摘要:

Brain depression in a patient with severe multisystem disease can be a diagnostic challenge, particularly when the patient is maintained on artificial life-support systems.A case report is presented of a 13-year-old girl with severe pneumonia who was treated with prolonged cardiopulmonary bypass during which time she developed a clinical picture simulating brain death with marked depression of cerebral cortical activity on two successive EEGs. Following correction of some of her metabolic defects, the patient showed marked improvement of cortical function.Multisystem disease can be so severe as to produce a clinical picture of brain death. We wish to emphasize that brain hypofunction of depression is best evaluated by both clinical examination and the EEG, and that neither one alone is sufficent to conclude that cerebral death has occurred.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Nine variables were studied in 56 patients to analyze hemodynamic patterns of critically ill and shock patients. The variables were central venous pressure, mean arterial pressure, heart rate, cardiac index, left ventricular stroke work, stroke index; total peripheral resistance, arteriovenous oxygen difference, and oxy-gen consumption. We observed six patterns; three with low cardiac index (hypodynamic) and three with high cardiac index (hyperdynamic).Group IA: Low cardiac index with increased central venous pressure and arteriovenous oxygen differences associated with myocardial infarction, cardiac insufficiency, and postoperative cardiac surgery;Group IB: Low cardiac index with normal arteriove-nous oxygen difference associated with myocardial infarction or hypovolemia.Group IC: Low cardiac index and decreased arterio-venous oxygen difference in patients with hypodynamic septic shock.Group IID: High cardiac index and increased arte-riovenous oxygen difference in patients with sepsis and stable hemodynamic conditions.Groups IIE and IIF: Increased cardiac index and normal or increased arteriovenous oxygen difference in septic patients, who were hemodynamically unstable or in shock.These hemodynamic observations were found to be useful for understanding physiological compensations, for deciding on therapy, and in evaluating the effective-ness of therapy.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The Therapeutic Intervention Scoring System (TISS) has been introduced (Cullen DJ, Civetta JM, Briggs BA, et al: Therapeutic intervention scoring system: A method of quantitative comparison of patient care.Crit CareMed 2:57–60, 1974) at the Massachusetts General Hospital as a means of quantifying the medical and nursing care required by critically ill patients. The method has been instituted in the Intensive Care Unit of Memorial Cancer Center to evaluate its applicability to patients who develop life-threatening complications of their disease or its treatment. This is a preliminary report of the system's use in 55 consecutive patients who averaged 33.4 intervention points per day. This average compares closely with that of postcardiac surgery patients (31.8 points), the group that required the most care of all patients in the initial study.The results indicate the usefulness of this system in evaluating severity of illness, predicting survival, and assessing cost benefits. It has proven to be a simple and accurate method of assessment when applied to this patient population, but certain modifications seem warranted and have been suggested herein.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Of 45 patients observed in the ICU with severe acute hepatic insufficiency, 15 patients were in hepatic coma. All patients received combined treatment consisting of standard conservative methods (drug therapy) and surgical methods for temporary support of liver function (hemodialysis, exchange blood transfusion, pig liver perfusion). Intensive therapy which began during the early phase of hepatic coma enabled us to bring six patients out of the coma, four of whom completely recovered. These studies showed that of the diseases causing hepatic coma, the worst results were obtained with viral hepatitis. This may be explained both by the extensive liver damage and marked metabolic disturbances, which led to failure of other vital organs and systems. At present, the combined therapy contributes to a greater percentage of recovery of patients with hepatic failure and coma.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

A multidisciplinary intensive care unit has been developed in a community hospital by planning tech-niques which are still not common in the hospital development environment. The resulting Acute Care Center has special attributes, especially in ongoing professional educational and consultation support, in continuous physician staffing around the clock, in equipment, and in operational policies. The net result appears to be the provision of a higher standard of patient care, a lower mortality rate for the critically ill patient, and various cost benefits. The concepts and policies involved are being met with increasing acceptance in the local medical community.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

During the control period in this study, small premature infants, 1500 g in birth weight, had insensible water loss (IWL) of 2.28 g/kg/hr (equivalent to 54 ml/kg/day), which is considerably higher than in full term infants. Under phototherapy, there was a significant increase in IWL (3.14 g/kg/hr) associated with increase of skin and rectal temperature. The heart rate and respiratory rates were comparable.Full term infants in stress situations such as photo-therapy can compensate for water losses by increasing oral intake. In small premature infants, reliance must be placed upon increased amounts of parenteral fluids when under phototherapy.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID