Pulmonary Dysfunction Following Traumatic QuadriplegiaA prospective study of the pulmonary complications occurring in 22 consecutive patients admitted to hospital within 24 hours after acute traumatic quadriplegia was compared with the findings of a retrospective survey of 22 comparable patients. Patients in the prospective group received therapy designed to prevent or reverse secretion retention. All patients in this group survived. In the retrospective group there were nine deaths; pulmonary complications and the need for tracheal intubation and mechanical ventilation were three times more frequent. Serial pulmonary function testing in the prospective group demonstrated a greater compromise of expiration than inspiration and progressive improvement in diaphragm function with time. It is concluded that vigorous pulmonary therapy in the prospective group was associated with increased survival, a decreased incidence of pulmonary complications, and a decreased need for ventilatory support.
Continuous Monitoring of Mixed Venous Oxygen Saturation in Critically Ill PatientsA new pulmonary artery balloon flow-directed catheter combines a fiberoptic photometric system for continuous display of mixed venous blood oxygen saturation (SvO2) with the capacity for hemodynamic measurements including thermodilution cardiac output estimation. This oximetry system was studied to determine its accuracy, reliability, and usefulness in the surgical intensive care unit (ICU). Twenty-two catheters were tested, but only 17 were successfully placed in 16 patients. There were technical problems associated with 10 catheters and on six occasions these necessitated the use of another catheter. The catheter values for SvO2 were closely related (r = 0.9516) to those obtained from a laboratory Co-oximeter. Continuous monitoring of SvO2 is accurate and valuable as a warning system for deterioration in cardiopulmonary function and as an indicator of the effects of various therapeutic maneuvers in critically ill patients.