摘要:

To ascertain the problems and needs of surgical ICUs, questionnaires (prepared by the author) were submitted to 50 medical directors and ICU head nurses at major hospital centers throughout the country. Is there a demand for intensive care not being met? If so, why? What is the frequency of overcrowding or need for triage?Thirty-one of the 50 questionnaires were returned, most fully completed. Demographic information about the hospital and surgical ICU itself was obtained. In most hospitals, patients requiring elective surgery and who need postoperative intensive care were not canceled even though no ICU bed was available. The major factor which limited surgical ICU caseload was the lack of ICU nurses needed to manage the volume of patients requiring intensive care in already existing beds and with equipment already purchased and in use. The current nurse:patient staffing ratios are approximately 1:2 in most ICUs. Nurse staffing averaged 82% of the authorized complement (range 15–105%). The ICU nursing turnover rate was extremely variable, ranging from 50–75% per year in seven units to as low as less than 15% in six units.This survey suggests that both large and small hospitals have difficulty carrying out their surgical ICU mission because the demand for more ICU facilities is outstripping the supply of ICU staff. The medical and nursing critical care societies must address these problems and attempt to solve them.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The authors evaluated transcutaneous Pco2(PtcCo2) and Po2(PtcO2) electrodes in 25 infants. Their diagnosis were severe hyaline membrane disease (HMD) (18), aspiration syndrome (3), severe hydrops, (3) persistent fetal circulation (6), and the others, congenital pneumonia, congenital plural effusion, pulmonary hemorrhage. In almost all, the cardiovascular system was compromised, i.e., PDA with congestive heart failure and shock. PtcO2electrode was heated to 43.5°C while PtcCO2electrode was not heated. Simultaneous arterial blood pressure (ABP), pH, arterial blood gases were obtained with the transcutaneous gas measurements. The data were analyzed first dividing all the paired arterial and transcutaneous gas tensions into those with and without cardiovascular drugs (dopamine, isoproterenol), and second, the paired values were divided into those taken (a) during severe acidosis (pH < 7.25), (b) hypotension (<2 SD) of normal, and (c) hypotension and acidosis. These data show: (1) the unheated PtcCO2and heated PtcO2accurately correlated with the simultaneous arterial measurements; (2) Ptcco2reflects tissue Pco2; (3) drugs affect both Ptco2and Ptco2; (4) elevated Ptcco2dissociating from the simultaneous Paco2in neonates with cardiovascular compromise results from decreased tissue perfusion. These data suggest that transcutaneous gas sensors perform dual functions; first, as gas monitors in patients without cardiovascular alterations, and second, in patients with cardiovascular compromise, Ptcco2reflected tissue perfusion and Ptco2monitored oxygen delivery to the tissues.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The cerebral function monitor (CFM) was used in 26 subjects, deeply comatose for a variety of reasons, in order to determine its value as a proghosticator for survival in this group of patients. Results suggest that it may be useful in predicting outcome in patients who do not regain neurologic competence within 2 h after cardiac arrest and resuscitation. In this group, initial CFM values of 10 μv or above correlated well with survival, and values of 3 μv or below correlated with death.The instrument was not a useful tool in predicting outcome in patients with dynamic primary neurological disorders, although a reduction in the CFM tracing did precede deterioration in clinical neurological function in some.The value of the CFM could not be determined for patients with drug overdosage because of the small size of this group.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Ultrasonographic scans of the right side of the neck of 16 subjects were done in order to determine the anatomical features relevant to efficient cannulation of the internal jugular vein. The cross sectional area of the jugular vein was estimated from scans at the level of the cricoid as well as 1.5 cm cephalad and caudad to the cricoid; the jugular was significantly larger caudad to the cricoid. A head-down tilt of 14° provided significant distension of the jugular, similar to that produced by a Valsalva maneuver. Both palpation of the carotid and extreme rotation of the head produce anatomical changes that seem to make cannulation of the jugular difficult.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Long-term effects of high frequency percutaneous transtracheal ventilation (HFTV) have not been studied. The purpose of this study is to evaluate the cardiopulmonary effects of 24 h of transtracheal ventilation in dogs at a respiratory rate of 100/min.Four dogs were anesthetized with intermittent pentobarbital and paralyzed with pancuronium. Ventilation in the supine position was through a 14-gauge Angiocath introduced into the trachea through the cricothyroid membrane. A respiratory rate of 100/min was used at an Fio2of 0.4 using a fluidic logic controlled ventilator. The inspiratory-expiratory ratio was 1:2 and tidal volume 70 ml. The driving pressure of the air-oxygen mixture was 50 psi. After 24 h, residual muscle relaxant was reversed and the animal allowed to recover.There was no significant change in the following parameters over 24 h compared to starting values: Pao2, Paco2, pH, aortic, central venous, pulmonary artery and pulmonary artery wedge pressures, heart rate, cardiac index (CI), stroke index (SI), left ventricular stroke work (LVSW), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), C(a)o2, oxygen consumption (Vo2), pulmonary shunt (Qs/Qt). A PEEP effect of 2.9–5.0 torr was maintained. All dogs recovered uneventfully. Three days after the experiment, blood gases of 2 dogs were normal. One dog was killed after 3 days; macroscopic and microscopic examinations of the upper and lower airway and pulmonary parenchyma were normal.Dogs can be ventilated for as long as 24 h using HFTV transtracheally at rates of 100/min without adverse cardiopulmonary effects.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

In order to determine and analyze the complication rate of the insertion and maintenance of the balloontipped, flow-directed pulmonary artery catheter (PAC), the authors prospectively studied the use of 320 catheters in 219 critically ill patients. Mean patient age was 53 ± 1 years, and 36% had a history of cardiovascular disease. Mean duration of catheterization averaged 76 ± 3 h. Major complications occurred in 3% of catheterizations. These included six pneumothoraces; three arrhythmias requiring treatment, one of which was fatal; and one subclavian vein thrombosis. Site complications occurred more frequently in catheters maintained longer than 72 h. These findings suggest that, when indicated in the care of critically ill patients, the properly placed and maintained PAC has an acceptably low morbidity and mortality rate, particularly when used for 72 h or less.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

To determine the relative importance of the alpha and beta adrenergic effects of epinephrine in resuscitation, 32 dogs were studied in four groups. Group A (α blocked) received phenoxybenzamine, 70 mg/kg; group B (β blocked), propranolol 5 mg/kg; group C (α and β blocked) both drugs; and group D (control), no drug. After this treatment and 5 min of asphyxial arrest, all animals received closed chest cardiac massage (CCCM), artificial ventilation (AR), and epinephrine, 1 mg, iv. Resumption of spontaneous circulation occurred with the following frequency: group A, 0/8; group B, 6/8, group C, 0/8; group D, 7/8. The difference in successful resuscitation of the alpha blocked animals and the not alpha blocked animals is statistically significant (p≤ 0.01). It is concluded that the efficacy of epinephrine in aiding resumption of spontaneous circulation from asphyxial arrest is due to alpha adrenergic receptor stimulation and that beta receptor stimulation is not important in determining outcome.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The hemodynamic effects of propranolol, lidocaine, and dopamine were studied in anesthetized, mechanically ventilated dogs, cooled to 25°C with a venovenous shunt through a heat exchanger. After 1 h at 25°C, the shunt was converted to an arteriovenous shunt which remained functional until the study was completed. Before rewarming, the authors treated each group of 8 dogs with intravenous doses of the drugs: group 1: 10 ml saline as control; group 2: propranolol 0.3 mg/kg; group 3: 50 mg lidocaine initially, followed with continuous infusion of 40–50 μg/kg-min; group 4: dopamine infusion at 12 μg/kg min; and group 5: lidocaine as in group 3 and dopamine as in group 4. For the dopamine-treated groups, 2 min of infusion was allowed; in all other groups, 5 min elapsed after injection before the hemodynamic data were recorded. The hemodynamic data were collected at esophageal temperatures of 25, 30, and 37°C.The findings were: (1) hypothermia impaired cardiovascular function; (2) lidocaine and propranolol had minimal hemodynamic effects during hypothermia; lidocaine was physiologically more desirable than propranolol; (3) dopamine, alone or combined with lidocaine, reversed the cardiovascular depression from hypothermia; the improvement was equivalent to rewarming by as much as 5°C; and (4) at the completion of rewarming, cardiovascular recovery was more complete with dopamine/lidocaine-treated animals compare to untreated and propranolol-treated animals. Based on these findings, these inotropes appear to be safe adjuncts to resuscitation during hypothermia.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The hemodynamic effect of dobutamine infusion (DI) was studied in 19 patients with septic shock. DI resulted in hemodynamic improvement as indicated by a significant increase in cardiac index (+36%,p< 0.001), stroke index (+15%,p< 0.01), mean arterial pressure (+20%,p< 0.01), and a significant decrease in avDo2(-27%,p< 0.01). This hemodynamic improvement occurred concomitantly with a fall in both right and left filling pressures. Mean systemic arterial resistance remained unchanged with a scatter of individual responses depending on other factors, such as infusion rate, initial vascular resistance, and underlying hemodynamic setting.In patients mechanically ventilated, venous admixture in the lung (Qs/Qt) during DI increased significantly (+30%,p< 0.001) and insignificantly reduced Pao2, but this adverse effect was not observed when PEEP was used in patients mechanically ventilated.It is concluded that dobutamine can be useful in management of septic shock, particularly when filling pressures are high because of fluid overload or cardiac failure.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID