ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectivesTo assess the effects of low-dose dopamine on norepinephrine-induced renal and systemic vasoconstriction in normotensive healthy subjects.DesignOn separate days, either a low-dose dopamine (4 [micro sign]g/kg/min) or a placebo (5% glucose) infusion was added in a single, blinded, randomized order to incremental norepinephrine infusions of 40, 80, and 150 ng/kg/min over a 60-min period each.SettingOutpatient clinic of a university-affillated hospital.SubjectsNormotensive healthy volunteers.InterventionsInfusions of norepinephrine and dopamine.Measurements and Main ResultsBlood pressure and heart rate were measured with a semiautomated device, and glomerular filtration rate and effective renal plasma flow were determined with constant infusions of125I-iothalamate and131I-hippurate, respectively. Norepinephrine alone progressively increased mean arterial pressure to pressor levels, whereas this effect was attenuated by the addition of dopamine (p < .05 vs. norepinephrine alone). Glomerular filtration rate increased during lower norepinephrine doses and did not decrease at the highest norepinephrine dose. Addition of dopamine further increased glomerular filtration rate. Effective renal plasma flow decreased with each norepinephrine alone infusion step, but this decrease was completely prevented by concomitant dopamine infusion (p < .01 vs. norepinephrine). Sodium excretion tended to decrease with norepinephrine, but increased two- to three-fold after addition of dopamine (p < .01 vs. norepinephrine alone).ConclusionsIn healthy man, norepinephrine causes a large decrease in renal plasma flow but not in glomerular filtration rate. Concomitant dopamine administration prevents this decrease in renal plasma flow, increases sodium excretion, and also attenuates the norepinephrine-induced systemic blood pressure increase. These findings warrant further clinical evaluation of the effect of concomitant low-dose dopamine and norepinephrine administration in critically ill patients. (Crit Care Med 1998; 26:260-265)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo measure the ability to meet family needs in an intensive care unit (ICU).DesignDescriptive survey.SettingUniversity hospital ICU.SubjectsNinety-nine next of kin respondents and 16 secondary family respondents were recruited.InterventionsA modified Society of Critical Care Medicine Family Needs Assessment instrument was used.Measurements and Main ResultsDemographic variables included patient age, gender, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission, Therapeutic Intervention Scoring System (TISS) score on the date of interview, cumulative TISS of the ICU on the day of interview, number of patients in the ICU at time of interview, nurse/patient ratio for the patient, average nurse/patient ratio of the entire unit, day of the week of the interview, timing of the interview, number of ICU attending physicians who cared for this patient (scheduled for a period of seven consecutive days), number of nurses who cared for the patient, if a nurse was assigned the same patient on two consecutive days worked, length of stay in the ICU, and length of hospital stay. Demographic information concerning the family member included gender, age, commuting time to the hospital, visiting time in the hospital per day, number in family group, relationship to the patient, ethnic background, and education level. The additive score of all questions in the needs assessment instrument was calculated and used as the dependent variable. The independent variables were demographic information concerning patients, ICU, and respondents. The model coefficient of determination (R2adj) was 0.20 with a p = .0079. Greater family dissatisfaction (i.e., higher score) was present if there were more than two ICU attendings per patient (p = .048), or if the same nurse was not assigned on two consecutive days (p = .044). Family satisfaction increased if the respondent was female (p = .006), if the patient had a higher APACHE II score (p = .007), and if the patient's relationship with the most significant family member was brother/sister (p = .012). The family needs instrument was reliable and demonstrated a high degree of concordance with a second respondent in the same family surveyed.ConclusionsCommunication by the same provider was important when measuring the ability of an ICU to meet family needs. Instrument scores and the ability to meet family needs differed depending on the gender and the relationship to the patient of the most significant family member. We speculate that this instrument may be a useful adjunct in assessing quality of critical care services provided. (Crit Care Med 1998; 26:266-271)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectivesSurgery involving cardiopulmonary bypass induces an inflammatory response due to the contact of blood with the extracorporeal circuit. In some patients, this inflammatory response leads to multiple organ failure and death. Inflammatory states may increase the production of nitric oxide, either by increasing the activity of constitutive enzyme systems or by inducing of inflammation-specific systems. We hypothesized that surgery involving cardiopulmonary bypass would increase the production of nitric oxide in association with the inflammatory response.DesignProspective, single center, observational study.SettingUniversity-affiliated, tertiary referral cardiothoracic center.PatientsEleven adult patients undergoing routine myocardial revascularization.InterventionsSurgery for myocardial revascularization.Measurements and Main ResultsObservations were made after induction of anesthesia, before bypass, after completion of the bypass, and on return to the recovery area. Parameters measured included hemodynamics, exhaled nitric oxide concentrations, plasma nitrate/nitrite concentration, plasma and bronchoalveolar lavage myeloperoxidase concentrations, and protein carbonyl conversion. All patients survived surgery. Oxygenation index fell significantly after bypass. Plasma myeloperoxidase increased significantly during the study period. Plasma carbonyl conversion also increased, although not significantly. Plasma nitrate/nitrite and airway nitric oxide concentrations did not change through the course of the study.ConclusionSurgery involving cardiopulmonary bypass induced a demonstrable inflammatory response, but this response was not associated with increased nitric oxide production. (Crit Care Med 1998; 26:272-278)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo determine whether the Acute Physiology and Chronic Health Evaluation (APACHE) II system for the measurement of severity of illness is able to provide an accurate risk of hospital death in patients with acetaminophen-induced acute liver failure or identify those patients needing transfer for possible hepatic transplantation.DesignData for admission (first 24 hrs) APACHE II scores and King's criteria for urgent transplantation were collected prospectively to compare the APACHE II system and the King's criteria for the prediction of death or need for transplantation.SettingA nine-bed specialist liver failure unit (LFU).PatientsOne hundred two consecutive patients admitted to the LFU with acetaminophen self-poisoning and a prolonged prothrombin time were studied.InterventionsNone.Measurements and Main Results15 was able to identify four more patients than the King's criteria on the first day of admission to the LFU.ConclusionsThe crude admission APACHE II score correlated well with mortality in patients with acetaminophen-induced acute liver failure. However, the calculated APACHE II risk of death, using the original drug overdose coefficient, was poorly calibrated. Since specialist liver scores are unfamiliar in the general intensive care setting, the use of an APACHE II score might earlier identify more patients at risk of needing a liver transplant, and hence, expedite appropriate transfer to a specialist liver unit. (Crit Care Med 1998; 26:279-284)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectivesIn patients with multiple trauma, actin released from damaged cells may cause severe circulatory disturbance due to thrombi formation. The aim of this study was to evaluate serum concentrations of the actin scavenger, Gc-globulin, in relation to the severity of injury and outcome.DesignProspective, longitudinal, observational study.SettingTrauma center at a university hospital.PatientsTwelve patients with multiple trauma, consecutively included, according to defined criteria.InterventionsNone.Measurements and Main ResultsSerum Gc-globulin concentrations were measured at the time of admission and daily thereafter for 1 wk or until death. In all patients, the Gc-globulin concentration was significantly low (p < .0001), and the proportion of Gc-globulin bound to actin was already increased compared with normal values (p < .0001) by the time of hospital arrival. There was an inverse correlation between the mean concentration of serum Gc-globulin in the first week after trauma and the Injury Severity Score (r = -0.72, p<.05). Surviving patients had a significantly (p<.05) higher concentration of serum Gc-globulin in the first week after trauma compared with nonsurvivors.ConclusionsSerum concentrations of Gc-globulin were significantly low in trauma patients. The reduction took place within 60 mins after injury. Because the normal half-life of Gc-globulin is almost 48 hrs, our observations suggest a marked consumption of Gc-globulin immediately after the trauma. This finding could be the first clinical evidence that Gc-globulin plays a role in the systemic inflammatory response syndrome after trauma. This result is supported by the finding that lack of Gc-globulin was related to nonsurvival and the severity of the trauma. (Crit Care Med 1998; 26:285-289)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

ObjectiveTo evaluate and compare the effect of tracheal gas insufflation using two gases with different physical properties, helium and oxygen, as an adjunct to conventional mechanical ventilation in patients with respiratory failure.DesignProspective, intervention study.SettingGeneral intensive care unit in a tertiary university medical center.PatientsSeven sedated and paralyzed patients with respiratory failure of various etiologies. All patients were ventilated in the volume-control mode (tidal volume 5 to 7 mL/kg). Inclusion criteria were PaCO2or=to35 cm H2or=to14 breaths/min.InterventionsAll patients were intubated with an endotracheal tube that had an additional lumen opening at its distal end, through which tracheal gas insufflation was administered. The tracheal gas insufflation was applied continuously throughout the respiratory cycle at three flow rates (2, 4, and 6 L/min) with two gases, oxygen and helium, while the ventilatory settings were maintained constant.Measurements and Main ResultsIn addition to airway pressures and arterial blood gases, the relative efficacy of tracheal gas insufflation with each gas was estimated using a "coefficient of efficiency" (which we defined as the change in PaCO2/peak inspiratory pressure) compared with baseline measurements.Tracheal gas insufflation with both gases decreased PaCO sub 2 significantly (p < .05) at all flow rates. This effect was accompanied by an increase in airway pressure with both gases (oxygen and helium). However, at flow rates of 6 L/min, tracheal gas insufflation with helium resulted in lower peak inspiratory pressure than with oxygen. Tracheal gas insufflation with helium was more effective (as estimated by the coefficient of efficiency) than with oxygen at all flow rates (p < .05).ConclusionIn volume-controlled, mechanically ventilated patients with respiratory failure, tracheal gas insufflation with helium might be suggested as an alternative to oxygen. (Crit Care Med 1998; 26:290-295)

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1998

数据来源: OVID