ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine the effectiveness of cardiopulmonary rescucitation (CPR) in the pediatric intensive care unit (ICU).DesignA nonconcurrent cohort study of consecutive admissions.SettingThirty-two pediatric ICUs.PatientsConsecutive admissions to 32 pediatric ICUs.InterventionsNone.Measurements and Main ResultsPediatric ICU patients were followed for the occurrence of a cardiopulmonary arrest (external cardiac massage for at least 2 mins). Patients who were in a state of continuous cardiopulmonary arrest on admission, or who never achieved stable vital signs, were excluded from the study.30 mins, the survival rates were 18.6%, 12.2%, and 5.6%, respectively (linear trend p = .022). Thirty-five (17.1%) patients had a cardiopulmonary arrest before pediatric ICU admission and another arrest in the pediatric ICU. Only two (5.7%) of these 35 patients survived to discharge. Pediatric ICU survival decreased as the number of pediatric ICU arrests increased. Patients with one arrest (n = 155), two arrests (n = 29), and more than three arrests (n = 21) experienced survival rates of 14%, 14%, and 9.5%, respectively. Severity of illness, as measured by the Pediatric Risk of Mortality III score, was a significant predictor of survival (p < .001).ConclusionsPediatric ICU cardiac arrest is an uncommon event. When it does occur, prehospital CPR, duration of resuscitation, traumatic etiology, and severity of illness are important factors associated with survival. (Crit Care Med 1997; 25:1951-1955)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo test the hypothesis that adult sheep pretreated with polymyxin-dextran and then made septic by cecal ligation and perforation would have fewer changes in microvascular integrity and cellular architecture in extrapulmonary organs.DesignProspective, randomized, double-blind, placebo-controlled animal study.SettingAn animal research facility in a university-affiliated hospital.SubjectsMature, male Suffolk sheep (32 to 67 kg).InterventionsAnimals with chronic indwelling catheters were pretreated with polymyxin B-dextran (6 mg/kg) or placebo (dextran) and an intra-abdominal focus of infection was then produced by cecal ligation and perforation. Treatment (polymyxin B or placebo) was continued every 8 hrs for 48 hrs.Measurements and Main ResultsForty-eight hours after randomization, the polymyxin B-dextran group manifested significantly less pyrexia (p = .04), higher mean arterial pressures (p = .02), less variable serum albumin concentrations (p = .05), and a trend toward decreased lactate concentrations (p = .10). Qualitative morphometry and semiquantitative scoring of tissue from gastrocnemius muscle demonstrated that polymyxin B-dextran-treated sheep had significantly increased total capillary (p = .04) and capillary luminal areas (p = .038) and less mitochondrial swelling and damage (p = .03) compared with the placebo sheep.ConclusionsPretreatment of sheep in a polymicrobial, peritonitis model of sepsis with polymyxin B-dextran resulted in a significant amelioration of sepsis-induced ultrastructural damage. In placebo-treated control animals, these ultrastructural lesions were associated with a greater severity of sepsis, as measured by the presence of pyrexia, increased lactate concentrations, and less stable blood pressures. These findings justify the investigation of the effects of polymyxin B-dextran in a post onset model of sepsis. (Crit Care Med 1997; 25:1956-1961)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

ObjectiveTo determine if body mass Index (BMI = weight [kg]/height [m]2), predictive of mortality in longitudinal epidemiologic studies, was also predictive of mortality in a sample of seriously ill hospitalized subjects.DesignProspective, multicenter study.SettingFive tertiary care medical centers in the United States.Patientsor=to18 yrs of age who had one of nine illnesses of sufficient severity to anticipate a 6-month mortality rate of 50% were enrolled at five participating sites in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT).InterventionsNone.Measurements and Main Resultsor=to85th percentile) was not significantly related to risk of mortality.ConclusionsBody mass index, a simple anthropometric measure of nutrition employed in community epidemiologic studies, has now been demonstrated to be a predictor of mortality in an acutely ill population of adults at five different tertiary centers. Even when controlling for multiple disease states and physiologic variables and removing from the analysis all patients with significant prior weight loss, a body mass index below the 15th percentile remained a significant and independent predictor of mortality. Examination of patient vs. proxy data did not change the results. Future studies examining variables predictive of mortality should include body mass index, even in acutely ill populations with a poor probability of survival. (Crit Care Med 1997; 25:1962-1968)

ISSN:0090-3493    

出版商:OVID    

年代:1997

数据来源: OVID