摘要:

Critical decreases in oxygen delivery (Do2) and mixed venous oxygen saturation (Svo2) are associated with anaerobic metabolism and, therefore, lactic acidosis. We studied 50 consecutive patients with sepsis and 50 consecutive patients with acute myocardial infarction (AMI) in whom the arterial blood lactate was > 1 mmol/ L in order to determine critical thresholds of Do2and Svo2. In both groups, critical values of Do2or Svo2associated with lactic acidosis could not be identified. The Do2ranged from 136 to 811 ml/min m2and Svo2ranged from 28% to 73% in the patients with sepsis. The Do2ranged from 115 to 434 ml/min m2and Svo2from 17% to 72% in patients with AMI. The absence of threshold values for Do2Svo2and probably reflects the influence of distributive flow abnormalities as well as differences in metabolic requirements in these critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In 15 critically ill patients requiring adrenergic support, right ventricular ejection fraction (RVEF) and right ventricular (RV) volumes were measured by the thermodilution technique receiving 5 μg/kg ± min of dopamine and after replacement by the same dose of dobutamine. Shift from dopamine to dobutamine resulted in significant increases in stroke index from 28.1 ± 3.6 to 31.0 ± 3.8 ml/m2(p<.01) and significant decreases in pulmonary artery balloon-occluded pressure from 15.1 ± 1.0 to 13.9 ± 1.2 mm Hg (p<.05) and right atrial pressure (RAP) from 14.0 ± 1.3 to 12.2 ± 1.1 mm Hg (p<.05). RVEF increased slightly but significantly from 21.5 ± 2.7% to 23.7 ± 2.9% (p<.01) so that RV end-diastolic volume (RVEDVI) was unchanged (140 ± 12 vs. 141 ± 12 ml, nonsignificant). RVEDVI/RAP ratio increased from 11.3 ± 1.0 to 12.9 ± 1.1 nil/mm Hg (p=.037).These results support the view that dobutamine has more favorable effects on RV function than dopamine in critically ill patients in the absence of profound hypotension and also indicates that higher filling pressures under dopamine administration can be related to changes in ventricular pressure/volume relationship.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Ten patients with severe septic shock were studied. After plasma volume expansion to an optimal pulmonary artery wedge pressure, above which there were no further increases in cardiac index, all patients remained hypotensive and oliguric. The arterial hypotension was unresponsive to increasing doses of dopamine and dobutamine alone and to a fixed combination of both. In all patients studied, infusion of norepinephrine alone reversed the hypotension and increased significantly the mean arterial pressure, systemic vascular resistance and left ventricular stroke work index (p<.005). There were only minor increases in heart rate. Oxygen trans-port indices measured in six patients demonstrated variable alterations in oxygen delivery and consumption.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The effect of the infusion of mixed amino acids with glucose and fat on metabolic rate (MR) in sepsis (S) and in nonseptic trauma (NS) was investigated. The results demonstrated that dietinduced thermogenesis (specific dynamic action) controlled in S and in NS 25% and 18% of the MR variability, respectively (r2=.25 and 18,p<.01 for both). Also, diet-induced thermogenesis represented a quantitatively relevant portion of the total MR. There was a larger thermogenic effect of amino acids in S with respect to NS (22.3 vs. 5.7 cal/ mg N,p<.01) with a concomitantly increased thermogenic effect of fat. The results suggest the importance of recognizing the thermogenic effect of administered nutrients as an important determinant of MR during calorimetric measurements. The finding of an enhanced thermogenic effect of amino acids and fat in S also implies the need for more complete investigations of the impact of these substrates in modifying oxidative and energy metabolism in S.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Patients with hepatic failure admitted to the medical ICU (MICU) generally have a poor prognosis. To determine if there were readily identifiable clinical factors associated with a high predictive value for outcome, we reviewed retrospectively the charts of 100 patients with serious liver disease admitted to the MICU. The overall mortality of the group was 64%. We found that Child's class, a need for mechanical ventilation, and an elevated serum creatinine had the greatest prognostic significance. Ninety-one percent of the patients receiving assisted ventilation, 89% of the patients in Child's class C, and 93% of the patients with creatinine values > 1.3 mg/dl died during their MICU admission. Furthermore, a multivariant regression analysis indicated that patients in Child's class C receiving mechanical ventilation who had an abnormal serum creatinine (>1.3 mg/dl) during the first 72 h in the MICU had only a 2% survival rate.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Daily cultures were obtained from the proximal tubing port on 108 indwelling urinary catheters in 100 pediatric ICU (PICU) patients aged 1 month to 17 yr to establish the risk of acquiring bacteriuria. Group 1 patients (58 catheters) were catheterized in the PICU and group 2 patients (50 catheters) were catheterized in the operating room. Group 1 patients had a significantly (p<.03) greater risk of bacteriuria than group 2 during the early days of surveillance, but the final cumulative risk in both groups was similar (27% in group 1 and 37% in group 2). Combined, the overall cumulative risk was 29.1%. The risk of acquiring a urinary tract infection was not related to sex or prior antibiotic use. There was a significantly greater risk (p<.025) in children under 1 yr of age.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

A prospective study of 100 autopsies was carried out. The clinical and pathologic diagnoses were made independently by intensivists and pathologists; at the end of the study, the differences were determined. There were seven Class I errors (which if detected before death, would probably have led to a change in management that might have resulted in cure or prolonged survival), six of these relating to the basic disease and one to the cause of death. Class II errors occurred in 15 patients, ten relating to the basic disease and five to the cause of death. In 61% of the patients, the major and minor diagnoses coincided. In 77% of the patients, the major diagnoses coincided. No relationship was found between the incidence of Class I and Class II errors and the length of the patients' stay in the ICU.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

PEEP can significantly reduce cardiac output. This reduction in cardiac output is frequently attributed to transmission of airway pressure to intrathoracic vascular structures. We designed an acute lung injury (ALI) model in swine (n = 7) characterized by low lung thorax compliance (CLT) and compared the fractional trans-mission of airway pressure to pleura (PPL) and pericardium (PPc) and hemodynamics to normal animals (n = 5) during controlled mechanical ventilation (CMV) and PEEP. Fractional transmission of PEEP to PPL and PPc was reduced significantly from 62 ± 8% and 54 ± 19 (sn)% to 34 ± 7% and 36 ± 9% in normal and ALI animals, respectively. End-inspiration tracheal pressure was significantly higher in the low compliant group; thus, cardiac output was equally depressed in both groups despite reduction in fractional airway pressure transmission in ALI animals, possibly because absolute inspiratory PPL and PPc were similar due to increased pressure required to inflate injured lungs. The results of this investigation do not support the presumption that low CLT blunts hemodynamic consequences of CMV and PEEP.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Previous CPR studies from our laboratory have shown that a standard iv dose of lidocaine (2 mg/kg) has a rapid antifibrillatory effect, while a standard dose of bretylium (5 mg/kg) produces a delayed but more pronounced effect. In order to determine the optimal doses, we investigated the antifibrillatory effects of a) high dose bretylium (10 mg/kg) and b) a combination of lidocaine (2 mg/kg) and bretylium (5 mg/kg) during CPR in two groups of anesthetized dogs. Ventricular fibrillation threshold (VFT) was determined using a train method and CPR was performed by a pneumatic device. During both a control and drug phase, the VFT was determined in each dog before CPR, and after each of three consecutive 3-min CPR periods. The combination of lidocaine and bretylium (11 dogs) caused a significant increase in VFT compared to the control phase after each of the 3-min CPR periods and maintained this effect for > 2 h. Bretylium 10 mg/kg (eight dogs) significantly elevated the VFT only after the third 3-min CPR period. We conclude that the combination of standard doses of lidocaine and bretylium produces a rapid and prolonged antifibrillatory effect and may be the optimal regimen in the CPR setting. High dose bretylium has a delayed onset of effect and appears to produce no greater effect than standard doses of the drug.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The hemodynamic, renal, and hematologic responses to fluid resuscitation with four different hydrating solutions (lactated Ringer's and hypertonic salt solutions, with and without albumin) administered in equal quantities were compared in an ovine burn model. Forty-five animals, including a sham group, were studied. The burn (40%, flame) was inflicted under anesthesia, but the animals were then studied while in the awakened state. Fluid resuscitation was begun one hour after the burn. While all animals survived the burn and disclosed reasonable hemodynamic stability throughout the experiment, those that received lactated Ringer's with albumin (LRA) restored their cardiac output to preburn values, by 24 h postinjury demonstrated higher serum albumin and colloid osmotic pressure levels, experienced no electrolyte or acid-base imbalances, and maintained serum osmolality within normal limits. In contrast to the other solutions, LRA did not induce edema in unburned tissues, and seemed optimal for burn resuscitation.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID