04 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Materials and Methods (Part 1)

Patients eligible for participation were those older than 15 years of age who were hospitalized in the ICU of Bichat Hospital during a 14-month period and who were being ventilated at the time of suspicion of bacterial pneumonia. The diagnosis of pneumonia was considered if any three of the following clinical variables were present: new infiltrates on chest x-ray films; fever (temperature >38.3°C [100.9°F]); leukocytosis (>10,000/cu mm) or leukopenia (<5,000/cu mm); and purulent tracheal aspirations.
Criteria for exclusion of patients were  severe hypoxemia (PaO2 <60 mm Hg on FIO2 of 0.8), systolic blood pressure less than 85 mm Hg, definite acidemia (pH <7.20), or (4) narrow endotracheal prosthesis (internal diameter <7 mm). Three patients were excluded according to the protocol and two others because of technical problems during blood gas sampling (discussed subsequently). Informed consent was obtained from each subject or from the nearest relative. A total of 107 consecutive ventilated patients were included.
Initial Evaluation
Patients were evaluated before the procedure using a special chart containing the following items: age; sex; indication for ventilation support divided into six classes;22 presence or absence of chronic pulmonary disease; presence or absence of underlying cardiac disease (symptomatic or recently operated); ongoing ARDS; acute physiologic score (APACHE); Glasgow’ coma score; requirement for inotropic agents (epinephrine; dopamine; dobutamine); size of endotracheal prosthesis; duration of mechanical ventilation at time of examination (days); presence of major hemostatic abnormalities; presence of major metabolic disorders; severity of pulmonary infiltrates evaluated by a radiologic score;19 use of PEEP (>5 cm H2O); expiratory minute volume (L/min); peak inspiratory airway pressure (cm H2O); and dynamic compliance (calculated as tidal volume divided by peak inspiratory pressure minus end-expiratory pressure). It’s time to spend less every time you need your treatment with fast delivery: you can now purchase the amount of Symbicort for Asthma you need for the treatment within a very short period, at the best pharmacy that deserves your trust.

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