摘要:

The hospital records of 7 patients with severe bronchopulmonary dysplasia (BPD) were reviewed. All patients were ventilator dependent for prolonged periods (mean duration intermittent mandatory ventilation (IMV) 14.3 ± 3.5 months) but eventually were successfully weaned from mechanical ventilation and sent home. The early phase of the disease was characterized by excessive CO2retention, tachypnea, and inability to tolerate reductions in IMV. A turning point was reached halfway through the course of mechanical ventilation (7.3 ± 1.4 months) which was identified by a persistent and significant reduction in Paco2and spontaneous respiratory rate. Thereafter, gradual reductions in IMV were generally well tolerated. Average monthly weight gain was less prior to the turning point than it was subsequently.

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:

Arterial blood gases, pulmonary mechanics, lung volume measurements and clinical profiles were determined pre and postextubation in 19 infants recovering from respiratory disease. This study evaluated clinical and physiological factors which may be valuable in predicting successful extubation in neonates. Of the 19 patients, 4 required reintubation within 72 h. In this group of patients, the combined profile of low birth weight (1050 g), low gestational age (31 weeks), and high pulmonary resistance (inspiratory 278 cm H2O/L · sec, expiratory 309 cm H2O/L · sec) was significantly different from the 15 patients who were successfully extubated. In addition, lower pHaafter extubation was also characteristic of those infants requiring reintubation.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Sodium nitroprusside (SNP) is known to inhibit platelet aggregation and has been implicated in postoperative hemorrhagic complications. Because it is a useful agent for treating postoperative hypertension and low cardiac output in the cardiac surgical patient, the authors retrospectively reviewed the course of 53 patients undergoing open heart procedures on cardiopulmonary bypass.Twenty-three patients received SNP and 30 did not. There were no differences in baseline hematological or clotting profiles, liver functions, bypass or cross-clamp times or heparin/protamine requirements between the two groups.Analysis revealed no significant differences between the groups in blood product requirements, actual mediastinal drainage, or postoperative measurements of routine clotting parameters.Although biochemical inhibition of platelet aggregation can be demonstrated, the use of SNP in the cardiac surgical patient has no apparent clinical effects which should detract from its utility in treating hypertension or low cardiac output.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Renal and hemodynamic effects of furosemide were studied in 30 patients with acute myocardial infarction. When marked congestion of lungs was absent, the effects of furosemide were somewhat different from those of recent reports. The changes of pulmonary arterial pressure and wedge pressure were biphasic; there was first pressure rise in many occasions followed by reduced pressure; the latter is commonly believed to be the beneficial effect of furosemide. In these patients without marked congestion but in an acute state of myocardial infarction, within 5 min of furosemide administration, there was marked increase in urine volume, sodium and potassium excretion along with increases in creatinine clearance which is commonly found in the other conditions, but is in contrast to the recent reports on patients with acute myocardial infarction complicated with pulmonary congestion.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The authors evaluated the effectiveness of 6% hydroxyl-ethyl starch (hetastarch) solution for treatment of hypovolemia in 46 critically ill patients. Thirty-two of the patients were studied retrospectively and in 14 patients, cardiopulmonary variables were prospectively measured. A total of 29 patients were in shock secondary to hypovolemia (13), sepsis (13), or myocardial infarction (3). Average hetastarch infusion volume was 829 and 842 ml, respectively, in prospectively and retrospectively studied patients, with maximum volumes of 2000–2500 ml infused over 48 h. Approximately 30% of 24 h fluid needs were supplied with colloids.Infusion of 500 ml of hetastarch in 14 prospective study patients was associated with increases in pulmonary artery wedge pressure (WP) from 9 ± 1.5 to 12 ± 2.1 mm Hg, cardiac index (CI) from 2.9 ± 0.2 to 3.5 ± 0.3 (p< 0.05) along with an increase in mean arterial pressure (MAP) from 87–99 mm Hg and reduction in arteriovenous O2difference [C(a-v)o2] from 4.9 to 4.2 ml/dl. Intrapulmonary shunt (Qsp/Qt) was similar (20 vs. 21% as were alveolar-arterial O2gradient [P(A-a)o2] (165 vs. 158 torr), whereas O2consumption (Vo2) increased from 224 to 247 ml/min. Immediate survival was 90% in shock patients and 100% in nonshock patients, whereas hospital survival was 65.5% and 88%, respectively. The authors conclude that hetastarch is an effective fluid for resuscitation of hypovolemic patients. This synthetic colloid does not appear to adversely affect pulmonary function.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

The authors studied 86 consecutive patients admitted to the ICU after severe head trauma. Of these, 19 nondiabetic patients developed persistent nonketotic hyperglycemia (NKH), defined as plasma glucose greater than 270 mg/dl (15 mM/L), 1.7 ± 1.1 (SD) days after injury. When NKH occurred, all patients were in very deep coma (Glasgow Coma Scale score 3), and when intracranial pressure (ICP) was measured (12 patients), its mean value was 59.8 ± 20.4 mm Hg. Although 11 of 19 patients had associated diabetes insipidus (DI), NKH was not related to increased fluid and glucose loading. All patients with NKH died (mean time of survival after NKH was 2.1 ± 1.4 days) in contrast to a 17.1% early mortality rate in patients with severe head injury without NKH. The authors could not show a direct correlation between the height of ICP and the level of blood glucose.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

After the induction of ventricular fibrillation (VF) in 29 animals, ECGs were serially recorded to determine whether a very low amplitude or a straight line ECG could occur in some leads while coarse fibrillatory waves were present in the other leads. Ventricular fibrillation was electrically induced via a transvenous catheter electrode advanced into the right ventricle in the initial group of 11 animals. Five of the 11 had straight line ECGs recorded in lead aVR or aVL whereas coarse VF was present in the other frontal plane leads. In the second group of 7 animals, VF was induced by placing one needle electrode into the apex of the left ventricle and the other in the opposite chest wall. Two of the 7 had straight line recorded in either aVR or aVF. In the last 11 animals, regional ischemia followed by reperfusion was induced by ligation and release of the coronary arteries. Spontaneous VF occurred after coronary occlusion and reperfusion in 8 and was electrically induced in 3. None of these 11 animals had a straight line recorded in any of the frontal leads after the first 2 min of VF. VF was terminated at 2 min in these animals by direct current defibrillation. One of the animals refibrillated 10 min after defibrillation. This animal had serial frontal plane ECGs at 1-min intervals during the 11 additional min of VF. A straight line was recorded in aVL in each of the sets of frontal plane leads.These observations lead us to conclude that VF may not always be caused by numerous small reentry ringlets of depolarization but may occur with larger irregular waves of depolarization, producing an electrical vector. The direction of the depolarization waves may depend upon the site of initiation. The result of this vector is an electrical null plane that can produce the ECG appearance of ventricular standstill in one lead while coarse fibrillatory waves are present in others.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Interstitial fluid potassium ion activity (IF K+) may be an accurate indicator of adequacy of cellular perfusion because normal transmembrane K+gradient appears to be related to oxygen-dependent energy supply, and with a large gradient, even a small absolute increase in IF K+may represent an easily detected percentage increase in that compartment. Ion sensitive field effect transistor (ISFET) devices combine integrated circuit and ion selective electrode technology to produce electrochemical sensors which are sufficiently small, rugged, and biocompatible to allow placement in the interstitium for continuous in vivo monitoring in unparalyzed subjects.K+ISFETs were mounted at the tips of 19 gauge vascular catheters. In each of 10 dogs, 1 such probe was inserted in a central vein and another was surgically placed between medial thigh muscle fascicles. Shock (MAP = 40 mm Hg) was produced and maintained for 1 h by exsanguination into citrated blood bags. Shed blood was then reinfused. Continuous monitoring of arterial pressure, serum potassium activity (S K+) and IF K+v and intermittent determinations of cardiac output (thermodilution) and S K+(off-line clinical analyzer) were continued for another 5 h. Mean IF K+rapidly and monotonically increased from a control value of 3.6 to 5.1 mEq/L after 1 h of shock (p< 0.005), and then temporarily returned to a value indistinguishable from control within 2 h after resuscitation. During most of these same intervals and events, variations in S K+were statistically indistinguishable (p> 0.05) from control values.It is concluded that ISFET probes can reliably and continuously monitor IF K+in vivo for extended intervals. The consistently observed increase in IF K+in response to hemorrhage, a phenomenon invisible systemically (S K+), suggests that such probes may provide clinically valuable information regarding perfusion related events at the cellular level during onset of and resuscitation from hypoperfusion states.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Cardiac output (Q) was measured with the thermodilution technique at 4 points during the respiratory cycle in dogs. Boluses of an ice-cold solution were injected at mid- and end-inspiration while the animals were on intermittent positive-pressure ventilation (IPPV) or after induction of positive end-expiratory pressure (PEEP), with and without induction of experimental respiratory failure. Values were most constant at end-inspiration. During IPPV without respiratory failure, the standard error of 74 measurements at end-inspiration was 5.1% and of 74 measurements randomly selected was 9.8%. Continuous infusion resulted in similar fluctuations in Q (r = 0.92). Values obtained during experimental respiratory failure were not significantly different.The authors conclude that timing the bolus injections with the respiratory cycle enhances the reproducibility of Q values obtained with the thermodilution technique.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID