摘要:

ObjectivesThe purpose of this study is to compare normal saline with Isolyte S as the wash solutions during high-volume cell saver autologous blood transfusion. Normal saline, the standard wash solution in cell saver autologous blood transfusion, is associated with acid-base and electrolyte derangements. Isolyte S is a physiologic, balanced multielectrolyte crystalloid solution that approximates the electrolyte content of plasma.DesignOpen-label, prospective, randomized study.SettingResearch laboratory in a Department of Veterans Affalrs medical center.SubjectsFourteen mongrel dogs, weighing 22 to 23 kg each.InterventionsFourteen mongrel dogs were prospectively randomized to receive normal saline (n = 7) or Isolyte S (n = 7). Animals were anesthetized, received heparin for anticoagulation, and underwent 18 cycles of cell saver autotransfusion. In each cycle, 125 mL of blood was arterially withdrawn, and washed with either normal saline (mEq/L) (sodium 154, chloride 154) or Isolyte S (mEq/L) (sodium 141, potassium 5, magnesium 3, chloride 98, phosphate 1, acetate 28, and gluconate 23). The washed blood was retransfused.Measurements and Main ResultsAcid-base and electrolyte analyses were performed throughout the study on the systemic blood of each group and compared. By the end of the study, the Isolyte S group had a normal pH and an increased blcarbonate concentration (mEq/L: normal values 24 to 32; normal saline 9.0 +/- 1.9 vs. Isolyte S 13.2 +/- 3.0 [p < .01]) and an increased magnesium concentration (mg/dL: normal values 1.6 to 2.4; normal saline 1.6 +/- 0.2 vs. Isolyte S 2.2 +/- 0.2 [p < .0001]). Additionally, the Isolyte S group had a lower chloride concentration (mEq/L: normal values 95 to 110; normal saline 130 +/- 9 vs. Isolyte S 117 +/- 7 [p < .02]) and a lower potassium concentration (mEq/L: normal values 3.5 to 5.0; normal saline 4.4 +/- 0.5 vs. Isolyte S 3.7 +/- 0.3 [p < .01]). There were no significant differences between normal saline or Isolyte S in the values of PCO2, lactic acid, sodium, total and ionized calcium, inorganic phosphorus, total protein, albumin, hemoglobin, and hematocrit.ConclusionsFewer systemic acid-base and electrolyte derangements were observed when blood was washed with Isolyte S. Differences between the normal saline and Isolyte S groups are ascribed primarily to the constituents of the wash solution. We conclude that Isolyte S, a physiologic, balanced, multielectrolyte solution, should be considered as the wash solution in high-volume autologous cell saver blood processing and transfusion. (Crit Care Med 1997; 25:2031-2038)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveIn recent years, small high-performance batteries have become very popular. With this increasing miniaturization of batteries, clinicians have noted an increasing frequency rate of esophageal injury due to battery ingestion by infants. The sltuation is associated with severe injury to the esophagus due to the electrical current produced, particularly in the case of high-performance batteries producing high currents. The pathophysiologic features and complications of esophageal battery burns have not been thoroughly investigated. Our study intended to investigate the pathophysiologic features and complications of esophageal battery burn.DesignOpen, randomized, controlled study.SettingExperimental animal laboratory in a university hospital.SubjectsMale adult mixed-breed rabbits, 22 wks old and weighing 3 to 3.5 kg.InterventionsThe experimental rabbit model of esophageal injury due to battery ingestion described herein was designed to study not only the direct influence of contact with the battery but also damage to neighboring tissues and the biochemical and pathologic mechanisms of injury. We investigated the relationship between the direction of the inserted battery and the mechanism underlying these complications. Esophageal burn injury was created by placing a 3-V battery into the esophagus for 9 hrs.Measurements and Main ResultsThe cathode side of the esophagus became increasingly alkaline, while the anode side was acidic. Low-voltage battery burns are likely to be due to secondary chemical reactions caused by the electric current because of acid generated at the anode and alkall at the cathode using a micro pH meter. Injury was significantly more severe on the alkaline side when a battery was placed with its cathode directed toward the trachea. Alkaline complications affecting neighboring tissues were more severe than acid complications. These results indicate that as well as the esophageal mucosa itself being injured, deleterious effects are exerted on surrounding tissues, the severity of which vary depending on the orientation and duration of the battery being lodged in the esophagus.ConclusionsThe direction of the battery cathode, which produces alkali, is important in determining the severity of complications. Based on our investigation of the underlying mechanisms of these complications, we advocate the establishment of treatment guidelines for battery swallowing accidents. (Crit Care Med 1997; 25:2039-2044)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether inflammatory cytokine production by stimulated human alveolar macrophages is affected by perflubron exposure.DesignControlled laboratory investigation of alveolar macrophage function in vitro.SettingResearch laboratory.SubjectsCultured alveolar macrophages obtained by bronchoalveolar lavage from eleven normal volunteers.InterventionsEndotoxin-stimulated alveolar macrophages were treated with perflubron.Measurements and Main ResultsAlveolar macrophages were stimulated for 1 hr with lipopolysaccharide and then treated with perflubron for 23 hrs. Cell-free supernatants were collected and cytokines were assayed by enzyme-linked immunosorbent assay. Tumor necrosis factor-alpha, interleukin-1, and interleukin-6 were stimulated by lipopolysaccharide (endotoxin) and all of these cytokines were significantly (p < .05) inhibited by perflubron. Cell viability was not affected by perflubron. Basal cytokine concentrations from unstimulated alveolar macrophages were not altered by perflubron.ConclusionsExposure of stimulated human alveolar macrophages to perflubron in vitro decreases cytokine production. This observation suggests that perflubron may have anti-inflammatory activity. (Crit Care Med 1997; 25:2045-2047)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectivesThe use of multimodality monitoring of patients in the intensive care unit (ICU) and the subsequent collection and analysis of such data are increasing. The aim of this work was to assess the importance of recording complementary textual data referring to patient care maneuvers, calibrations, and other incidents, in addition to the raw numerical values.DesignA retrospective analysis of multimodality monitoring data, which included comments entered concurrently at the bedside, collected from head-injured patients admitted to an ICU.PatientsOne hundred forty-seven patients with a postresuscitation Glasgow Coma Scale score of <or=to12 were monitored for a total of nearly 1 million minutes on up to eight commonly used channels.Measurements and Main ResultsApproximately 13,000 comments were added to the raw data at the time of collection. The data were subsequently validated using these comments as indicators of artifactual values. The comments were classified into a surprisingly small number of important categories, with the most frequent referring to monitor calibrations and regular ICU care maneuvers. The difference between validated and unvalidated data on the quantity of secondary insult observed was in some cases nearly 50%.ConclusionsThis work demonstrates that such textual information should be recorded concurrently with the raw monitoring values to ensure proper interpretation of the data in any retrospective analysis. Furthermore, it also suggests that a small number of prespecified categories could be used in the on-line validation of such data. (Crit Care Med 1997; 25:2048-2050)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveThe aim of the study was to test the reliability and variation in the readings of two widely used pulse oximeters in preterm infants.DesignTwo different pulse oximeters and a transcutaneous Po2monitor were used to record the data continuously on a cotside computer database.PatientsSixteen preterm infants were studied in the Neonatal Unit, Simpson Memorial Maternity Pavilion, Edinburgh, UK.InterventionsNone.Measurements and Main ResultsApproximately one fifth of the time, the pulse oximeter readings could be established as artifactual. Study of the remaining four fifths of the data showed that, on average, the Nellcor pulse oximeter recorded saturation percentages 2.2% higher than the Ohmeda oximeter.ConclusionsWe recommend that all neonatal units adopt a policy of using different saturation alarm limits for these two instruments. We further recommend that other pulse oximeters be tested by a methodology similar to the one we present in this paper, before their use in monitoring oxygenation in preterm infants.(Crit Care Med 1997; 25:2051-2054)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine whether a clinical, nonradiographic criterion can be used to predict when the tip of a blindly placed feeding tube is in the small intestine.DesignProspective sample.SettingPediatric intensive care unit at a tertiary care children's hospital.PatientsCritically ill children requiring transpyloric feeding.InterventionsThe small bowel was intubated, using a blind, bedside transpyloric feeding tube placement protocol. The feeding tube was considered to be in the small bowel when <2 mL of a 10- mL aliquot of insufflated air could be aspirated from the feeding tube. This clinical criterion was confirmed with an abdominal radlograph.Measurements and Main ResultsPatient age ranged from 1 month to 19 yrs (median 6 months). Weight ranged from 2.2 to 60 kg (median 4.9). Median time to feeding tube placement was 10 mins (range 5 to 60). Eighty-nine percent of the patients were mechanically ventilated, while 28% of these patients were pharmacologically paralyzed.Seventy-five feeding tubes were inserted. There were no known complications. Ninety-nine (74/75) percent of the feeding tubes were positioned in the small bowel. The inability to aspirate insufflated air correctly predicted small bowel intubation with 99% certainty (Sequential Probability Ratio Test, p = .05 and power = .80). This test incorrectly predicted the position of only one feeding tube, the 26th, which was in the stomach.Of the 74 feeding tubes positioned in the small bowel, 13 feeding tubes were in the duodenum and 61 were in the jejunum.ConclusionsThe inability to aspirate insufflated air confirms the transpyloric position of a feeding tube. Other clinical criteria did not successfully predict small bowel intubation. Use of this single test may obviate confirmatory abdominal radiographs in carefully selected patients and may lead to more cost-effective and timely initiation of enteral feedings. (Crit Care Med 1997;25:2055-2059)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID