摘要:

Serum levels of creatine kinase (CK) and its myocardial isoenzyme (CK-MB) were measured and serial ECG recorded in 24 male and 6 female patients with severe head trauma. All patients were comatose, but no patient sustained a spinal or chest injury. Total CK activity was elevated in at least one sample in each patient. Elevated CK-MB activity was found in 28 patients. The serial CK-MB data did not follow the same pattern as that of patients suffering from myocardial infarctions. The mean CK-MB remained elevated for at least 3 days after injury, although individual patterns were variable. ECG abnormalities included prolonged corrected QT interval (QTc) in 90% and a variety of nonspecific ST segment and T wave changes in 53%. These ECG findings are consistent with other clinical studies of severe neurological disorders, particularly cerebrovascular accidents. The elevated CK-MB activity indicates that ongoing myocardial damage occurs in patients with severe head injury. Although the underlying mechanism is not entirely clear, an excessive release of catecholamines is the most likely mechanism accounting for diffuse myocardial damage, prolonged elevated CK-MB values and the observed ECG abnormalities.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

High frequency jet ventilation (HFJV) was compared to conventional (high tidal volume, low frequency) ventilation in 9 patients with acute respiratory failure (ARF). Alveolar ventilation was comparable or lower with HFJV in all but one case. When comparisons were made at the same concentration of oxygen and level of PEEP, no consistent change in arterial oxygenation (Pao2) was found. In one case, it was possible to increase Pao2) during HFJV by additional increases in PEEP without elevation in peak airway pressure (AWP) compared to conventional ventilation (CV). At the same level of PEEP, peak AWP was lower during HFJV, except in 1 patient with bronchospasm. Cardiac output did not differ significantly between the 2 ventilation systems, except in the same patient with bronchospasm. HFJV may be useful in acute respiratory failure when peak AWP during CV limits effective use of mechanical ventilation for gas exchange. Patients with significantly elevated airway resistance may be an exception. Improvement in Pao2will usually depend on increases in PEEP.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The effects of incremental increases in PEEP during mechanical ventilation on left ventricular (LV) contractility before and after intravascular volume expansion (IVE) were studied in 10 patients treated for ARDS. A pulmonary artery (PA) catheter, a LV catheter-tip mi-cromanometer, and an esophageal balloon catheter were inserted in these patients. We measured transmura) right atria) and PA pressures, transmural LV end-diastolic and systemic arterial pressures, the first derivative of LV pressure (LV dP/dt), the ratio of LV dP/dt at transmural developed LV pressure (dP/dt/DPt) with DPt= 5, 10, 40 mm Hg, cardiac index (CI) at every level of PEEP and after IVE at the highest PEEP. Stepwise increases in PEEP (from 0–20 cm H2O) were associated with progressive fall in CI whereas heart rate remained unchanged. Transmural right atrial and PA pressures did not change; transmural LV end-diastolic and systemic arterial pressures and peak dP/dt decreased significantly with PEEP, except for dP/dt/dPt. IVE reversed this fall in CI and peak dP/dt. Whereas transmural LV enddiastolic pressure rose markedly.We conclude that the observed fall in LV performance during PEEP is not the result of a depressed LV contractility because PEEP does not induce a decrease in dP/dt/DPt, the least sensitive to change in preload isovolumic phase indices of contractility.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A technique for sampling blood from the damaged pulmonary microvasculature in patients with acute respiratory failure is described. Blood was aspirated through the distal lumen of wedged pulmonary arterial catheters in 28 critically ill patients. Successful aspiration was achieved in 88% of the attempts and 20 ml of blood drawn before sampling was optimal for clearing mixed venous precapillary blood. The blood gas values obtained were classified as “capillary” when the wedge (w) Po2> Pao2and Pwco2< Paco7(17 patients, 61%); “mixed venous” when Pwo2and Pwco2were equal to values obtained from the main pulmonary artery (5 patients, 18%); and “mixed source” when intermediate Pwo2and Pwco2were noted, i.e., Pao2> Pwo2> Pvo2and Pwco2variably > or < Paco2(6 patients, 21%). When mixed venous samples are eliminated, microvascular sampling can be assumed in 82% of the successful aspirations.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Scoliosis associated with muscular dystrophy frequently necessitates surgical stabilization of the spine. The timing of surgery usually is based on the degree of spinal angulation. Pulmonary function, which deteriorates with age in children with muscular dystrophy, should also be an important consideration in this timing. In a retrospective study of 48 patients who underwent spinal stabilization, preoperative respiratory function tests were correlated with postoperative respiratory complications. The percentage of predicted vital capacity provided the best indicator of outcome and values of

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Hemodynamic function and volume of ultrafiltration (UF) during hemodialysis were studied in 8 patients with anuric acute renal failure (ARF) and severe sepsis. Patients were alternatively dialyzed with a saline priming (every 2 days) and with a 17.5% albumin priming. Hypovolemia, as indirectly reflected by reduced left ventricular filling pressure, decreased cardiac output (CO), and decline in mean systemic arterial pressure (MAP), was observed during the hemodialysis procedure using saline as the first prime. Hemodialysis was tolerated better after concentrated albumin priming; left ventricular filling pressure increased during the 1st h of dialysis, whereas CO and MAP remained close to that of control values. Furthermore, UF could be increased progressively without major hemodynamic consequences in the patients who received a concentrated albumin priming; moreover, larger volumes of fluid were removed.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Inasmuch as no single variable is able to predict the outcome or evaluate the effect of various treatments used for resuscitation of shock, a statistical method was applied to evaluate several plasma substitutes by a numerical system based on 10 different hemodynamic and metabolic variables. Shock was induced in 60 dogs by laparatomy and exteriorization of the small intestines. After 3 h, the intestine was returned and the abdomen closed. Fluid infusion was then given during a 20-min period. Measurements were carried out during the next 4 h. Seven therapeutic agents were studied in 7 groups: control (no infusion); Ringer's acetate; gelatin; dextran-40; dextran-70; ACD-plasma; albumin. Variables included: cardiac output, oxygen consumption, plasma volume, hematocrit, skeletal muscle capillary blood flow and permeability surface area, arterial blood pH and base excess, mean arterial blood pressure, and the extravascular water gain. Dextran-40, dextran-70, and albumin restored an average of 7 variables to values above the presbock median value. Gelatin and plasma restored 4 variables and Ringer's acetate restored 3 variables. When no infusion was given, no variable was restored and the animals remained in shock. It is concluded that 3.5% colloid solutions of dextran-40, dextran-70, and albumin are more effective than plasma, gelatin, and Ringer's acetate in this order.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

An initially widened pulmonary artery diastole-pulmonary wedge pressure (PAD-PWP) gradient >5 mm Hg has been reported to be associated with an 83% mortality rate in septic patients. To confirm and extend these observations, we retrospectively reviewed the charts of 47 septic patients. The patients were divided into 2 groups: group 1—12 patients who never had an abnormal gradient during their hospital course, and group 2–35 patients who had an abnormal gradient sometimes during their course. There were no hemodynamic differences. However, the mortality rate in group 2 patients was significantly higher than in group 1 patients (60% vs 25%,pinitialgradient, the mortality rate was 61% which is not significantly different than the 83% previously reported. In patients with a persistent or increasing gradient before death or the resolution of sepsis, the mortality rate was 91%. We conclude that although aninitialPAD-PWP gradient in patients with sepsis is associated with a high mortality, a much more sensitive indicator is whether the gradient increases or persists over time. There is a 91% mortality in patients with persisting or increasing gradients.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Ten patients with bacteremia and perfusion failure were given methylprednisolone sodium succinate (MPN), 30 mg/kg iv, as adjunctive therapy immediately after initial volume loading to a pulmonary artery wedge pressure (WP) of 12 ± 4 (SD) mm Hg. Hemodynamic and oxygen measurements were obtained before, and for 24 h after MPN. All patients exhibited arterial hypotension (x = 65 ± 17, mm Hg), mental clouding and lactacidemia (x 2.5 ± 0.7, mM/L). Nine patients recovered from shock within 12 h. However, only 4 were hospital survivors. Cardiac index (CI), oxygen delivery index, and lactate increased immediately after MPN from 3.7 ± 0.9 to 3.9 ± 1.0 L/min M2(p<0.05), 485 ± 143 to 534 ± 143 ml/min M2(p<0.05), and 2.5 ± 0.7 to 2.8 ± 0.8 mM/L (p= ns), respectively. However, there was a simultaneous decrease in arteriovenous oxygen difference [C(a-v)O2] so that oxygen consumption (Vo2) was unchanged. WP decreased immediately after MPN to 10.4 ± to 4.9 mm Hg (p= ns) accompanied by decreases in pulmonary and systemic vascular resistance. P50and erythrocyte 2,3 diphosphoglycerate (2,3 DPG) were little affected for 12 h (in vitro P5025.0 ± 2.1 to 25.9 ± 1.3 mm Hg, and 2,3 DPG 12.6 ± 3.7 to 15.4 ± 2.4 γm/g Hb (p= ns). For the patients who recovered from shock there were additional small (p= ns) increases in P50and 2,3 DPG by 24 h. These were not accompanied by an increase in C(a-v)o2or Vo2. We conclude that MPN increases cardiac output and O2delivery in bacterial shock, but these changes do not seem to be associated with increases in systemic oxygen extraction, erythrocyte 2,3 DPG, or P50

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The effect of graded application of positive end-expiratory pressure (PEEP) was studied in 10 mongrel dogs with pulmonary edema induced by oleic acid infusion. Six animals received progressive increases in PEEP (5 cm H2O) 120 min after the injection of oleic acid. These animals were compared to 4 control animals who did not receive PEEP. We found no difference between the 2 groups in lung water measured by a double indicator dilution technique during PEEP application. Lung water determined by gravimetric analysis was also not different between groups at the end of the experiment. PEEP did result in significant reductions in shunt fraction and alveolar-arterial oxygen tension difference suggesting that PEEP improves gas exchange in pulmonary edema by increasing lung volume, but not by altering lung water accumulation.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID