ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Objective.To determine the hemodynamic effects of maintaining atrioventricular synchrony during emergency cardiac pacing in critically ill patients.Design.Prospective, within patient double-blind study.Setting.ICU or coronary care unit patients in a university hospital.Patients.Forty (23 cardiac surgery, ten acute myocardial infarction, and seven general intensive care) seriously ill patients with severe symptomatic bradycardia.Intervention.Initial randomization of patients to receive either a pacing mode where atrioventricular synchronization was maintained (atrioventricular pacing: atrial demand, atrioventricular sequential, atrioventricular universal) or a mode of pacing where atrioventricular synchrony was not preserved (ventricular demand pacing).Measurements and Main Results.The cardiac output increased from a mean of 4.5 ± 1.7 L/min (95% confidence intervals: 4.0 to 5.0 L/min) during ventricular demand pacing to 5.3 ± 1.7 L/min (95% confidence intervals: 4.9 to 5.9 L/min) during atrioventricular pacing (p< .0001) despite trivial decreases in CVP from 14 ± 4 mm Hg (95% confidence intervals: 13 to 15 mm Hg) to 13 ± 5 mm Hg (95% confidence intervals: 12 to 15 mm Hg) and pulmonary artery occlusion pressure from 18 ± 5 mm Hg (95% confidence intervals: 16 to 20 mm Hg) to 17 ± 5 mm Hg (95% confidence intervals: 15 to 18 mm Hg). At the same time, mean arterial pressure (MAP) increased from 74 ± 15 mm Hg (95% confidence intervals: 64 to 79 mm Hg) to 83 ± 15 mm Hg (95% confidence intervals: 80 to 88 mm Hg) and left ventricular stroke work index from 22 ± 10 g.m/m2(95% confidence intervals: 19 to 25 g.m/m2) to 30 ± 11 g.m/m2(95% confidence intervals: 26 to 33 g.m/ms). There was no significant change in mean pulmonary artery pressure, pulmonary vascular resistance index, or systemic vascular resistance index.Conclusion.When cardiac pacing is required in critically ill patients, maintaining atrioventricular synchrony increases stroke volume, cardiac output, and MAP apparently with minimal effects on preload and after-load. (Crit Care Med 1991; 19:320)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Objective.To compare vital sign and urine output monitoring of seriously burned patients with invasive monitoring during early resuscitation.Design.Retrospective review.Setting.A university hospital burn unit.Patients.Fourteen seriously burned patients who had pulmonary arterial monitoring. Monitoring data were compared at baseline and after fluid challenges.Results.There was no correlation between invasively derived physiologic variables and vital signs and urine output. Vital signs and urine output changed little after fluid challenge, while variables from invasive monitoring demonstrated significant change. In half of the patients, oxygen consumption increased after fluid challenge; vital signs and urine output did not distinguish these patients.Conclusions.The use of urinary output and vital signs to guide initial burn resuscitation may lead to suboptimal resuscitation. Invasive cardiorespiratory monitoring may be necessary to optimize resuscitation of seriously burned patients. (Crit Care Med 1991; 19:327)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Objective.To evaluate the frequency and significance of aspiration and its clinical importance in patients with upper GI bleeding undergoing esophagogastroduodenoscopy in the ICU.Design.Thirty consecutive patients with active and severe upper GI bleeding were studied.Setting.ICU.Patients.Ranged in age from 20 to 78 yr with an equal number of males and females.Interventions.All patients had continuous pulse oximetry monitoring and had chest radiographs obtainedMeasurements.Six (20%) of 30 patients developed new lung infiltrates after esophagogastroduodenoscopy. In this group of patients, preendoscopy chest radiographs were obtained afterConclusion.Clinically significant aspiration pneumonia frequently complicates esophagogastroduodenoscopy in upper GI bleeding patients and is an important mechanism of esophagogstroduodenoscopy-induced hypoxia. (Crit Care Med 1991; 19:330)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Objective.To evaluate the efficacy and duration of action of iv isradipine in the control of postoperative hypertension immediately after myocardial revascularization.Design.Prospective, phase 2 trial.Setting.Surgical ICU, university hospital.Patients.Twenty-one (15 male, six female) patients, ages 49 to 75 yr (mean 65 ± 5), undergoing elective myocardial revascularization.Interventions.Twenty-one patients with postoperative hypertension after coronary artery bypass graft surgery received iv isradipine, a new dihydropyridine calcium-channel antagonist. Mean duration of the isradipine infusion was 96.9 ± 29 min. Mean dose of isradipine, indexed to weight, was 16.63 ± 6.66 μg/kg (n = 20).Measurements and Main Results.Twenty of the 21 patients achieved satisfactory BP control. The reduction in mean arterial pressure (MAP), first noted at the 15-min point, was maximal at 1 hr when MAP decreased from 102 ± 9 mm Hg baseline to 81 ± 5 mm Hg (p< .01), accompanied by a significant (p< .01) decrease in systemic vascular resistance from 1753 ± 339 baseline to 1180 ± 229 dyne-sec/cm5. The CVP, pulmonary artery diastolic pressure, and pulmonary artery occlusion pressure did not change significantly. Heart rate and cardiac index increased; however, stroke volume index did not change.Conclusions.Isradipine is an acceptable agent for the treatment of hypertension in this setting. (Crit Care Med 1991; 19:334)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Objective.To describe the hospital course and outcomes of trauma patients requiring ICU stays >30 days and the charges they incur.Design.A retrospective case series analysis of data collected from patient charts and trauma registry.Setting.A Level I regional trauma center that is part of a statewide trauma system.Patients.Over a 3-yr period, 87 patients (3% of all trauma ICU admissions) had prolonged stays (>30 days) in the ICU; they constitute the study group. Blunt trauma was responsible for 90% of injuries, and the mean Injury Severity Score was 34 ± 16 SD.Results.Mechanical ventilation was required for 78.5% of the time spent in the ICU. The mean time spent on mechanical ventilators was 47 ± 23 days; in the ICU, 60 ± 27 days; and in the hospital, 72 ± 29 days. Infectious complications occurred in 90% and organ dysfunction was seen in 76% of patients. The overall mortality rate was 17.2% (31% for patients >65 yr). PatientsConclusion.Length of ICU stay was most closely associated with the need for mechanical ventilation. The presence of premorbid illness, age >65 yr, and organ dysfunction was associated with increased mortality. Although trauma patients requiring prolonged ICU stays utilize many resources, the ultimate outcome may be fairly good. (Crit Care Med 1991; 19:339)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Objective.To assess the prognosis of patients with hematologic malignancies in acute renal failure who require hemodialysis.Design.Retrospective study.Setting.ICU.Patients.Forty-three consecutive patients.Methods.Prognostic analysis using both univariate and multivariate (stepwise regression) methods.Results.Fifteen (35%) patients recovered from acute renal failure and 12 (28%) were discharged from the ICU. The prognosis of patients with acute renal failure linked to sepsis is poorer than the prognosis of the patients with acute renal failure from other etiologies. Only one patient survived in the former group (n = 26) and 11 in the latter group (n = 17);p< .0001 in multivariate analysis. When accompanied by associated respiratory failure, mortality rate was higher (93% vs. 33%;p< .0001). The Simplified Acute Physiology Score (SAPS) calculated within the first 24 hr of admission was significantly (p< .001) related to mortality when the SAPS was >13. The presence of neutropenia and the type of hematologic malignancy were not related to a worse prognosis. Tolerance to hemodialysis appeared good, and complications were rare. (Crit Care Med 1991; 19:346)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID