摘要:

A retrospective evaluation of 350 axillary and femoral artery cannulations in ICU patients revealed a 6.3-day mean duration of catheterization. Minor incidents such as hematoma (3.7%), catheter malfunction (5.1%), and local inflammation (2.5%) were noticed. The catheter was removed in 25 patients in whom it was suspected of causing sepsis. Six septic patients had the same organism in catheter and arterial blood cultures (with a negative venous blood culture), probably denoting an infected, catheter-linked thrombus. In 241 cases the catheter was removed at the end of the monitoring period. In only 21 of these cases did an organism grow in the catheter culture, but in 18 of these cases, the same organism was found in previous blood, sputum, and/or urine cultures. Thus, in only six patients (of 266 survivors) could arterial cannulation be held responsible for generalized sepsis. However, because no bacteriologic study was performed on catheters removed after the patient's death, this number could have been higher. Percutaneous axillary and femoral artery cannulation is highly recommended for extended monitoring because of its low incidence of minor complications, and no evident danger of tissue ischemia.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Vasodilators have been reported to improve the hemodynamic status of some patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease (COPD). We investigated the effects of sodium nitroprusside (50 μg/min) and hydralazine (25 mg) on pulmonary hemodynamics in 12 patients during acute exacerbation of COPD. Apart from its known systemic effects, nitroprusside decreased significantly mean pulmonary artery pressure (MPAP) from 36 ± 10 to 31 ± 12 mm Hg (p< 0.04), decreased slightly pulmonary vascular resistance, and did not change cardiac index. Except for a slight but significant increase in MPAP from 35 ± 5 to 38 ± 5 mm Hg (p<.002), hydralazine produced no significant hemodynamic changes. These results suggest that vasodilator therapy with sodium nitroprusside and hydralazine for pulmonary hypertension secondary to acute COPD is probably not helpful.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were strictly controlled in 11 pediatric victims of near-drowning. Three outcome groups were defined: complete recovery, persistent vegetative state, and death. In the early postimmersion phase (first 72 h), CPP was consistently above 50 mm Hg in all patients. There were occasional, nonrepetitive, and easily controllable ICP spikes above 15 mm Hg in three patients from each group. Repeated ICP spikes above 15 mm Hg were observed in some patients with adverse outcome only after 72 h. Successful control of ICP and CPP did not ensure intact survival, and sustained late intracranial hypertension is more likely a sign of pro-found neurologic insult rather than its cause.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To determine the incidence of, and the factors contributing to spontaneous extubation (SE), we followed prospectively all intubated children admitted to a pediatric ICU. Eleven potential risk factors were monitored and scored twice daily for 8 consecutive months. Using data from the first 204 patient admissions, we evaluated the risk factors by orthogonal discriminant analysis and found that four factors (patient age, amount of secretions, endotracheal tube slippage, and state of consciousness), when considered together, had good discriminating power for SE vs. intentional extubation. We tested this method on the next 45 patient admissions and identified all seven spontaneously extubated patients as high risk. Analysis of covariance revealed successful discrimination between low-risk and high-risk patients for up to three days after patient admission. Overall, the incidence of SE was 13% (33 of 249). The effect of extubation on gas exchange was the same for spontaneously and intentionally extubated patients. No morbidity or deaths were attributed to SE. Standard ventilator low-pressure alarms did not reliably signal the presence of SE, nor did upper extremity restraints keep patients from extubating themselves.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To evaluate the effect of meconium on pulmonary surface tension properties, the mechanics of 30 excised, separated canine pulmonary lobes were studied. Meconia were blended in normal saline to produce solutions of 10% and 20%. Solutions were filtered to remove large particles and instilled endobronchially into the canine lobes. The static pressure-volume deflation curve of each lobe was determined before and 4 h after instillation of either normal saline or meconium solution. In the saline control group (eight lobes), the curve was essentially unchanged before and after instillation. In the 10% meconium group (14 lobes), the curve was significantly depressed after instillation, especially at a transpulmonary airway pressure of 10 cm H2O (p<.05) and 5 cm H20 (p<.005). In the 20% meconium group (eight lobes), the depression of the pressure-volume curve was essentially the same as that of the 10% solution group. It is concluded that meconium depresses the surface-active properties of the alveolar linings.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The clinical, radiographic, and pathologic correlates of acute respiratory failure due toPneumocystis cariniipneumonia were studied in 12 renal transplant patients treated with cyclosporin (CS) and prednisone. Six patients required only supplemental oxygen, while the other six patients developed the adult respiratory distress syndrome (ARDS) requiring prolonged mechanical ventilation despite similar predisposing factors and prompt initiation of therapy. Ten (83%) patients survived. Increased frequency of human leukocyte antigen (HLA) DR6 was noted in six of the 11 patients tested. The resolution of radiographic infiltrates was significantly slower in ARDS patients; however, there was no apparent difference in the severity of early alveolar damage between the two groups. There was also no association between the development of ARDS due toP. cariniipneumonia and the mean daily dose of CS and prednisone, the presence of cytomegalovirus infection or pneumonia, HLA-DR6 antigen, or initial hypoxemia.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Acute myocardial infarction is complicated by cardiac rupture in 4% to 24% of all infarction deaths, and approximately 10% of hospital infarction deaths. There are no reliable indices to determine which patients run an increased risk of cardiac rupture. This report de-scribes the surgical treatment and outcome of a patient who sustained a rupture of the left ventricular free wall, nine days after extensive anterior myocardial infarction.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A 34-yr-old male in delirium tremens required a total of 2640 mg iv diazepam for adequate sedation. Doses of benzodiazepines clearly must be individualized, and doses higher than those currently recommended may be required.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID