摘要:

Data at ICU admission and after 24 h in the ICU were collected on 755 patients, to derive multiple logistic regression models for predicting hospital mortality. The derived models contained relatively few and easily obtained variables. The weight associated with each variable was determined objectively. There were seven admission variables, none of which were treatment dependent, and seven 24-h variables reflecting treatments and patients' conditions in the ICU. Predicted outcomes using these two models were closely correlated with actual outcome. Theoretically, a predictive model would be useful to physicians for triage decisions as well as determining aggressiveness of care through discussions with families, determining utilization of ICU facilities, and objectively comparing different ICUs. This research represents an initial attempt to develop models that are not based on subjectively determined weights.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To develop a decision rule to aid in the diagnosis of myocardial infarction, we evaluated clinical and ECG data on 540 adults treated in an urban hospital emergency room for acute chest pain. Of 62 (11.5%) patients who had acute infarctions, 54 were admitted to intensive care (sensitivity 87%); 103 of 478 patients without infarctions were also admitted to intensive care (specificity 78%). Thirty-four percent of all patients admitted had infarctions. Multivariate analysis identified only four clinical variables which carried independent information predicting infarction: two from the ECG and two from the clinical history. A predictive model based on these four variables had significantly greater specificity (86% vs. 78%,p= .003) and accuracy of overall patient classification (88% vs. 79%,p= .013) but somewhat lower sensitivity (81% vs. 87%,p= .46) than physician judgments. However, a decision rule which would have admitted to intensive care those patients with a high probability of infarction who were not admitted by the emergency room physicians, would have increased the sensitivity for detecting infarction to 95% with no appreciable decrease in specificity or yield of infarctions among patients admitted to intensive care.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To understand better the incidence and meaning of hyperamylasemia in the intensive care setting, cellulose acetate membrane electrophoresis was used to measure the isoenzymes of serum amylase in 192 patients with a variety of critical illnesses. Seventy of these patients had elevated serum amylase levels, but none had clinical or biochemical evidence of acute pancreatitis or renal failure.Of the 70 patients who had hyperamylasemia, in only 18 (26%) was it due solely to an elevation of the pancreatic isoamylase fraction. The remaining 52 patients were hyperamylasemic due to elevations in the nonpancreatic isoamylase fraction or elevations in both pancreatic and nonpancreatic isoamylase fractions.These data indicate that hyperamylasemia in the absence of clinical pancreatic disease is common in the ICU and is frequently caused by nonpancreatic production of serum amylase. Caution is, therefore, advised in interpreting elevated serum amylase levels in critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To ascertain the value of the daily routine chest x-ray in the medical ICU, we determined prospectively the number of unsuspected abnormalities observed on 507 consecutive chest films and the consequent management changes in 94 ICU patients. Primary diagnoses were classified as pulmonary, hemodynamically unstable cardiac, uncomplicated cardiac, or miscellaneous. Admission films and those taken after procedures or a change in clinical status were excluded. Ventilator status and the tubes and catheters visible on the films were also noted. After clinical evaluation, management plans were made by ICU physicians and then the chest x-ray was examined and unsuspected abnormalities and resulting management changes were noted. Of the 507 chest films, 76 (15%) revealed an unsuspected abnormality, 71 (93%) of which led to a management change. There were significantly (p< .02) more unsuspected abnormalities and management changes, in the pulmonary and unstable cardiac patients, independent of ventilator status. Patients with two or more catheters and/or tubes visible on the chest film also had significantly more management changes (51/312 vs. 11/150,p< .05). We conclude that while routine chest films affect the management of pulmonary and unstable cardiac patients in the ICU, routine films rarely influence management of uncomplicated cardiac patients and those without heart or lung disease, and are not warranted in this group.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Total parenteral nutrition (TPN) increases CO2production (Vco2) in patients on intermittent positive-pressure ventilation who cannot match their CO2excretion to the CO2load, leading to an increase in Paco2. We studied gas exchange and blood gas values in six patients with chronic respiratory failure, who were ventilated at low (6 ± .7 L/min) and high (10 ± 2 L/min) minute ventilation during three randomized nutritional regimens: control (255 kcal/day), glucose TPN (2550 kcal/day), and lipid TPN (3000 kcal/day). At the two levels of ventilation, TPN compared to control increased Vco2and Paco2(p< .01) and decreased pH (p< .001). At low minute ventilation, the increase in Vco2and the hypercapnic acidosis were less with lipid than with glucose TPN (p< .05 andp< .01, respectively). These results indicate that the risk of TPN-induced CO2retention is lower if minute ventilation is increased before beginning TPN. Conversely, in patients with compromised ventilatory function, this risk could be higher during intermittent mandatory ventilation or weaning from the ventilator.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We compared the incidence of catheter contamination and catheter-related sepsis in 200 noninfected patients admitted postoperatively to the surgical ICU. Four methods of catheter fixation were used: (a) povidone-iodine ointment (Betadine) with a sterile gauze and adhesive dressing (Elastoplast); (b) Op-Site film; (c) Op-Site spray followed by Op-Site film; and (d) Betadine and Op-Site film. Of 708 catheters used for 200 patients, 516 (72.8%) were cultured. There was no catheter-related septicemia but 13 (2.52%) catheters were contaminated. However, these were evenly distributed among the four groups. We, therefore, conclude that aseptic insertion of catheters, daily inspection of puncture site, and replacement of tubing are the determining factors in preventing catheter-related sepsis.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Correctly diagnosing pulmonary embolism in the ICU can be very difficult, especially when cardiopulmonary disease is coexistent but unrelated. This study describes four hemodynamically unstable patients in whom pulmonary hypertension and an inability to obtain a wedge pressure during balloon flotation catheterization suggested total embolic occlusion of a major pulmonary artery segment distal to the catheter. The diagnosis was confirmed by angiography performed via the flotation catheter in three patients, and by a perfusion scan in one patient. Streptokinase was infused directly into the pulmonary artery of two patients, resolving the pulmonary hypertension and occlusion in both.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The microbiologic risk of invasive hemodynamic monitoring was studied prospectively in 574 patients undergoing open-heart surgery under cover of cephalothin prophylaxis. Of a total of 2277 catheters inserted in these patients, 1.5% yielded positive cultures. The rate of positive cultures was not significantly different between percutaneous and surgically placed catheters (1.7% vs. 0.8%, respectively). Specifically, the incidence of positive catheter tips for intravenous, central venous, arterial, and pulmonary artery catheters was 1.1%, 3.9%, 1.5%, and 2.1%, respectively; while the corresponding rates for surgically inserted right atrial and left atrial catheters were 0.8% and 0, respectively. Pulmonary artery catheters had a significantly (p< .01) higher incidence of positive catheter tips after 72 h in situ. However, there was no relationship between the in situ time and the incidence of positive tips for arterial and intravenous catheters. Although the rate of positive catheter tip cultures was low, it affected 4.9% of the patients. Nevertheless, no patient developed catheter-related septicemia or endocarditis, and the data generally supported the microbiologic safety of invasive hemodynamic monitoring in patients undergoing open-heart surgery.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The purpose of this study was to determine the consequence of intermittent mandatory ventilation (IMV) on gas exchange, cardiac function, and blood oxygenation immediately after cardiopulmonary bypass grafting. The results showed a marked increase in oxygen uptake, cardiac index, and pulmonary artery pressure, and a decrease in mixed venous oxygen saturation of 20 adult patients recovering from surgery. These effects may have been associated with the presence of an endotracheal tube, because 2 h after removal of this tube there were significant decreases in elevated cardiac function and blood oxygenation variables, while mixed venous oxygen saturation increased from 64% to 75% (p< .001). These results suggest that IMV can dramatically increase oxygen uptake, cardiac index, and pulmonary artery pressure in awake and intubated patients.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Brainstem auditory evoked potentials (BAEPs) were examined prospectively in ten clinically brain-dead and 13 comatose nonbrain-dead children. All clinically brain-dead children failed to demonstrate brainstem impulse transmission, displaying no waves or only wave I. The comatose, nonbrain-dead children maintained evidence of brainstem electrical activity, manifested by at least two waveforms. This suggests that BAEPs are a useful noninvasive method of supporting the clinical diagnosis of brain death in children.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID