Bedside Clinical Evaluation Research Articles

Pulmonary Artery Catheters: An Update

Pulmonary artery (PA) catheters are widely used in the care of the critically ill. Numerous catheter designs are available, and the list of indications for their use is con stantly expanding. Extensive physiological data are sup plied by catheters. Right atrial, right ventricular, PA, and PA wedge pressure waveforms, as well as cardiac output and several derived parameters (e.g., systemic vascular resistance, pulmonary vascular resistance) are easily measured. Clinical application of these data may aid in diagnosis and management of acutely ill patients. Physi cians using catheters need to be aware of the numerous complications associated with their use. Scrupulous at tention to insertion and maintenance techniques will minimize the incidence of many of these complications. The undefined risk/benefit ratio of PA catheterization has caused controversy among physicians. Prospective studies to define better the risks versus benefits of PA catheters are currently being planned. Physicians using PA catheters should recognize that the catheters have no direct therapeutic benefit and that PA catheterization should neither replace bedside clinical evaluation nor delay treatment of the patient.

Protocol for the Use of Videofluoroscopy in Pediatric Swallowing Dysfunction

A clinical and research protocol was developed to compare the sensitivity and clinical value of videofluoroscopy with the traditional bedside clinical evaluation in the evaluation of children's swallowing dysfunction. The bedside and videofluoroscopic evaluations of 33 children were reviewed retrospectively. Our findings indicated that recommendations for feeding changed for 14 of the children as a result of the information gained from videofluoroscopic evaluation. The results suggest that videofluoroscopy provides therapists with more objective evidence than a bedside evaluation for determining the etiology of swallowing dysfunction and directing the management or treatment of this dysfunction.

A graphic approach to assessing interrelationships among minute ventilation, arterial carbon dioxide tension, and ratio of physiologic dead space to tidal volume in patients on respirators.

A graphic analysis of the relationships among minute ventilation, arterial PCO2, and the ratio of physiologic dead space to tidal volume is presented for the bedside clinical evaluation of patients receiving continuous respiratory support. With simultaneous measurement of minute ventilation and arterial PCO2, the graph can be used to determine the patient's ratio of dead space to tidal volume. This information can subsequently be used (1) for respirator adjustments to obtain the desired arterial PCO2; (2) to assess the severity of ventilation/perfusion unevenness; and (3) to follow the patient's response to respiratory therapy. It provides the clinician with a conceptual tool with which he can assess the status of a patient's gas exchange and more accurately evaluate and plan his course of treatment.