摘要:

To facilitate increased utility of Neonatal Intensive Care Unit (NICU) beds, we adopted a policy of early discharge (ED) of infants < 2000 g to the hospital of their birth after recovery from acute illness and when the infant was breathing room air and taking adequate oral feedings. An inservice teaching program at the primary hospitals preceded such policy. In a 24-month period, 446 infants were referred to the NICU. 111 of 446 died; 335 infants survived. 114 of 335 were infants < 2000 g at birth; 42% (48 of 114) of them were discharged early to the hospital of their birth (ED); 58% were discharged late (LD) to their homes. 59.7% of the ED and 46.3% of the LD required assisted ventilation. Gestational age, birth weight, and final weight at discharge from hospitals were the same in both groups. None of the ED infants developed complications at the hospital of birth after retransfer. The length of NICU stay for LD was significantly higher 40 ± 6 (p< 0.001) than the ED; 20 ± 2.2 days. In addition, a 15% increase in bed utilization was also noted because of ED. We conclude that ED of infants from the NICU 1) increases utilization of beds; 2) decreases the cost of health care; and 3) increases the participation of primary physicians.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100–4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown. Intracardiac pressures and oxygen saturations were measured in each chamber entered. The authors also evaluated the presence of right to left shunting through the patent ductus arteriosus and assessed the degree of pulmonary arterial hypertension. In 5 hypoxemic infants, the authors found a patent ductus arteriosus with pulmonary hypertension. Intermittent measurement of PAP served as a guide to further therapy. In 2 infants, the unexpected diagnosis of cyanotic congenital heart disease was made.The placement of flow directed pulmonary arterial catheters in critically ill infants can be performed safely at the bedside and can provide useful diagnostic and therapeutic information.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The medical records of 21 patients with smoke inhalation admitted to a medical ICU (MICU) were reviewed. Of 21 patients, 6 (29%) died. Of 21 patients, 13 (62%) had facial burns and 11 of the 13 (85%) later developed pneumonia. Only 1 of 8 patients (12%) without facial burns developed pneumonia (p< 0.005). Of the 12 patients with pneumonia, 7 required ventilatory assistance and 6 of the 7 died in the MICU. The authors conclude that the presence of facial burns is associated with the later development of pneumonia in a high percentage of cases. Pneumonia contributes significantly to the high mortality rate. The need for ventilatory assistance in smoke inhalation patients is associated with a poor prognosis.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

We measured rat brain cortex PO2(PtO2) with gold microelectrodes (tip diameter 5–10 μm) for up to 2 hours after 16 min of transient global brain ischemia with and without thiopental 90 mg/kg infused iv over 60 min beginning at 5 min postischemia. Seventeen rats were immobilized and mechanically ventilated on 1% halothane in oxygen with continuous monitoring of PtO2, ECG, end-expiratory CO2, rectal temperature, and arterial blood pressure. Global ischemia was induced by trimethaphan hypotension to an MAP of about 50 torr and a neck tourniquet inflated to 1500 torr. Postischemia, nine control rats (11 PtO2measurements) were untreated and eight rats (8 PtO2measurements) received thiopental 90 mg/kg. Preischcmia, PtO2values in both groups ranged from < 5–70 torr with values of greatest frequency between 10 and 15 torr. Postischemia, PtO2in control rats peaked at 45 ± 8 (SEM) torr at 20 min. In thiopental treated rats, peak PtO2was 24 ± 6 torr at 10 min postischemia. Relative frequency histograms of PtO2revealed that PtO2in thiopental treated rats was lower (p< 0.05) between 15 and 30 min postischemia. The magnitude of the decrease in PtO2between 105 and 120 min postischemia appeared to correlate directly with the absolute preischemic value (i.e., the higher the preischemic PtO2, the greater the decrease in PtO2postischemia). These results suggest that thiopental administered in large doses in early postischemia does not improve brain oxygenation secondary to a reduction in brain oxygen consumption. The relevance of the correlation between the magnitude of the fall in PtO2postischemia and the magnitude of the preischemic value is discussed.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Although the traditional management of aspiration of foreign bodies has been extraction with the open tube bronchoscope, an expanding array of these have now been removed with the flexible bronchofiber-scope. Accidental introduction of a foreign body into the tracheobronchial tree is a poorly recognized, but potentially common hazard of topical anesthetic preparation before endotracheal intubation. We demonstrate that this can be safely and rapidly managed by bedside fiberbronchoscopy. Circumstances favoring the use of the fiberbronchoscope for foreign body extraction are suggested.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A method of passing a pediatric feeding tube using a guide wire is explained and contrasted with current methods. This method is inexpensive, atraumatic, and easier to use than other methods tested.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The development of a bronchopleural fistula (BPF) is an infrequent, but potentially devastating complication of positive pressure ventilation. A case report is detailed in which a BPF arose in a patient on controlled ventilation with a PEEP of 22 cm H2O. Within 12 hours, fistula flow was continuous and accounted for 75% of the delivered tidal volume. PEEP fell rapidly during expiration; oxygenation steadily deteriorated as the aAO2fell from 0.27 to 0.14. Conventional treatment methods were unsuccessful, and a system was constructed for adding controlled levels of positive pressure to the pleural space on the side of the BPF. By decreasing the expiratory transpulmonary pressure difference (PEEP minus pleural pressure), the fistula leak was greatly decreased, and PEEP and oxygenation were stabilized.This system can be rapidly constructed at the bedside with equipment routinely available in most hospitals and offers the ability to adjust the expiratory transpulmonary pressure, lung volume, and BPF flow while maintaining positive pressure ventilation with PEEP.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID