摘要:

Biomaterials are essential for life support and monitoring of critically ill patients, but their use increases the risk of nosocomial infection. Of the various plastics used for life support and monitoring devices, polyvinyl chloride is one to which bacteria most readily adhere. Through the use of qualitative culture techniques and scanning and transmission electron microscopy, we studied the surfaces of polyvinyl chloride endotracheal tubes removed from 25 ICU patients, to determine if bacterial adhesion to those tubes was sufficient to provide a possible source for repeated contamination of the tracheobronchial tree. Of the surfaces studied, 16% were partially covered and 84% were completely covered by an amorphous bacteria-containing matrix. Some biofilm-enclosed bacterial aggregates projected from the matrix into the lumen of the tube. The mechanism by which endotracheal tubes repeatedly inoculate the lungs of intubated patients may prove to be dislodgment of such aggregates by suction apparatus.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The association of multiple organ system failure (MOSF) with mortality was investigated in 831 consecutive admissions to a pediatric ICU. The incidence of MOSF (at least two organ system failures, OSF) was 27%. Of the 62 nonsurvivors, 60 (97%) had MOSF. The mortality for patients with MOSF was 54%, compared to a mortality of 0.3% for patients without MOSF. Mortality increased directly with increasing number of OSF (p <.0001). The mortality was 1% for one OSF, 11% for two OSF, 50% for three OSF, and 75% for four OSF. Comparison of these results with data from adult ICU patients indicates that the mortality and clinical course of MOSF in children is distinct from adults. MOSF is significantly associated with mortality in pediatric patients; however, it is not sufficiently discriminating to determine continuation or withdrawal of ICU support.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A 30-month, retrospective study of CPR was under-taken in a 10-bed, medical/surgical pediatric ICU (PICU). The 121 episodes of CPR reviewed represented 81 of 1357 admissions and 7537 cumulative days of PICU care. Of the 121 CPR attempts, 64% were initially successful, 48% were associated with at least 24-h survival, and 31% were followed by discharge from PICU. Unlike pediatric arrests outside the hospital or on general pediatric wards, PICU arrests were seldom unanticipated, were commonly nonrespiratory in origin, and generally occurred in spite of aggressive support. Of 118 PICU deaths during the study period, 45 (38%) were associated with CPR. In the 73 remaining PICU deaths, CPR had been withheld because of an order not to resuscitate. CNS status before arrest was the most important factor influencing outcome. In this pediatric population, 29% were noncomatose survivors 24 h after more than 30 min of resuscitation.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Of 41 pediatric cases of acute epiglottitis treated at the same institution during an 8-yr period, 33 patients were managed by nasotracheal intubation, one by tracheostomy performed at a referring hospital, and seven by intensive care observation and iv antibiotics. Twenty of the 33 nasotracheally intubated patients underwent intubation in the pediatric ICU by the pediatric anesthesiologist-intensivist, who used iv anesthetic agents and muscle relaxants. The remainder were intubated at referring hospitals. All of the intubated patients were paralyzed, sedated, and mechanically ventilated. The intubation technique caused no apparent complications; however, it required the skill and expertise of an experienced pediatric anesthesiologist-intensivist.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In a heterogeneous group of 23 critically ill patients with recurrent and intractable bouts of supraventricular arrhythmia, increases in pulmonary artery wedge pressure significantly decreased cardiac output and exacerbated respiratory failure. Most patients were eventually stabilized on a long-term iv infusion of the calcium antagonist verapamil which, with appropriate monitoring, was well tolerated. We suggest that the use of verapamil infusion may play a significant role in the management of such patients and that further studies are justified.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The effects of constant-infusion verapamil were studied in ten postoperative ICU patients who developed supraventricular tachycardia (atrial fibrillation) with rapid ventricular response rates. A 5-mg iv bolus dose of verapamil was followed by a 5-mg/h infusion that continued for 8 h. Ventricular rates were significantly (p <.005) reduced from a pretreatment mean of 156 ± 14 (SD) to 104 ± 9 beat/min on constant-infusion therapy. This therapy was well tolerated without observed side-effects. Moreover, constant-infusion verapamil might avoid the hypotension and wide range of ventricular rates frequently encountered with repeated bolus doses of verapamil.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Fluid filtration rate (FFR) was measured under predominantly zone-three conditions in isolated rabbit lung perfused at constant flow. During forward and reverse perfusion, alveolar hypercapnia significantly increased mean pulmonary artery pressure but did not change FFR. We conclude that the pulmonary vasoconstriction induced by alveolar hypercapnia occurs on both arterial and venular sides of the pulmonary circulation.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We used a digital display value, a recorded pressure curve, and manometric measurements to determine CVP in 35ICU patients who had either a central venous line or a pulmonary artery catheter. CVP was measured by each method up to five times per patient, for a total of 107 data sets. Display values compared well to those from the recorded pressure curve. Manometric measurements, however, poorly matched electronically determined values. Factors influencing these results are discussed.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The incidence of microbial colonization of injectate was studied in open and closed delivery systems used for thermodilution measurement of cardiac output. Patients with pulmonary artery catheters were prospectively randomized to receive either open two-bottle systems or closed systems. Paired cultures of injectate solution were withdrawn through the stopcock at the time of the initial setup and every 12 h for 48 h. Injectate from eight (35%) of 23 patients with the open system and one (5%) of 20 patients with the closed system yielded a positive culture (p <.05). Thirteen (10%) of 129 pairs of cultures were positive from the open system, compared to one (0.9%) of 111 pairs from the closed system (p <.01). There was no statistically significant difference in the number of cardiac output injections between the two groups, but patients having more than the mean number of injections for cardiac output measurement had a significantly (p <.05) greater likelihood of positive injectate cultures.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The reliability of ultrasonic cardiac output measurement was assessed using a commercial device that combines A-mode aortic root diameter determination and continuous wave (CW) Doppler flow velocity measurement in the ascending aorta. We compared this method with thermodilution (TD) cardiac output in 41 intensive care patients. Aortic root diameter measurement with A-mode was not possible in four (10%) patients. Using strictly defined criteria based upon our initial experience, we could not obtain acceptable CW Doppler flow signals in nine (22%) patients. Thus, ultrasonic cardiac output measurement was possible in 28 (68%) patients in whom there was an excellent correlation with cardiac output (r=0.97;p <.001). This study demonstrates that the transcutaneous CW Doppler method for measuring cardiac output is accurate and reliable in a limited percentage of ICU patients. Combining the CW Doppler with B-mode echocardiogram increases the applicability when an A-mode measurement is not possible.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID