Gas exchange in low-compression HFPPV is maintained at low distending pressures in the pig.

The fact that collateral ventilation normally occurs in the human lung has led to the suggestion that it might contribute to the successful clinical effects of low-compression high-frequency positive-pressure ventilation (HFPPV). As the pig has poor collateral ventilation, pulmonary vasoconstriction has to be part of the regulatory mechanisms matching ventilation-perfusion. A study was made on nine pigs anesthetized with ketamine hydrochloride intravenously to elucidate the maintenance of ventilation-perfusion balance during mechanical ventilation. Comparisons were made between the ventilatory patterns provided by a conventional ventilator (Servo-Ventilator 900C) and an improved prototype of a low-compression system for volume-controlled ventilation (system H). A ventilatory frequency of 20 breaths per min (bpm) with SV-900C (SV-20) and system H (H-20) and of 60 bpm with system H (H-60) was used. The experimental conditions were otherwise identical. Positive end-expiratory pressures (PEEP) were applied to maintain the same mean airway pressure with the three systems. The tidal volume required for normoventilation differed significantly between the three ventilatory patterns, but there were no differences in circulatory and oxygen-transport variables. By measurements of airway pressure and intrapleural liquid surface pressure, it was demonstrated that the distending pressure (at end-inspiration) was significantly lower with a low-compression system (H-20 versus SV-20), especially at a high ventilatory frequency (H-60 versus H-20). Consequently, although the mean airway pressure was set at the same level for the three different ventilatory modalities, the distending pressures required for the same alveolar ventilation and arterial oxygenation differed significantly.(ABSTRACT TRUNCATED AT 250 WORDS)

Hipertension arterial pulmonar como causa del deterioro hemodinamico en pacientes con sepsis por Gram-negativos: (presentacion de un caso). / Pulmonary arterial hypertension as a cause of hemodynamic abnormalities in patients with Gram-negative sepsis: report of a case

Se presenta el caso de una paciente con sepsis por Gram negativos que, durante su evolucion, curso con la aparicion subita de hipertension arterial pulmonar. Este evento correlaciono con la progresion rapida de la fase hiperdinamica a la de hipodinamia caracteristicas de la sepsis. Esta situacion se revirtio con el empleo de vasodilatadores. En este caso nitroprusiato sodio, exclusivamente. Se informan los cambios observados en los diversos parametros hemodinamicos medido, se analizan las hipotesis convencionalmente invocadas tendientes a explicar la progresion de fase A a fase B en la sepsis y se revisan los criterios tradicionales de manejo en los enfermos en estas condiciones. Se propone la hipertension arterial pulmonar como un mecanismo mas a ser considerado como causa del deterioro hemodinamico agudo durante la evolucion del choque endotoxico sugiriendo ademas que, estos casos, son tributarios de tratamiento con vasodilatadores solos o, en asociacion, con inotropicos

Anudamiento de un cateter de SwanGanz en la vena subclavia. / Swan-Ganz catheter knotting in the subclavian vein

Se presenta el caso de un enfermo sometido a cateterismo pulmonar en el que se observo el anudamiento del cateter en la vena subclavia como complicacion, poco usual, inherente al procedimiento. Se analizan sus implicaciones y se sugieren formas de evitarlo y de corregirlo en el caso de que se presentara