摘要:

Clinical and metabolic derangements that accompanied the hyperosmolal state, with plasma osmolality in excess of 350 mOsm/L, were examined in 48 patients. All were in coma, and spontaneous ventilation was impaired in more than two-thirds of the patients. Seven discrete groups of patients were identified. Most of the cases were associated with renal failure or iatrogenic loading with sodium. Less frequent conditions were diabetes mellitus with hyperglycemia and septic shock associated with renal failure. The minority of cases was associated with parenteral alimentation, dehydration due to fluid deprivation, or acute alcoholism.Only five of the 48 patients survived. In each survivor, hyperosmolality was reversed within 12 hr. Peritoneal dialysis proved effective for three patients. Control of hyperglycemia by judicious treatment with fluids and insulin was effective in the fourth patient; and in the fifth, hyperosmolality reversed spontaneously.The availability of osmolal measurements of plasma has proven to be a practical asset to management of the critically ill. If hyperosmolal states are promptly identified and expeditiously treated, substantial improvement in survival may be anticipated.

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

Measurement of regional ventilation and blood flow in infants with the use of an intravenous bolus of133Xenon reliably estimates the ventilation-perfusion abnormalities responsible for hypoxemia and eventually hypercapnea.A composite ventilation-perfusion index (&OV0312;ci/&OV0422;) of >0.85 was found in well infants with Pao2>90 torr, and < 0.55 in sick infants with Pao2< 50 torr. Indices of < 0.6 were associated with CO2retention; indices of < 0.55 were found in patients requiring mechanical ventilation.Redistribution of blood flow away from a poorly ventilated region during air breathing but not during oxygen breathing suggests that alveolar hypoxia is an effective stimulus to increase regional vascular resistance. It is predictable that the lack of redistribution during oxygen breathing contributes to CO2retention.The findings of this study substantiate the use of133Xenon bolus technique for a better understanding of the regional contribution to the pathophysiology in the infant's lung.

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

摘要:

A multidisciplinary pediatric ICU was developed at the Children's Hospital of Pittsburgh as part of the Critical Care Medicine Program at the University of Pittsburgh Health Center. As a result, the ICU mortality was reduced from 26.2% in 1967–68 to 14.9% in 1971–72. The most significant reduction occurred in patients with acute respiratory failure, from 6.3% to 0.8%.The quality of patient care was greatly influenced by continuous coverage by full time ICU physicians (staff and fellows), highly-trained nurses and inhalation therapists, and the use of a special ancillary staff of paramedicals.

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1973

数据来源: OVID