07 Sep

Evaluation of Cardiopulmonary Risk under Midazolam Sedation: Results (Part 1)

Clinical characteristics of the 107 patients are summarized in Table 1. The patients had been admitted to the ICU for a variety of problems, including postoperative respiratory failure (31 cases; 29 percent), respiratory insufficiency associated with chronic obstructive pulmonary disease (24 cases; 22 percent), acute pulmonary disease (16 cases; 15 percent), neurologic emergencies (14 cases; 13 percent), drug overdose (6 cases; 6 percent), and other miscellaneous disorders (16 cases; 15 percent). Patients were intubated for an average of 4.6±6.7 days (range, 0 to 45 days). Thirty-eight patients (36 percent) had bacterial pneumonia as defined by quantitative protected specimen brush culture using a threshold of 10^3 cfu/inl. The mean duration of the fiberoptic bronchoscopy was 120 ±41 seconds.

Arterial Blood Gas Monitoring
Changes in Pa02 are shown in Figure 1. The Pa02 was not affected by sedation but had decreased significantly by the end of the procedure, with a mean decrease of 26 percent from the baseline value (p<0.01). There was a mild but significant diminution of Pa02 that persisted for up to two hours after the investigation. In 35 patients the Pa02 fell by more than 30 percent. Such an event was more frequent in patients with ARDS (p<0.02). For this subgroup of patients, the mean value at the end of the procedure was 63 ±23 mm Hg (mean±SD) vs 175 ±85 mm Hg for the 93 others (p<0.001). There is always a great pharmacy waiting for you to visit and purchase the amount of medicine you need, be that Cheap Diskus Advair or any other one. You can see that all for yourself once you visit, enjoying most advantageous deals ever.

Table 1—Characteristics of 107 Patients 

Characteristic

Mean*

2 SEM

Median

Range

Age, yr

61

3

64

20-88

Sex ratio (M/F)

68/39

History of chronic pulmonary

34

disease, percent

Presence of underlying cardiac

41

disease, percent

Presence of ARDS, percent

13

APACHE score

16.2

1.5

14

5-53

Glasgow^ coma score

12

0.8

14

3-15

Treatment with inotropic

28

agents, percent

Presence of hvdroelectrolytic

30

disturbances, percent

Radiologic score

5.3

0.4

5

2-10

Use of PEEP, percent

23

Minute ventilation, L/mint

10.4

0.5

10

5-19

Peak inspiratory airway

29.7

1.9

30

14-58

pressure, cm H2Ot

Dynamic compliance,

24.6

1.6

22

11.7-50

ml/cm H2Ot

*For quantitative variables. tMeasured at control time.
Figure_1

Figure 1. Sequential measurements of Pa02 (mean ±2 SEM) in ventilated patients undergoing flexible fil>eroptie bronchoscopy; FIo2 was adjusted to 0.8 at 20 minutes before endoscopy and was maintained unchanged during study. T1, Control time; T2, five minutes after IV premedication; T„ at end of procedure, with fiberoptic bronchoscope still in place; T1, 15 minutes after removing endoscope; and T5, two hours after examination. Asterisk indicates significant differences vs any other time (p<0.01).

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