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:

Background/ObjectiveTo assess effective alternate care sites for the technology-dependent, but less acute critically ill child, we surveyed pediatric training programs to determine the availability and characteristics of non-neonatal pediatric intermediate care units.MethodsA questionnaire was mailed to the program directors of all 226 United States pediatric residency programs in October 1988. Institutions were queried about pediatric residency program and hospital demographics, along with specific day-to-day management issues in an intermediate care unit.ResultsThe intermediate care unit offers highly skilled nursing care with >90% of the units primarily covered by RNs in a 1:2 or 1:3 RN/patient ratio. The technologies used in these units were similar to those technologies used in an ICU, and the average daily bed charge 'was 40% less than the average daily bed charge in an ICU. However, an intermediate care unit was present in only 33% of pediatric training programs and pediatric residents were not specifically trained to care for patients in these units; 37% of these units did not have daily attending physician/nurse/resident rounds, despite the complexity and degree of illness in the patients located in these units. In addition, >20% of intermediate care units were predominantly staffed by RNs with degrees less than BSN. Thirteen percent of these units had a predominance of RNs with only routine experience.ConclusionsStandard levels of care and academic and financial guidelines should be established to optimize the value of pediatric intermediate care units.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveWe studied the pharmacokinetics of dopamine in hemodynamically stable children.DesignProspective clinical trial.SettingPediatric ICU.PatientsChildren (age 3 months to 13 yrs) recovering from cardiac surgery or shock.InterventionPlasma dopamine concentrations were measured at the steady state or at termination of infusion using high-performance liquid chromatography.ResultsThe half-lives of distribution and elimination were 1.8 ± 1.1 and 26 ± 14 (SD) mins, respectively. The apparent volume of distribution was 2952 ± 2332 mL/kg. The clearance rate was 454 ± 900 mL/kg-min. Dopamine clearance was linearly related to dose only in patients who were also receiving dobutamine (r2= .76,p< .05). Hepatic and renal dysfunction did not affect the pharmacokinetics of dopamine.ConclusionsA relationship between dopamine and dobutamine that affects the disposition of these two drugs may exist. The pharmacokinetics of dopamine are variable even in hemodynamically stable children. Hepatic or renal function does not adversely affect the pharmacokinetics of dopamine.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveAnimal studies have shown an aortic-carotid artery pressure difference during cardiopulmonary resuscitation (CPR), which compromises cerebral perfusion. This pressure difference is most marked with prolonged CPR and can be abolished with administration of high doses of epinephrine. To better understand the mechanism of cerebral blood flow during CPR in humans, we determined the aortic-carotid artery pressure difference, the cephalic perfusion pressure (the carotid artery-jugular vein pressure difference), and thoracic inlet venous “valving” (the central venous-jugular vein pressure difference), while administering standard doses of epinephrine.DesignProspective study with randomization as to which side the carotid artery was catheterized.SettingThe resuscitation room of a large urban hospital's emergency department.PatientsFifteen adults in normothermic, nontraumatic prehospital cardiac arrest treated according to Advanced Cardiac Life Support guidelines, including administration of 1 mg epinephrine iv every 5 mins.InterventionsThe descending aorta, cervical common carotid artery, internal jugular vein, and central venous system were catheterized. Pressures were recorded during standard CPR for 5 mins after administration of 1 mg epinephrine iv.Measurements and Main ResultsMost patients received CPR for >20 mins before the first epinephrine dose and for >45 mins before pressure recording as described above. There was no significant difference between aortic and carotid artery compression and relaxation phase pressures. The mean ± SD compression central venous-jugular vein pressure difference was 22.1 ± 15.0 mm Hg, and the mean cephalic perfusion pressure was 20.8 ± 19.5 mm Hg.ConclusionsThere is no clinically important aortic-carotid artery pressure difference during human CPR using the standard dose of epinephrine, even with prolonged CPR. Despite carotid artery patency and thoracic inlet venous valving, the cephalic perfusion pressure is low during CPR in humans.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo compare percutaneous tracheostomy with conventional operative tracheostomy.DesignRandomized clinical trial.SettingThe medical and surgical critical care units of a large, tertiary-care, private hospital.PatientsTwenty-five male and 21 female translaryngeally intubated patients with respiratory failure, in whom tracheostomy was indicated on clinical grounds, were randomly assigned to one of two groups.InterventionsThe 24 patients in group 1 underwent conventional operative tracheostomy, and the 22 patients in group 2 underwent percutaneous tracheostomy. One patient in group 2 required tracheostomy on three separate occasions during a prolonged hospital stay.Measurements and Main ResultsPatients were examined daily throughout their hospital stays for adverse events related to the tracheostomy. In all patients who survived until decannulation, plain tomography of the trachea was performed within 3 days of decannulation. Repeat physical and tomographic examinations were performed 6 and 12 wks later.Fifty-eight percent (14/24) of the operative tracheostomies were associated with at least one complication, compared with 25% (6/24) of the percutaneous tracheostomies (p< .05, 95% confidence interval 7% to 59%). Predecannulation problems were more frequent in group 1 patients than in group 2 (46% vs. 13%, respectively;p< .01, 95% confidence interval 9% to 57%), as were later sequelae (88% vs. 27%;p< .05, confidence interval 26% to 96%) in survivors. Group 1 patients were more likely to have multiple complications, and their complications tended to be more serious.ConclusionIn this study, percutaneous tracheostomy appeared to be superior to the conventional operation.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo determine the accuracy of in vivo mixed venous hemoglobin saturation (S&OV0456;o2) measurements with a fiber optic thermodilution catheter during acute changes in hematocrit.DesignComparison of fiberoptic in vivo S&OV0456;o2values with in vitro S&OV0456;o2values obtained with a multiwavelength spectrophotometer.SettingOperating room in a university hospital.PatientsSix consecutive patients who are Jehovah's Witnesses.Measurements and Main ResultsBefore and after each step of hypervolemic hemodilution and after every 500 mL of blood loss, blood gases were analyzed and hemodynamic, hemoglobin, hematocrit, and in vitro and in vivo S&OV0456;o2measurements were made. Hematocrit values were measured in the range of 40% to 18%. Plotting all in vivo S&OV0456;o2values (n = 74) against the in vitro S&OV0456;o2measurements obtained during the entire study period gives r2= .86. The accuracy of in vivo S&OV0456;o2measurements was not affected by changes in hematocrit or cardiac output. The S&OV0456;o2catheter value at the beginning of the study differed from the in vitro S&OV0456;o2value by −0.86 ± 2.56% and at the end of the study period of 8 to 10 hrs by 0.71 ± 3.04%.ConclusionsThe accuracy of the studied fiberoptic continuous measuring S&OV0456;o2system was not affected by changes in hematocrit or cardiac output. No significant drift in the in vitro S&OV0456;o2measurements was observed.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo assess the thermogenic response of dopamine at three different infusion rates and to analyze its effects on various biochemical variables.DesignRandomized sequential experimental treatment bracketed by control periods.PatientsEight young healthy male volunteers with normal body weight (51 to 89 kg).InterventionsThree experimental periods during which dopamine was administered iv in a randomized order at rates of 2.5, 5, or 10 μg/kg·min with one preinfusion baseline and two recovery periods in between.Measurements and Main ResultsA significant (p< .01) increase in resting energy expenditure was observed in response to the two highest dopamine infusion rates (5 and 10 μg/kg·min), corresponding to 6% and 15% median increases, respectively, as compared with preinfusion values. At the lowest dopamine infusion rate, no variation in resting energy expenditure was observed. Dopamine induced a significant (p< .01) increase in hyperglycemia at all three infusion rates, and, at the highest infusion rate, dopamine induced a significant (p< .05) increase of plasma free fatty acid concentrations. Insulin plasma concentrations were significantly (p< .05 top< 0.1) increased at the three dopamine infusion rates.ConclusionsDopamine infusion produces a dose-dependent thermogenic effect and induces various metabolic actions in man.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID