ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

A 30% glucose solution was infused for 4 h at a rate of 1.53 ml·kg−1·h−1, corresponding to 10 g·kg−1·24 h−1in 8 critically ill patients requiring parenteral nutrition. The osmotic load resulted in an expanded blood volume due to hemodilution. Stroke volume (SV) increased, while peripheral vascular resistance (PVR) and pulmonary capillary wedge pressure (WP) decreased. Otherwise, no major effects on the circulation were observed. Thus, during these experimental conditions, the heart seems to cope very well with the increased osmotic load.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Hypophosphatemia and its consequences have received considerable attention due to their frequency and occurrence in a wide spectrum of clinical disorders.1–7The cardiac, pulmonary, neurological, and hematological complications of hypophosphatemia offer ample justification for implementing therapy in the setting of phosphorus depletion. However, the goals of such therapy are poorly defined because serum phosphate levels may not reflect total body stores of phosphorus.8Despite its popularity, little comment has been made in the medical literature concerning adverse reactions of phosphate therapy. In this regard, two case histories are presented to illustrate the potential complications of overgenerous phosphate therapy.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Mechanical ventilation with different ratios of inspiratory to expiratory times (I:E ratio) and levels of positive end-expiratory pressure (PEEP) were applied to 9 dogs after the aspiration of fresh water and then were compared. The dogs were ventilated with an I:E ratio of 2:1 with 0 PEEP; an I:E ratio of 2:1 with 5 torr PEEP; and an I:E ratio of 1:2 with 5 torr PEEP. Peak airway pressures were regulated to maintain a mean airway pressure of 13 mm Hg. Arterial oxygenation was better with an I:E ratio of 1:2 with PEEP than with an I:E ratio of 2:1 either with or without PEEP (60 ± 15 torr as compared with 42 ± 11 torr and 43 ± 10 torr). Cardiac index was depressed with all ventilatory modes, but oxygen delivery did not significantly differ among all the modes of ventilation. A ratio of prolonged I:E was not seen to benefit blood gas tension.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In 179 healthy boys and girls, the relationship between body surface area (S) in dm2and body weight (bw) in kg was investigated. The body surface was calculated from the DuBois and DuBois formula. For infants below 20 kg, the relationship followed the regression equation S = 3.6 · kg + 9;r= 0.996. For infants with bw between 20–40 kg, the regression equation S = 2.5 · kg + 33;r= 0.977 was found. These equations can easily be memorized and may be able to replace nomograms when bedside calculations of the S is required. In addition, formulas for the volume of plasma expander to be used in the prophylaxis and treatment of shock, trauma, and burn injuries are presented.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The activities of nurses, residents, and fellows providing newborn intensive care were studied by time-lapse photography. Six of 40 frames taken each hour during a 23-day period were evaluated. Time spent in bedside care, charting, handwashing, and other activities were estimated for personnel in a four-bed area. The amount of care prescribed for each infant was assessed independently by calculation of a care score from the physicians' orders. Physician activities were significantly diminished at night and on weekends. Bedside care given by physicians increased abruptly at high care scores. Total bedside nursing care was unaffected by tune-related variables (day vs. night; weekday vs. weekend; nursing rotations). Regression analysis showed a linear two- to threefold increase in bedside nursing time with increasing care score. Individual nurses differed significantly in mean time devoted to bedside care and in their response to increasing infant care score. Differences between nurses accounted for as much of the total variation in bedside care (30%) as did differences between infants in care needs. Many factors are likely to affect the individual or group performance of nursery staff. The traditional duty schedule for physicians is associated with a deterioration in their performance at night and the noctural increase in neonatal acidosis and mortality previously reported by the authors.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

To test the hypothesis that fluctuations in global intra-thoracic pressure are the dominant cause of blood flow during external CPR, the authors studied the effects of open pneumothorax on experimental CPR in 7 domestic pigs and 12 mongrel dogs. Similar studies were conducted independently at three laboratories and are reported jointly. All studies were conducted during electrically induced ventricular fibrillation and with standard CPR technique: ventral-dorsal chest compression at 60/min, 0.5 sec compression duration, 1:5 ventilation:compression ratio. During alternate periods of CPR, intrathoracic pressure was vented through bilateral chest tubes, placed to create open pneumothorax and partial collapse of the lungs. During this maneuver, global intrathoracic pressure fluctuations were greatly attenuated, but direct cardiac compression and adequate ventilation continued. In the three laboratories, systolic/diastolic arterial pressures during CPR with thoracic venting (± se) averaged 68 ± 4.2/28 ± 3.3, 60 ± 10/18 ± 4.5, and 66 ± 6.3/23 ± 1.5 mm Hg. These values are compared to 68 ± 4.4/27 ± 3.0, 67 ± 12/17 ± 6.1, and 56 ± 6.2/22 ± 1.9 mm Hg with the thorax intact. Carotid artery mean flow, measured with an in-line flowmeter, was 13.0 ± 2.2 ml/min vented vs. 13.4 ± 2.6 intact in 7 pigs; 11.4 ± 3.8 ml/min vented vs. 11.2 ± 3.7 intact in 5 dogs. Cardiac output, determined by indicator dilution, was 25 ± 4.3 ml/min · kg vented vs. 20 ± 4.3 intact in 7 dogs. Thoracic venting did not decrease blood pressures and flows during CPR, as would be predicted from the hypothesis that generalized intrathoracic pressure fluctuations are the dominant hemodynamic mechanism. The results are consistent with the classical notion that CPR works by compression of the heart between the sternum and the spine. This mechanism should not be discounted in future attempts to improve CPR.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Pressures were measured in the right atrium, thoracic aorta, and pleural space during conventional cardiopulmonary resuscitation (CPR) and simultaneous ventilation compression cardiopulmonary resuscitation (SVC-CPR) in dogs, pigs, and a baboon. During both forms of closed chest resuscitation, the changes in atrial and aortic pressures were virtually identical over a range of 0–90 mm Hg and essentially equaled the change in pleural pressure measured at the most lateral portion of the chest cavity. During internal cardiac massage, there was no consistent relationship between right atrial and aortic pressures. However, even after the chest had been opened, the hemodynamics of external chest compression could be restored by the creation of a closed, air filled cavity surrounding the heart and great vessels. Thus, elevation of intrathoracic pressure, not direct cardiac compression, is essential to and determines circulation of blood during CPR.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The physical stress on the rescuer performing cardiopulmonary resuscitation (CPR) was assessed utilizing the ECG, rate pressure product (RPP), and total body oxygen consumption (Vo2). Six healthy physicians served as rescuers. Only a submaximal physical effort was required to perform good CPR, as demonstrated by the heart rate and Vo2changes. However, the effect was enough to generate a mean rescuer RPP approaching 20,000, with 2 of the rescuers well over 20,000. These data suggest that CPR might elicit ischemic symptoms in a rescuer with coronary artery disease.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Ventilatory response to CO2was examined in 6 patients with severe chronic obstructive lung disease (COLD) shortly after discontinuance of long-term ventilation for acute respiratory failure (ARF). Ventilatory response to CO2was extremely low in all patients 6–10 h after discontinuance from ventilator. One month later, however, CO2response curves shifted to the left and in 3 patients there was improvement which was seen in the slope of response curve. In patients who had mechanical ventilation for ARF from COLD, abnormally low responses to CO2probably contribute to the difficulty in weaning from mechanical ventilation. The presence of reduced CO2responsiveness should be considered in these circumstances.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID