverse sequelae. However, as a result of numerous studies over the past century, and especially...
The approach to ventilator weaning has changed considerably over the past 30 years. Change has resulted from research in three areas: pathophysiology, weaning-predictor testing, and weaning techniques. Physiology research illuminated the mechanisms of weaning failure. It also uncovered markers of weaning success. Through more reliable prediction, patients whose weaning would have been tedious in the...
The topic of cardiorespiratory interactions is of extreme importance to the practicing intensivist. It also has a reputation for being intellectually challenging, due in part to the enormous volume of relevant, at times contradictory literature. Another source of difficulty is the need to simultaneously consider the interrelated functioning of several organ systems (not necessarily limited to the...
In Part I of this review, we have covered basic concepts regarding cardiorespiratory interactions. Here, we put this theoretical framework to practical use. We describe mechanisms underlying Kussmaul's sign and pulsus paradoxus. We review the literature on the use of respiratory variations of blood pressure to evaluate volume status. We show the possibilities of attaining the latter aim by investigating...
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