摘要:

P50, 2,3-diphosphoglycerate (DPG), inorganic phosphorus (Pi), adenosine triphosphate (ATP), and blood gases were measured daily in 23 patients with burn injuries, until their death or discharge from the ICU. At the time of admission, P50values were high. In nonsurvivors, P50started to decline 1 week after the injury. Corrected P50values to pH 7.4 were well correlated with DPG values. In survivors, P50tended to correlate with Pi values, but in nonsurvivors at the septic or terminal stage, the values of P50did not correlate with Pi or ATP. Low P50predicted the poor outcome of severely burned patients. At the convalescent stage of major burn injury, P50and DPG were higher than normal and often remained elevated for weeks.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Elective cricothyroidotomy was carried out on 61 adult patients in the ICU between June 1977 and October 1980. This procedure replaced elective tracheotomy in those patients who were judged to require respirator treatment for a period longer than 72 h. Twenty-six of the patients were examined by the ENT department. Of these, 19 were bronchoscoped more than 3 months after the cricothyroidotomy. Autopsies were carried out on 25 of the 30 patients who died. Histology of the larynx was available in 20 of the cases; in eight of these, a slight inflammation of the perichondrium was found and in two cases, the cartilage of the larynx was more seriously affected. Complications were few and mild. No damage to the vocal cords due to cricothyroidotomy was detected, and there have been no cases of stenosis in the larynx or trachea. Contraindications to cricothyroidotomy are endotracheal intubation for a period longer than 72 h, respiratory difficulties after previous endotracheal intubation, and acute infections of the larynx. Cricothyroidotomy is faster and much easier than tracheotomy. The authors believe that every anesthetist and every doctor who works in intensive care should be able to carry out this procedure.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The authors evaluated prospectively an index for outcome prediction previously developed retrospectively from the cardiorespiratory data of a series of 113 critically ill postoperative general surgical patients. A predictive score was generated by nonparametric multivariate analysis of the observed value for each cardiorespiratory variable and the frequency distributions of survivors' and nonsurvivors' values of that variable at each stage of postoperative shock. An overall global predictive index was then generated from the sum of the weighted predictive scores in each variable. This predictive index was tested prospectively in a new series of 156 operations and was found to be 94% accurate for the values of the last available data set, suggesting that the method satisfactorily predicts outcome. This index may be used as an objective measure of the severity of illness; i.e., it may be used to track the clinical course of postoperative general surgical patients during periods of critical illness. It was concluded that the predictive index aids in evaluation of monitored cardiorespiratory variables, improves interpretation of physiologic alterations, and facilitates clinical decision-making of critically ill patients at the bedside.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The hypothesis was tested that the median values of survivors of h'fe-threatening postoperative conditions, rather than the norms of unstressed healthy volunteers, are the appropriate therapeutic goals for critically ill postoperative patients. The authors studied prospectively a series of 100 consecutive critically ill postoperative patients; normal values were used as the therapeutic goals of the control patients, while the median values of survivors were used as the goals of therapy for the protocol group. The age, sex, primary illness, surgical operation, lowest mean arterial pressure (MAP), time in hypotension incidence of severe hypotension (MAP < 50 mm Hg), and presence of associated severe medical illnesses (defined by predetermined criteria) were comparable in the control and protocol groups; i.e., clinical conditions of the protocol group were at least as severe as those of the control group. The mortality was significantly less in the protocol group (13%) than in the control group (48%); the number of life-threatening complications were also greater in the control group. These data suggest that the cardiorespiratory pattern of survivors are the appropriate goals of therapy for critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Modern intensive care often requires multiple intravascular catheters, and sites of access may be limited. Therefore, a technique for insertion of two vascular catheters via a single skin puncture has been developed. No increased incidence of bleeding, sepsis, or other complications has been observed, the hazards of multiple procedures are avoided, and alternative sites for vascular access are preserved.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Former trainees in Critical Care Medicine (CCM) were polled regarding the reasons which have dissuaded intensivists from continuing practice in this field. Among the reasons cited, the most common were poor reimbursement for services rendered and the constant rivalry among practitioners in various fields for responsibilities in caring for the critically ill. A greater portion of anesthesiologists have discontinued practice in CCM than internists. Among those trained in CCM fellowship programs who are still practicing CCM, internists are most numerous.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID