摘要:

Twenty-six near-drowning children were assessed for neurologic damage with the Glasgow Coma Score, and for spontaneous respirations after CPR. All children had a Glasgow Coma Score of 3 or 4; after resuscitation, 13 children had spontaneous respiration and 13 were apneic. The 13 children with spontaneous respiration suffered little or no residual neurologic impairment. Those children with apnea had severe neurologic impairment or died despite treatment. It appears that the present of spontaneous respirations correlated with surviving a near-drowning episode with minimal or no neurologic deficit and may be of benefit as a prognostic indicator.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Variability in technique and reporting time may limit radiographic quantitation of extravascular lung water by portable chest x-ray in critically ill patients. Using double indicator dilution technique and a commercially available lung water computer, we measured extravascular thermal volume (ETVL) in 14 patients with x-ray evidence of pulmonary edema and compared these results to x-ray quantitation of pulmonary edema. The diagnosis of pulmonary edema by interpretation of initial x-rays in each patient's series was 64% accurate as 5 of 14 patients had normal ETVL. Estimation of the magnitude of change in ETVLby radiologic interpretation was 42% accurate. No correlation was found between venous admixture &OV0422;sp/&OV0422;t, pulmonary capillary wedge pressure (WP) or ETVLvalues. Measurement of ETVLmay aid in the care of critically ill patients with suspected pulmonary edema.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A comparison was made of automated versus manual measurement of pulmonary artery (PA) and wedge (WP) pressures. The manual pressure measurements were taken at end-expiration whereas the automated measurements were taken using existing monitor and computer algorithms. A total of 40 critical care patients were divided into groups according to the ventilatory mode used (spontaneous, intermittent mandatory ventilation [IMV], or assist/control). In patients who were breathing spontaneously, the automated method underestimated mean PA pressure (MPAP) (p<0.01), WP (p<0.001), and PA diastolic (p<0.001) pressure but not PA systolic pressure. In patients on IMV, the automated method underestimated MPAP (p<0.05), WP (p<0.001), and PA diastolic (p<0.001) pressure and overestimated PA systolic pressure (p<0.05). In patients on assist/control, the automated method overestimated WP (p<0.001) and PA systolic (p<0.005) pressure, underestimated PA diastolic (p<0.001) pressure and did not affect MPAP. The error was not affected by respiratory rate, thoracic compliance, or level of PEEP.The errors in automated pressure measurements believed to be clinically important varied with the ventilatory mode used. Patients breathing spontaneously had the largest measurement error, with 42% of these patients having a clinically important error in WP and 99% having a clinically important error in PA diastolic pressure. Patients on assist/control had the fewest errors in automated pressure measurements. In all ventilatory modes used, automated measurement of PA diastolic pressure had the largest amount of error.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Two experiments were performed in 35 mongrel dogs, weighing 18–21 kg, to define hemodynamic and respiratory consequences of different mechanical conditions using high frequency ventilation.In the 1st experiment, 6 dogs were used as controls; respiratory failure was induced in 9 with oleic acid iv and HCI intratracheally. The dogs were anesthetized, paralyzed, and ventilated on either volume-cycled ventilation (VCV) with a minute ventilation of 300 ml/kg, or high frequency jet ventilation (HFJV) with a minute ventilation of 600 ml/kg. Respiratory rate (100 and 150 breath/min), injector cannula diameter (1.06 and 1.62 mm) and PEEP (0 and 15 cm H2O) were the independent variables on HFJV. PEEP was 0 and 15 cm H2O on VCV. Ten experimental conditions were alternated at random in each dog. Hemodynamic and respiratory variables were measured.In the 2nd experiment, 10 dogs served as controls; in the other 10, respiratory failure was induced. PEEP was 10 cm H2O and Fio20.50 in all conditions; respiratory rate was 15 breath/min on VCV and 100 breath/min on HFJV. Injector cannula diameter was 1.62 mm. Minute ventilation was 200, 300, and 400 ml/kg on VCV; 600, 900, and 1200 ml/kg on HFJV. Inspiratory time was 20, 30, and 40% on HFJV. Twelve different experimental conditions were alternated in random order.The first experiment indicated that a minute ventilation of 600 ml/kg cannot maintain a normal alveolar ventilation in most conditions tested. Ventilation and oxygenation deteriorated with higher respiratory rate and injector cannula of smaller diameter. Ventilation deteriorated with higher PEEP. In the 2nd experiment, oxygenation and ventilation were within normal limits in most experimental conditions. The end-expiratory pressure generated by HFJV, albeit small (3–5 mm Hg), impaired cardiac function in normal dogs. Otherwise, there was no significant difference in hemodynamic function between the 2 types of ventilation. The major differences between HFJV and VCV were the tidal volume required to maintain a normal alveolar ventilation, which was half as large on HFJV than on VCV, and the peak inspiratory pressure, which was considerably lower on HFJV. The best physiologic results were obtained on HFJV with a respiratory rate of 100 breath/min, an injector cannula diameter of 1.62 mm, and a tidal volume of 9 ml/kg. This investigation indicates that HFJV is a safe and predictable method of mechanical ventilation in animals with normal and abnormal pulmonary physiology.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To determine the appropriateness and rate of complications from central venous catheterization (CVC) in the emergency department of a university teaching hospital, criteria for justifiability were established and all such catheterizations during a 1-yr period were reviewed. Of 61 catheterizations in 57 patients, 41% could not be justified according to the criteria established. Eight (14%) patients had serious complications from catheter placement. This complication rate is higher than that in any previously published study, but no other study has examined only emergent catheter placement. These findings underline the importance of adhering to a limited set of indications for CVC in emergency departments.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

In a prospective study comprising 50 patients, we evaluated the hemodynamic, pulmonary, renal and coagulation changes after resuscitation with 2 colloidal fluids, 6% hydroxyethyl starch (HES) and 5% albumin (ALB). Twenty-five patients studied in each group were well matched for age, clinical presentation, presence of shock and type of surgical proceures. A standard fluid challenge with 500 ml of either solution significantly (p<0.01) increased pulmonary artery wedge pressure (WP), mean arterial pressure (MAP) and left ventricular stroke work index (LVSWI) and decreased systemic vascular resistance index (SVRI). Increases in LVSWI of 43% to 68% over baseline in HES patients compared favorably to 15–22% increases in ALB patients.The cardiopulmonary variables at 12 and 24 h were comparable in both groups. Improvement in cardiac function was also reflected by better tissue perfusion as judged by reduction in arterial lactate from 2.9 to 1.5 mM/L (ALB) and 2.6 to 1.4 mM/L (HES). Increased O2delivery and reduced O2extraction without significant deterioration of Pao2or alveolar-arterial O2gradient were observed with stabilization of circulation. Clinical bleeding due to colloid resuscitation was not documented and renal function was not affected significantly by either fluid. It seems that HES may offer a cost-effective alternative to ALB for patients requiring colloid resuscitation.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Fifty consecutive patients with severe chest trauma were studied prospectively to evaluate the frequency of significant cardiac injury and to determine what diagnostic studies were useful. Forty-nine of 50 patients had elevated cardiac enzymes and 26 of 50 had abnormal ECGs on admission. No patient had complications associated with myocardial infarction, including 15 who underwent general anesthesia. We found persistent (greater than 48 h) ECG changes in only 3, 2 of these 3 also had markedly elevated MB fraction of CPK. Significant pericarditis occurred in 5 patients, 2 of whom never had ECG abnormalities.We conclude that minor cardiac injury is common in severe chest trauma, but only rarely causes myocardial contusion. Myocardial isoenzymes may be useful in making that important distinction. Clinically significant traumatic pericarditis may occur in the absence of ECG changes and must be considered in every patient with chest injury and unstable hemodynamics.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Twenty-four pediatric patients undergoing corrective posterior spinal fusion surgery for idiopathic scoliosis were studied to determine the frequency with which the syndrome of inappropriate antidiuretic hormone secretion (SIADH) developed. We measured arterial blood gases, serum and urine electrolytes and osmolalities, CVP, and urine output during and after surgery. The 20 patients receiving hypotonic iv salt solution in the immediate postoperative period experienced a significant drop in serum sodium values (6.2 ± 2.9 mEq/L) and 5 (25%) developed SIADH as diagnosed by routine laboratory procedures. Four patients were treated with iv isotonic salt solution. No patient developed hyponatremia (serum Na+<130 mEq/L) and the decrease in serum sodium (3.0 ± 0.8 mEq/L) was not statistically significant. We conclude that SIADH occurs commonly in patients undergoing corrective vertebral surgery and that vigilant attention must be paid to their fluid and electrolyte management in the postoperative period.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Neonatal heart rate (HR) and arterial blood pressure (BP) were recorded continuously for the 1st hour of life in term newborn infants of normotensive (control group) and pre-eclamptic (study group) primiparous mothers. Infants were matched for gestational age, birth weight, method of delivery, and Apgar scores. In infants of pre-eclamptic mothers, the HR was significantly lower for the 1st 50 min of life, and their mean arterial blood pressure (MAP) was significantly higher during the 1st 20 min of life.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID