摘要:

To evaluate the status of the complement system and to determine the effects of corticosteroids on complement component levels in septic shock, C3, C4, and Factor B were measured in 42 patients with severe late septic shock. Serum levels of C4 and Factor B correlated with C3 levels (r = 0.48 and 0.64, respectively;p< .01) in patients in shock for more than 4 h, but only Factor B correlated with C3 (r = 0.85;p< .01) in patients in shock for 4 h or less. C3 and Factor B levels were significantly (p< .05) lower in patients who died (12,174 ± 1,524 CH50U/ml and 14 ± 1 mg/dl, respectively) than in patients who survived (18,418 ± 2,833 CH50U/ml and 21 ±2 mg/dl, respectively). Corticosteroids did not alter complement component levels.The alternative pathway appears to be activated early in septic shock, whereas the classical pathway is activated later. C3 and Factor B levels may predict survival of patients in septic shock. In this study, corticosteroids did not change the complement component levels of patients in late severe septic shock.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We retrospectively evaluated the clinical and pathologic effects of hypothermia and high-dose barbiturate therapy on hypoxic/ischemic cerebral injury after near-drowning in children. Of 40 near-drowned patients admitted to the ICU, 13 died, seven had permanent cerebral damage, and 20 survived. Twenty-four patients (group 1) were treated with a regime of hyperventilation, hypothermia, and high-dose phenobarbitone while intracranial pressure (ICP) was continuously monitored. Of ten who died in this group, three were diagnosed as having cerebral death shortly after admission; autopsy revealed severe cerebral edema with herniation. The remaining seven nonsurvivors had severe cerebral hypoxia without raised ICP and had the features of severe adult respiratory distress syndrome and hypoxic/ischemic damage to other organs. Six of these seven patients developed septicemia which was invariably associated with a profound neutropenia. Sixteen patients (group 2) were treated with a similar protocol but without hypothermia. Three of these patients died but only one developed septicemia. Neutropenia after resuscitation from near-drowning seemed to indicate a poor prognosis; the mean polymorphonuclear leukocyte count in nonsurvivors (1.9 ± 0.5 x 109cell/L) was significantly (p< .01) lower than that in survivors (6.4 ± 1.1 x 109cell/L). Hypothermia was associated with a decreased number of circulating PMNs but did not increase the number of neurologically intact survivors. Similarly, although barbiturates may control ICP, their use did not improve outcome. Because severe cerebral edema and herniation after near-drowning is usually associated with irreversible brain damage, measures to control brain swelling such as hypothermia and barbiturates will be of little benefit. Therapy should be directed at maintaining cerebral perfusion and adequate oxygenation to prevent further damage to vital organs.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The magnitude of variability in resting energy expenditure (REE) during the day was assessed in nine healthy young subjects under two nutritional conditions: I) mixed nutrient (53% carbohydrate, 30% fat, 17% protein) enteral feeding at an energy level corresponding to 1.44 REE; and 2) enteral fasting, with only water allowed. In each subject, six 30-min measurements of REE were performed using indirect calorimetry (hood system) at 90-min intervals from 9 AM to 5 PM. The mean REE and respiratory quotient were significantly (p< .01) greater during feeding than during fasting (1.08 ± 0.07 [SEM] vs. 1.00 ± 0.06 kcal/min and 0.8/4 ± 0.007 vs. 0.829 ± 0.008 kcal/min, respectively). Mean postprandial thermogenesis was 4.9 ± 0.4% of metabolizable energy administered. The intraindividual variability of REE throughout the day, expressed as the coefficient of variation, ranged from 0.7% to 2.0% in the fasting condition and from 1.2% to 4.1% in the feeding condition. There was no significant difference between the REE measured in the morning and that determined in the afternoon.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We examined cardiovascular changes in 37 patients transported to an ICU after major general or vascular surgery (n = 14), open heart surgery (n = 13), or carotid endarterectomy (n = 10). Cardiovascular variables were also measured in a control group of 11 patients transported from an ICU for diagnostic or therapeutic procedures. All patients were followed for 30 min before transport until approximately 30 min after they arrived at their destinations. During this period, systolic BP and heart rate significantly increased only in patients recovering from major general/vascular surgery or carotid endarterectomy. These changes were apparently related to acute emergence from inhalational anesthesia (isoflurane plus nitrous oxide), since the other surgical patients were anesthetized with narcotic anesthesia, and the control group did not receive any anesthesia.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Interhospital transport can be hazardous because of rapid changes in a patient's physiologic status and the use of monitoring systems. A retrospective study evaluated the first 204 critically ill adult patients transported from community hospitals to Stanford Medical Center by a special transport team. To relate the risk of transport to severity of illness, a retrospective scoring system was devised. Sixty-one percent (n = 125) of the patients were at high risk for transport. The patients were stabilized at the referring hospital, and invasive monitoring was used as mandated by the patient's condition. The average transport distance was 133 km, and the average duration of transport was 4.38 h. One hundred and five patients (51.5%) were transported by air, and the remaining patients were transported by surface ambulance. All patients survived the transport, and 71.6% were eventually discharged from the hospital. Hospital mortality correlated with the risk-scoring system (p< .01) and increased five-fold as severity of illness increased. This study demonstrates that, with appropriate hemodynamic stabilization and monitoring, severely ill patients can be transported safely.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In an attempt to determine which hypoxic newborns might benefit from administration of tolazoline hydrochloride (Tz), we identified all neonates known to have received Tz at four Chicago area perinatal centers over a 4-yr period. For each of 41 infants, five statistical analyses were used to correlate 31 clinical and ventilatory variables with Pao2values before and after Tz administration. Fourteen neonates responded to Tz infusion with more than a two-fold increase in Pao2. None of 31 clinical variables successfully predicted a positive Tz response in these infants, and a positive response (increased Pao2) was not associated with increased likelihood of survival. BP fell after Tz in 72% of patients, while heart rate rose after Tz treatment in 66% of cases. These data suggest a need to re-evaluate the administration of Tz to hypoxic newborn infants.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Twenty-four patients suffering hyperglycemic hyperosmolar nonketotic syndrome were studied retrospectively to define initial prognostic factors. Twenty percent of these elderly patients (mean age 76 ± 4.6 yr) had no history of diabetes, and only 54% experienced coma, which was not related to the level of plasma osmolality or to final outcome. The overall mortality was 46%, but death was directly related to nonmetabolic disorders in 64% of cases. Age; sex; acute precipitating factors (except precipitating drugs); admission levels of serum sodium, serum potassium, blood glucose, plasma osmolality, and serum creatinine; and insulin, macromolecular, and total fluid volumes infused during the first 24 h in the ICU were not related to death. The simplified acute physiology score was approximately the same for both survivors and nonsurvivors.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We used a modification of Langendorffs isolated perfused nonworking rat-heart model to study the effects of diabetes, insulin-treated diabetes, and hyperinsulinemia on left ventricular pressure, force of ventricular contraction, and myocardial contracture, before, during, and after 20 min of complete normothermic global ischemia. Untreated diabetic rat hearts behaved the same as normal hearts, but insulin-treated diabetic hearts had more ischemic and postischeimic contracture (p< .01), and less return of left ventricular function. Chronic insulin treatment potentiated ischemic contracture in diabetic and nondiabetic rat hearts. These results support the hypotheses that insulin can increase Ca++actin-myosin ATPase activity, and increase the affinity of myofibrillar receptors for calcium, which may lead to increased ischemia contracture. Insulin as a risk factors in myocardial ischemia, cardiothoracic surgery and cardiac resuscitation, and other pathogenetic factors of “stone heart‘’ development, deserve further investigation.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Perfusion of isolated, nondiabetic rat hearts with high concentrations of regular insulin (10 mU/ml) produced earlier onset of myocardial contracture during ischemia than control perfusions without insulin. High insulin concentrations also increased total myocardial calcium content (p< .001) and myocardial Ca-45 uptake postischemia (p< .05). Insulin perfusion before ischemia did not enhance calcium uptake. These results support the hypothesis that insulin may increase calcium movement across myocardial cell membranes, which may lead to increased ischemic contracture. Insulin-aggravated myocardial ischemia in cardiothoracic surgery and cardiac resuscitation deserves further investigation.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The effectiveness of transtracheal jet ventilation is a function of gas delivery pressure (drive pressure), duty cycle (insufflation time/total cycle time), and respiratory frequency. Nine dogs, anesthetized with sodium pento-barbital, were ventilated through a cricothyrotomy cannula using a controller that allowed separate setting of drive pressure, duty cycle, and frequency. Pao2and PaCO2were measured after achieving steady-state gas exchange at 15 to 22 different combinations of drive pressure, duty cycle, and frequency in each dog. There were slight increases in Paco2and larger decreases in Pao2as frequency was increased from 10 to 200 cycle/ min. Increases in drive pressure and duty cycle resulted in reduced Paco2and increased Pao2. Multiple linear regression showed good correlation between Paco2and drive pressure, duty cycle, and frequency. The distribution of air flow between alveolar and physiologic dead space, upper airway leakage, and entrainment was determined for each set of conditions. Changes in alveolar ventilation corresponding to the blood gas changes resulted from interaction of dead-space ventilation and upper airway leakage, which varied with breath duration. Decreases in leakage during short breaths tended to compensate for the increased fractional dead-space ventilation at high frequency, thus minimizing the effects of frequency changes on gas exchange.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID