ABSTRACT
Pneumonia caused by Pseudomonas aeruginosa carries a high rate of morbidity and mortality. A lung-protective strategy using low tidal volume (V(T)) ventilation for acute lung injury improves patient outcomes. The goal of this study was to determine whether low V(T) ventilation has similar utility in severe P. aeruginosa infection. A cytotoxic P. aeruginosa strain, PA103, was instilled into the left lung of rats anesthetized with pentobarbital. The lung-protective effect of low V(T) (6 ml/kg) with or without high positive end-expiratory pressure (PEEP, 10 or 3 cmH(2)O) was then compared with high V(T) with low PEEP ventilation (V(T) 12 ml/kg, PEEP 3 cmH(2)O). Severe lung injury and septic shock was induced. Although ventilatory mode had little effect on the involved lung or septic physiology, injury to noninvolved regions was attenuated by low V(T) ventilation as indicated by the wet-to-dry weight ratio (W/D; 6.13 +/- 0.78 vs. 3.78 +/- 0.26, respectively) and confirmed by histopathological examinations. High PEEP did not yield a significant protective effect (W/D, 4.03 +/- 0.32) but, rather, caused overdistension of noninvolved lungs. Bronchoalveolar lavage revealed higher concentrations of TNF-alpha in the fluid of noninvolved lung undergoing high V(T) ventilation compared with those animals receiving low V(T). We conclude that low V(T) ventilation is protective in noninvolved regions and that the application of high PEEP attenuated the beneficial effects of low V(T) ventilation, at least short term. Furthermore, low V(T) ventilation cannot protect the involved lung, and high PEEP did not significantly alter lung injury over a short time course.
Subject(s)
Pneumonia, Bacterial/therapy , Positive-Pressure Respiration/methods , Pseudomonas Infections/therapy , Pseudomonas aeruginosa , Sepsis/prevention & control , Animals , Bacteremia/etiology , Bacteremia/prevention & control , Carbon Dioxide/blood , Male , Partial Pressure , Positive-Pressure Respiration/adverse effects , Rats , Rats, Sprague-Dawley , Sepsis/etiology , Severity of Illness IndexABSTRACT
VIA Blood Gas Monitor System (Baxter) withdrawals and reinforces blood automatically and measures pH, PaCO2, PaO2, sodium, potassium, and hematocrit. We evaluated VIA for use during cardiopulmonary bypass in 8 patients and during differential lung ventilation in 6 patients. The bias and precision were calculated on all the measured parameters. A total of 127 blood samples were obtained for comparison. Blood gas data measured by VIA were clinically acceptable except sodium. These findings suggest that VIA is useful for the management of patients in whom frequent arterial gas measurements are necessary.
Subject(s)
Blood Gas Analysis/instrumentation , Blood Gas Analysis/standards , Monitoring, Intraoperative , Aged , Female , Humans , Male , Middle Aged , Point-of-Care Systems , Surgical Procedures, OperativeABSTRACT
We investigated the relationship between the degree of hemodilution during cardiopulmonary bypass (CPB) and weight gain after coronary bypass grafting by use of intraoperative hemodilution and autologous blood transfusion. There is no significant difference in weight gain between the higher hemoglobin group (Hb > or = 6 g.dl-1) and the lower hemoglobin group (Hb < 6 g.dl-1). Furthermore, there is no significant correlation between hemoglobin levels during CPB and weight gain after operation. We conclude that slightly excessive hemodilution than usual during CPB does not influence weight gain when cardiac and renal functions are fair.
