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:

ObjectiveTo evaluate the role of amino acid profiles in septic encephalopathy.DesignRetrospective analysis.SettingMedical wards and medical ICU of a university hospital.PatientsPatients with infections and normal mental status were compared with patients with septic shock and altered sensorium.InterventionsPlasma amino acid levels and Acute Physiology and Chronic Health Evaluation (APACHE II) scores were determined.Measurements and Main ResultsPatients with septic shock and altered sensorium had higher circulating concentrations of ammonia (425 ± 55 vs. 127 ± 7 mmol/L) and the aromatic amino acids phenylalanine (122 ± 19 vs. 74 ± 3 mmol/L) and tryptophan (97 ± 7 vs. 32 ± 13 mmol/L), and lower levels of the branch-chain amino acid isoleucine (48 ± 7 vs. 68 ± 5 mmol/L) than patients with infections and normal sensorium (p< .05). Aromatic amino acid levels correlated with APACHE II scores (r2= .4,p< .001) and mortality. APACHE II scores were higher in the septic shock patients (30 < 2 vs. 8 < 1,p< .001), and these patients had a higher mortality rate (71% vs. 12%,p< .01). Patients with septic shock who died had higher levels of ammonia (524 ± 58 vs. 227 ± 40 mmol/L,p± .05) and sulfur-containing amino acids (172 ± 31 vs. 61 ± 7 mmol/L,p< .05) than patients who survived.ConclusionsPlasma amino acid profiles appear to be important in septic encephalopathy and the severity of septic disease. (Crit Care Med 1991; 19:753)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo study efficacy and safety of hypertonic saline administration in the management of hyponatremic seizures.DesignRetrospective, observational, cross-sectional study with factorial design.SettingIn-patient population in a university hospital.PatientsAll children admitted with serum sodium concentrations <125 mmol/L. Sixty-nine episodes of severe hyponatremia in 60 children were reviewed. Forty-one of these children presented with seizures.InterventionsTwenty-five of 41 seizure patients received an iv bolus of 4 to 6 mL/kg body weight of 3% saline. Twenty-eight patients were treated with a benzodiazepine and/or phenobarbital with or without the subsequent administration of hypertonic saline.Measurements and Main ResultsThirteen treatment failures and ten instances of apnea occurred among the 28 patients treated with benzodiazepine/phenobarbital. Administration of hypertonic saline resulted in resolution of seizures and apnea in all cases. Those patients receiving 3% saline had a higher serum sodium increase rate from 0 to 4 hrs than the remaining patients (3.1 ± 1.3 vs. 1.7 ± 1.2 mmol/L-hr, p < .01). None developed subsequent neurologic deterioration or clinical manifestations of osmotic demyelination syndrome.ConclusionTreatment of hyponatremic seizures with routine anticonvulsants may be ineffective and is associated with a considerable incidence of apnea. A rapid increase in the serum sodium concentration by 3 to 5 mmol/L with the use of hypertonic saline is safe and efficacious in managing acute symptomatic hyponatremia. (Crit Care Med 1991;19:758)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo examine the possibility that nosocomial pneumonias might be caused by the translocation of enteric bacteria and their toxins.DesignProspectively collected previous database was examined by logistic regression analysis.SettingUniversity medical center.PatientsSixty-two ICU patients.Measurements and Main ResultsThe best stand-alone predictors for nosocomial pneumonia were bleeding from stress ulceration (p< .001), the severity of illness present (p< .001), and intramucosal acidosis in the stomach (p= .023), a metabolic indication of mucosal ischemia. Mechanical ventilation (p= .038) and the administration of antacids/cimetidine (p= .054) were also of stand-alone predictive value, but did not significantly improve the best predictive model for nosocomial pneumonia derived from the severity of illness present and the intramucosal pH in the stomach.ConclusionsThe findings are consistent with the hypothesis that ischemic mucosal injury and its associated translocation of enteric bacteria and toxins might be more important in the pathogenesis of nosocomial pneumonia in the critically ill than the aspiration of contaminated nasopharyngeal secretions. (Crit Care Med 1991; 19:763)

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo investigate whether oxygen consumption (&OV0312;o2) is dependent on oxygen delivery (&U1E0A;o2) in adult respiratory distress syndrome (ARDS) and non-ARDS acute respiratory failure.DesignIntervention study of a consecutive sample of patients admitted to the ICU with the diagnosis of acute respiratory failure.SettingTertiary care center.PatientsThirteen consecutive patients with a diagnosis of ARDS and 11 with a diagnosis of respiratory failure not due to ARDS. Patients were monitored with an oximetric pulmonary artery catheter and mechanically ventilated.Interventions&U1E0A;o2was decreased by the application of positive end-expiratory pressure (PEEP) (20 cm H2O), and subsequently increased by an iv infusion of dobutamine (10 μg/kg-min).ResultsAfter the application of PEEP, &U1E0A;o2decreased significantly in both groups. However, &OV0312;o2decreased significantly (p< .01) only in the ARDS group. When dobutamine was infused, &U1E0A;o2increased significantly (p< .01) in both groups, but &OV0312;o2increased only in ARDS patients. &U1E0A;o2correlated significantly with &OV0312;o2both in ARDS (r2= .81,p< .01) and in non-ARDS (r2= .38,p< .05) patients. The correlation coefficient was significantly higher for ARDS than for non-ARDS patients. Comparing the slopes of the regression lines, a stronger dependency of &OV0312;o2on &U1E0A;o2was found in ARDS than in non-ARDS respiratory failure (p< .001). The oxygen extraction ratio correlated with &U1E0A;o2in non-ARDS patients (r2= .49,p< .05), but not in ARDS patients.Conclusions&OV0312;o2is dependent on &U1E0A;o2over a wide range of &U1E0A;o2values in acute respiratory failure. This dependency phenomenon is much stronger in ARDS than in respiratory failure due to the causes. Due to the abnormal dependency of &OV0312;o2on &U1E0A;o2, changes in the oxygenation status may not be reflected by changes in mixed venous oxygen saturation in ARDS.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo measure whole-body lipolysis and fatty acid re-esterification in critically ill patients.DesignThe rates of appearance of glycerol and palmitic acid in blood plasma were measured by infusing stable isotope tracers [2H5]glycerol and [1-13C]palmitic acid, respectively. Energy expenditure was measured by indirect calorimetry.SettingMedical ICU of The University of Texas Medical Branch Hospital, a universitybased referral center.PatientsFive uninjured critically ill patients. Four patients were hospitalized because of respiratory insufficiency and one because of myocardial infarction. Three patients died during their hospitalization.InterventionsMetabolic studies were performed in each patient after an overnight (12-hr) fast.Measurements and Main ResultsMean ± SE glycerol and fatty acid rates of appearance were 4.5 ±1.0 and 11.5 ± 0.8 umol/kg-min, respectively. The ratio of fatty acid to glycerol rate of appearance was 2.9 ± 0.5. Resting energy expenditure was 132 ± 6% of predicted.ConclusionsAn accelerated rate of lipolysis is part of the metabolic response to severe stress, regardless of its etiology. Because the rate of fatty acid release far exceeded energy requirements, fatty acids that were not oxidized as fuel were re-esterified to triglyceride, presumably in the liver.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

ObjectiveTo recognize cardiac stun syndrome and electromechanical dissociation in patients receiving extracorporeal membrane oxygenation (ECMO), and to define patients at risk.DesignRetrospective review.SettingTertiary neonatal ICU.PatientsFour newborn patients with car-diorespiratory failure who developed signs of cardiac stun syndrome and electromechanical dissociation early in the ECMO course.Measurements and Main ResultsInitially, these patients had metabolic acidosis, chest roentgenograms showing pulmonary granularity and moderate cardiomegaly, and symptoms of severe respiratory distress. Cardiac dysfunction was apparent after ECMO was begun, with poor perfusion, pale color, narrow pulse pressure, and tachycardia despite normovolemia. Within 1 to 2 hrs, electromechanical dissociation occurred manifested by the absence of pulse pressure, palpable pulse, cardiac sounds, and apical impulse while on 50% to 70% bypass. All patients survived.InterventionsPatients received ECMO, calcium gluconate, sodium bicarbonate, and dobutamine.ConclusionsPatients with cardiac stun syndrome have symptoms similar to severe respiratory distress syndrome, and may require ECMO support. In the ECMO patient, cardiac stun syndrome and electromechanical dissociation can be confused with low circuit volume, pneumothorax, or cardiac tamponade. Early recognition of electromechanical dissociation may improve care and outcome. Cardiac stun syndrome can be treated successfully with ECMO.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID

摘要:

Background and MethodsPreviously, we documented that nonlethal doses of endotoxin injure the intestinal mucosal barrier and promote bacterial translocation from the gut to systemic organs. The current study was performed to determine the role of cytokines and complement activation in the pathogenesis of endotoxin-induced mucosal injury and bacterial translocation, as well as to quantify the magnitude of endotoxin-induced intestinal mucosal permeability.ResultsThe frequency of endotoxin-induced bacterial translocation was similar between normal outbred (88%), complement deficient (67%), and macrophage-hyporesponsive (55%) mice, indicating that neither complement nor macrophage activation is necessary for endotoxin-induced bacterial translocation to occur. As early as 2 hrs after endotoxin challenge, there was evidence of a greater than two-fold increase in ileal (p= .008) but not jejunal (p= .11) permeability as measured by the clearance of51Cr EDTA. Both the increase in endotoxin-induced ileal permeability and the occurrence of bacterial translocation were largely prevented by pretreatment with allopurinol, a competitive inhibitor of xanthine oxidase.ConclusionsThese results suggest that endotoxin-induced bacterial translocation, mucosal injury, and ileal permeability are mediated via activation of xanthine oxidase, and not through complement activation or the liberation of macrophage products.

ISSN:0090-3493    

出版商:OVID    

年代:1991

数据来源: OVID