摘要:

Our findings confirm that acute pulmonary edema, when caused by left ventricular failure, represents a form of acute perfusion failure (shock) with metabolic acidemia, lactacidemia, and a reduction in forward blood flow. It is associated with a marked increase in peripheral resistance and an increase in venous capacitance. Most importantly, acute pulmonary edema is associated with a reduction in the intravascular blood volume.Acute pulmonary edema is not fundamentally different from other types of shock in which the shock state is initiated by one primary defect, and during the course of its progression, other primary mechanisms are called into action. In the instance of acute cardiogenic edema, the primary defect is cardiac pump failure and the secondary defects include hypovolemia and distributive defects associated with arterial vasoconstriction and expanded venous capacitance.Furosemide reverses acute pulmonary edema by increasing rather than decreasing intravascular blood volume with consequent improvement in the distributive and hypovolemic defects. Under extreme conditions, the volume defect in acute pulmonary edema may be so great that the patient presents with primary hypovolemia. The utilization of volume repletion is warranted under these circumstances.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A 4 F thermodilution catheter for measuring cardiac output was evaluated for accuracy and linearity in the laboratory and by comparison with the dye dilution method in infants and children following cardiac surgery. When 2 ml of 0°C injectate were used, the correlation of computer determined flows to calibrated pump flows, over a range encountered clinically, wasr= 0.998. The means of triplicate determinations by both the thermal and dye methods were compared in 8 of 25 patients and the comparison found to be favorable (r= 0.976). The complications of thermodilution catheter placement are described and related to the need for post-surgical chest x-ray and thermodilution recordings.The simplicity of the thermodilution technique and other advantages over the dye method in children, such as repeatability, and ease of calibration are discussed in relation to the increased flexibility in management which accrues.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

To quantitate the effect of changes in end-expiratory pressure (EEP) upon PaO2in infants with the respiratory distress syndrome, arterial blood gas (ABG) data was reviewed in 28 neonates. A total of 94 ABG specimen pairs were analyzed (specimen I taken before EEP adjustment; specimen II taken after EEP change). An overall change in PaO2of 15 torr was noted per cm H2O change in EEP. Patients in whom the level of EEP was low (0–3 cm H2O) at the time of Sample I had a greater change in PaO2(p< 0.01) than infants whose Sample I ABG was taken at mid-range of EEP (4–6 cm H2O) or at high ranges (7–12 cm H2O). At the high ranges of EEP a minimal and variable PaO2response was observed. The PaO2response was not statistically different between neonates on controlled ventilation and those breathing spontaneously. Survivors had a greater PaO2response than did nonsurvivors, but because of the variables affecting respiratory distress syndrome (RDS) patients, it could not be determined if this PaO2response had a prognostic value. From this data, the clinician is provided with a guide to the expected PaO2response when a change in EEP is made.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Five patients suffering from progressive Reye's syndrome were aggressively treated in our ICU. Our protocol consisted of endotracheal intubation, curarization, mechanical ventilation, hypothermia to 31°C, and fluid restriction. Intracranial pressure (ICP) was monitored and remained below 10–20 torr in all patients except one in whom ICP rose only once (for a few minutes) to 27 torr. Pulmonary artery wedge pressure was monitored in 4 patients and was maintained at 4–5 torr. Duration of active intervention as outlined above was 3–4 days. All 5 patients started with clinical stage IV and EEG grade IV or worse. Four patients had complete recovery and one died. In this group of patients, high ICP wasnota feature of the disease. We recommend that use of mannitol for active dehydration be reserved for cases with proven rise in ICP, in which case hemodynamics should be carefully monitored.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

Plasma colloid osmotic pressure was measured each day in 84 intensive care unit patients. Probit analysis demonstrated a direct relationship between colloid osmotic pressure (COP) and survival. The COP associated with a 50% survival rate was 15.0 torr. COP was higher in survivors than in nonsurvivors without respiratory failure and in patients who recovered from respiratory failure. We conclude that lowered COP is associated with an elevated mortality rate. However, the relationship to death is not explained by the relationship to respiratory failure.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

The complication rate for all patients receiving total parenteral nutrition (TPN) over a 4-year period of time in a small community hospital has been continuously reviewed. Audit of the complication rate of the initial 15 patients receiving TPN revealed a 12.5% sepsis rate. After instituting rigid protocols concerning catheter insertion and care, a nursing care plan, and metabolic flow sheet, we found that the catheter sepsis rate decreased to 5.1% (P< 0.05) in the subsequent group of 31 patients. However, metabolic complications related to TPN were not significantly different in the two groups. We conclude that community hospitals without a nutritional team can achieve acceptable complication rates for patients receiving TPN if the staff is committed to continuous critical analysis of complications. Transfer of depleted patients to institutions with demonstrated expertise in this area is recommended if such an analysis shows unacceptable complication rates.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

A detailed report on the activities of a major Australasian ICU is presented. An adequate team of specially trained medical and nursing staff is required to function efficiently. Despite a linear increase in admissions and a broadening scope of references, mortality has remained constant. Practice of Intensive Care Medicine must not be confined solely to special units. Involvement in other hospital areas is described.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID

摘要:

One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.

ISSN:0090-3493    

出版商:OVID    

年代:1977

数据来源: OVID