摘要:

Fifty-two Broviac catheters were inserted in 40 preterm and eight term infants for 1733 days of catheter use. Thirty-six (69%) catheters were associated with complications of infection and/or thrombosis, a complication rate of 1/48 catheter days. The patients who developed complications were of a significantly lower gestational age and had a lower mean birth weight when compared with those who developed no complications. The incidence of catheter-related sepsis was 69% in the very low birth weight infants and only 20% in the infants with birth weights over 1500 g. Eighteen of the 26 catheter-associated infections were treated with antibiotics without catheter removal. Successful resolution of the infections with retention of the catheter occurred in 14 of the 18 episodes. Infections withStaphylococcus aureusconstituted three of four treatment failures. Urokinase infusion was successful in causing thrombolysis in eight of the nine cases. Broviac catheters in neonates, and especially in preterm infants under 1500 g, are associated with a high incidence of complications. Our experience indicates that some complications can be selectively managed without sacrificing the venous access.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

A hygroscopic condenser humidifier was developed for neonates on mechanical ventilation and was evaluated by laboratory tests and clinically. Humidification provided by the unit was measured in the 10− to 50-ml tidal-volume range at ambient temperatures of 24°C and 38°C. The effect of a leaking patient connection on device performance was investigated. Leakage rates were measured routinely in a neonatal ICU and surgery to determine the clinical significance.In the entire tidal volume and temperature range, the unit provided an inspiratory water content in excess of 30 g/m3when the leak fraction (volume leaked/volume delivered at Y-piece) was less than 15%. This was found in three out of four cases. In about one out of ten cases, the leak exceeded 30%, which invariably led to corrective action, such as repositioning or changing the endotracheal tube. However, even at a 30% leak, a water content of about 26 g/m3was still available for humidifying the inspired gas, which corresponds to normal physiologic conditions found in the trachea for nasal breathing of room air.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The American Heart Association (AHA) recommends that those whose daily work requires knowledge and skills in advanced cardiac life support (ACLS) not only be trained in ACLS, but also be given a refresher training at least every 2 yr. However, AMA offers no recommended course for retraining; no systematic studies of retraining have been conducted on which to base these recommendations. In this paper we review and present our recommendation for a standardized approach to refresher training. Using the goals and objectives of the ACLS training program as evaluation criteria, we tested with the Mega Code a sample population who had previously been trained in ACLS. The results revealed deficiencies in ACLS knowledge and skills in the areas of assessment, defibrillation, drug therapy, and determining the cause of an abnormal blood gas value. We combined this information with our knowledge of other deficiencies identified during actual resuscitation attempts and other basic life-support and ACLS teaching experiences. We then designed a refresher course which was consistent with the overall goals and objectives of the ACLS training program, but which placed emphasis on the deficiencies identified in the pretesting. We taught our newly designed refresher course in three sessions, which included basic life support, endotracheal intubation, arrhythmia recognition and therapeutic modalities, defibrillation, and Mega Code practice. In a fourth session, using Mega Code testing, we evaluated knowledge and skill learning immediately after training. We similarly tested retention 2 to 4 months later. Performance immediately after refresher training showed improvement in all areas where performance had been weak. Two to four months later, performance in assessment, defibrillation, and drug therapy was maintained to some degree. However, the ability to determine the cause of an abnormal blood gas value remained weak, suggesting a need to examine how those skills are taught.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Oliguria in association with elevated infra-abdominal pressure developed in a patient with an ovarian mass. Operative decompression of the abdomen reversed the oliguric state. Clinically, laparotomy may be indicated in the presence of decreasing urinary output and elevated intra-abdominal pressure.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID