Gary W. Wahl

Comparison of noninvasive measurements of carbon dioxide tension during withdrawal from mechanical ventilation

End tidal CO2 tension (Petco2) and transcutaneous CO2 tension (Ptcco2) were compared with arterial CO2 (Paco2) before and after withdrawal of mechanical ventilation in 20 patients predisposed to hypercarbia. With stable Paco2 during mechanical ventilation, the correlation coefficient (r) between Pac

Apache Ii score and mortality in respiratory failure due to cardiogenic pulmonary edema

We reviewed retrospectively 88 patients to assess whether the APACHE II severity of disease classification system can predict mortality in patients with respiratory failure due to cardiac pulmonary edema. Mean score for survivors was higher than for nonsurvivors (24.5 +/- 6.7 vs. 20.7 +/- 5.7, p less than .01), and increasing APACHE II scores were not associated with increasing mortality. Mortality was 54% for APACHE II scores less than or equal to 18, 43% for scores greater than 18 and less than or equal to 24, 22% for scores greater than 24 and less than or equal to 31, and 25% for scores between 32 and 40. The relationship of APACHE II scores to mortality did not improve when the 25 patients with ICU stays less than 48 h were analyzed; the mean score of survivors in this group was 24.3 +/- 5.2 vs. 18.8 +/- 4.6 for nonsurvivors, p less than .001. The presence of myocardial infarction (MI) was associated with a high mortality. Mortality in the 51 MI patients was 52.9% vs. 13.5% in the 37 patients without MI (p less than .001), but APACHE II scores were similar (22.6 +/- 6.6 and 23.7 +/- 6.4, respectively). The relationship between APACHE II scores and mortality did not improve if patients with and without MI are analyzed separately. For patients with MI, mortality was 78.6% for scores between 12 and 17, 56.2% for scores between 18 and 23, 33.3% for scores between 24 and 29, and 33.3% for scores greater than 29.(ABSTRACT TRUNCATED AT 250 WORDS)

Journey of a Survivor of Near Drowning, Polymicrobial Pneumonia, and Acute Respiratory Distress Syndrome

This article discusses a woman who collapsed and landed in a puddle of water in a park near a horse trail. Her rescue and resuscitation started an extraordinary effort by her body to heal from multiple insults. This case study highlights the diagnosis and support of polymicrobial pneumonia secondary to near drowning and the multisystem complications throughout the 3-month hospitalization. It highlights the evidence for treatment of the polymicrobial nature of submersion injury, acute lung injury, and benefits of progressive mobility. Social media as a tool for the familys communication and coping are also discussed.

Comparison of Noninvasive Measurements of Carbon Dioxide Tension During Withdrawal from Mechanical Ventilation

End tidal CO2 tension (Petco2) and transcutaneous CO2 tension (Ptcco2) were compared with arterial CO2 (Paco2) before and after withdrawal of mechanical ventilation in 20 patients predisposed to hypercarbia. With stable Paco2 during mechanical ventilation, the correlation coefficient (r) between Paco2 and Petco2 was .9, and between Paco2 and Ptcco2, .87. Ptcco2 considerably overestimated Paco2 in three patients who were receiving dopamine. After withdrawal of mechanical ventilation, changes in Paco2 were closely paralleled by changes in Petco2 and Ptcco2 (r = .82 and .86, respectively). Nine of 20 patients had an increased Paco2 of 10 torr or greater. In eight of these, Petco2 and Ptcco2 rose by at least 5 torr, and in seven, the rise in Petco2 and Ptcco2 was within 5 torr of the rise in Paco2.During mechanical ventilation, Petco2 and Ptcco2 estimated stable Paco2 with sufficient accuracy for clinical use, except in patients with cutaneous vasoconstriction. After withdrawal of mechanical ventilation, changes in Petco2 and Ptcco2 were predictive of important Paco2 increases, warranting continued exploration and evaluation as to their use in monitoring patients predisposed to hypercarbia.