Comparison of Cardiorespiratory Effects of Pressure Controlled Ventilation with Volume Controlled Ventilation in Severe Respiratory Failure / 대한마취과학회지

Pressure controlled ventilation has been proposed to recruit closed alveolar units and improve oxygenation through changing the inspiratory flow pattern from a square wave as used with volume controlled ventilation to a rapidly exponentially decaying curve and through maintaining airway pressure at a constant level throughout the inspiratory phase. The purpose of this study was to evaluate the cardiorespiratory efficacy of pressure controlled ventilation in severe respiratory failure. Cardiorespiratory values were measured in ten patients with severe respiratory failure on volume controlled and pressure controlled ventilation. Tidal volume, ventilatory rate, PEEP, inspiratory:expiratory ratio and FIO2 were maintained at the same level for both ventilatory modalities. Changing from volume controlled ventilation to pressure controlled ventilation was associated with significant improvement in PaO2 and decrease in peak inspiratory pressure. There were no significant changes in other cardiorespiratory values, such as arterial blood pressure, heart rate, inspiratory pause pressure and static compliance. These results suggest that pressure controlled ventilation may be a beneficial ventilatory modality in the treatment of severe respiratory failure compared to volume controlled ventilation.

Midazolam Infusion for Sedation in the ICU Patients / 대한마취과학회지

Problems related to agitation in the ICU patients include cardiorespiratory instability, ina bility to cooperate with nursing care, failure to maintain op timal positioning in bed, dis- ruption of life sustaining tubes and catheters, and injuries to patients and hospital person- nel. Thus, the ability to provide safe, controllable, and reversible sedation can be important in the care of critically ill patients. Midazolam is a water soluble imidazobenzodiazepine with a rapid onset of ac tion and short elimination half life compared with diazepam or lorazepam. We evaluated the use of midazolam by continuous infusion for prolonged sedation of critically ill adult patients. The results were as follows ; 1) Midazolam infusion effectively controlled severe agitation in all patients. 2) No episodes of cardiovascular depression due to midazolam occur red during the study period. 3) In one patient, tolerance was developed 6 days after infusion. 4) Mean time to alertness was 2.23 hours. 5) In a renal failure patient, there was no significant prolongation of time to alertness. These results suggest that midazolam infusion provides safe, controllable, and reversible sedation in the care of critically ill patients.