摘要:

In this retrospective study, we attempted to identify early in the course of septic shock hemodynamic variables that differ between survivors and nonsurvivors. We examined the records of 78 patients with septic shock from our medical ICU (40 survivors and 38 nonsurvivors). Significant differences were found in cardiac index (CI) (4.07 ± 0.25 vs. 2.98 ± 0.25 L/min m2) and oxygen delivery (DO2) (15.6 ± 0.7 vs. 12.7 ± 0.8 ml/min kg) at 48 h between surviving and nonsurviving patients. Furthermore, an analysis of the relationship between DO2and &OV0312;O2suggests a critical level of &OV0312;O2to be 15 ml/min kg. Although no difference could be detected in initial arterial lactate concentrations, levels at 48 h were significantly different between survivors and nonsurvivors (2.6 ± 0.2 vs. 4.1 ± 0.5 mEq/L, respectively).

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Fatal multiple organ failure after severe infection may be related to an early activation of protease cascade systems. This study aimed to relate changes in coagulation, fibrinolysis, and kallikrein to shock and outcome. Of 53 patients with severe infection. 30 did not develop shock, 12 survived septic shock, and 11 died from organ failure after septic shock. No patient had overt disseminated intravascular coagulation. We measured 17 components of the coagulation/fibrinolysis/kallikrein pathways on admission and on the next 2 days. High values for fibrinogen, factor VIII:C. von Willebrand factor antigen, and D-dimer were seen in all patients; factor XII, prekallikrein, factor VII, antithrombin, protein C, and fibronectin were low. The patients thus appeared to be hypercoagulable. These disturbances were more pronounced in septic shock survivors, who also had low plasminogen and antiplasmin, indicating ongoing fibrinolysis. Nonsurvivors of sepsis were distinguished mainly by high plasminogen activator inhibitor values; this suggests an impaired functional fibrinolysis in fatal sepsis, with possible therapeutic implications. Cryoprecipitate infusion increased the fibronectin concentration, but did not influence the other factors studied.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Survival of major burn injuries has improved markedly from an expected survival of 10% to 20% in both children and adults to an expected survival of 60% in children with burns >70% BSA. Increased survival for adults after similar burn injuries has been less dramatic than in children because of the profound influences of advancing age and the coexistent processes of aging upon survival after a major injury. Consecutive admissions of patients with massive burn injuries (≥70% BSA) to the Massachusetts General Hospital Adult Burn Unit from 1974 to 1986 were analyzed statistically using univariate and multiple logistic regression analysis to identify factors associated with survival and to identify patient characteristics associated with increases in expected survival. Survival of adults with massive burn injuries has improved markedly, from 24% of adults admitted to the Adult Burn Center in 1974–75 to 48% of adults admitted in 1984–86. An increased likelihood of survival was shown to be associated with the use of artificial skin. Improved survival rates in these massive burn injuries were attributed to multiple factors including wound management of prompt eschar excision and immediate wound closure.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Visceral protein levels are used as indicators of prognosis, severity of injury, and nutritional status in hospitalized patients. Clinicians often use visceral protein levels to assess efficacy of nutritional support. The purpose of this study was to test the validity of such practices. Visceral protein levels were determined in patients in a medical ICU, head injury unit, and burn unit. The serum albumin and thyroxine-binding prealbumin (TBPA) levels correlated significantly with mortality in the medical ICU patients. Burn patients had depressed albumin and TBPA concentrations over the duration of hospitalization that related to the severity of thermal injury but not to adequacy of nutritional support. Head-injured patients had depressed admission albumin and TBPA levels, with neither protein level adequately related to caloric or protein supplementation. We conclude that visceral proteins may reflect severity of injury and prognosis in critically ill hospitalized patients, but they often do not accurately reflect nutritional status or adequacy of nutritional support.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We reviewed all patients treated for intoxication in the pediatric ICU (PICU) of the Sainte-Justine Hospital over a 3-yr period. Poisoning (105 patients) constituted 3.1% of PICU admissions. Most involved children < 3 (42%) yr or >12 (33%) yr. Products most commonly ingested included tricyclic antidepressants (22%), benzodiazepines (15%), theophylline (10%), ethanol (10%), hallucinogens (8%), salicylates (8%), narcotics (8%), antihistamines (7%), and carbamazepine (5%). Three children became comatose after ingesting about 1 g of hashish. Multiple drug ingestions were frequent (22%), particularly in suicide attempts (11/23). Treatment was, in general, interventionist and nonspecific; aggressive measures for poisoning were required in only two patients who were hemodialyzed. Two patients stayed in the PICU >2 days. All patients survived with no sequelae, except for one patient who required an intestinal resection. Poisoning in children is a common occurrence leading to PICU admission: however, the medical prognosis is usually excellent.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Eighteen critically ill postoperative patients < 1 yr of age were studied to determine the pharmacokinetics and adverse effects of amrinone. All patients had undergone cardiopulmonary bypass for repair of congenital heart lesions. Plasma samples were obtained every 12 h while patients were receiving amrinone to determine when steady state was achieved; samples were also obtained within 24 h after amrinone had been discontinued. Elimination half-life (T2), clearance, and volume of distribution were calculated from plasma amrinone concentrations, and the incidence of platelet transfusion was monitored. T2(22.2 vs. 6.8 h) and clearance (1.1 vs. 2.6 ml/min kg), but not the volume of distribution (1.8 vs. 1.6 L/kg), differed significantly in patients < 4 wk of age in comparison to patients >4 wk of age. A negative correlation between T2and age (r = -.79) was observed. Platelets were administered no more frequently in study patients than in a similar group that did not receive amrinone. To achieve the plasma concentration of amrinone that is therapeutic in adults, current dosage recommendations are inadequate in neonates and infants. Infants should receive an initial iv amrinone bolus of 3.0 to 4.5 mg/kg in divided doses followed by a continuous infusion of 10 μg/kg min, while neonates should receive a similar bolus followed by a continuous infusion of 3 to 5 μg/kg rnin.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

While GI hemorrhage is a recognized complication of critical illness, nonhemorrhagic GI complications are less well described. We studied prospectively the incidence and predisposing factors of nonhemorrhagic GI complications in 124 acute respiratory failure (ARF) patients over a 13-month period. Diarrhea occurred in 51% (63/124), decreased bowel sounds in 50% (62/ 124), and abdominal distention in 46% (57/124). Patients with pneumonia as the etiology of respiratory failure had the highest number of different complications (five per ICU stay). Ileus was found more frequently in patients with a past history of liver disease (p< .03). Antacid administration was associated with a significant increase in diarrhea (p< .01), as were the combined treatments of antacids and cimetidine (p< .02).Patients with ARF have a high incidence of nonhemorrhagic GI complications. Diarrhea is the most common complication and occurs more frequently in patients who receive antacids.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

Parenteral agents for hypertension management are commonly required in the ICU. During hypertensive emergencies such as aortic dissection or intracerebral hemorrhage, or in the management of patients with essential hypertension who are not able to take their usual oral medications, parenteral antihypertensives are essential to avoid hypertensive cardiovascular injury. Intravenous agents such as sodium nitroprusside, trimethaphan, and diazoxide have been used for rapid and reliable reduction of BP in the first 24 h in the ICU. Antihypertensive therapy >24 h involves more individualization of therapy, primarily to avoid side-effects.Labetalol has been shown to be an effective parenteral antihypertensive agent, either by iv bolus (1–3) or continuous infusions of < 24 h (4). This report details successful continuous administration of iv labetalol for 6 to 9 days in three patients in a critical care setting. Labetalol should be considered as a therapeutic option in patients who require prolonged iv antihypertensive therapy.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

The effects of high dose naloxone in humans have not been studied extensively. We treated 36 patients who had acute ischemic cerebral infarction with high doses of naloxone to evaluate potential efficacy and toxicity. All patients were treated with a 160-mg/m2(4-mg/kg) loading dose followed by 80 mg/m2h (2 mg/ kg h) ± 24 h. There were no statistically significant changes in group mean arterial pressure, respiratory rate, or heart rate in response to the loading dose or infusion, although clinically significant changes did occur in four patients. Twenty-three patients had adverse reactions possibly related to naloxone. the most common of which were nausea (n = 20), bradycardia and/ or hypotension (n = 3), myoclonus (n = 1), and hypertension (n = 1). Seven patients had naloxone discontinued for possible adverse reactions. All adverse reactions abated with discontinuation of naloxone and/or phar-macologic therapy when indicated. No deaths were attributable to naloxone treatment. High dose naloxone appears to be well tolerated in the majority of elderly patients with acute cerebral infarction.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID

摘要:

We studied the effect of CPR rate on the hemodynamic indices of surgically instrumented canine experimental models. Using pneumatic vest CPR, we applied simultaneous rib cage and abdominal compressions at rates of 1 to 12 Hz. CPR with 2-Hz frequency yielded the highest aortic and coronary flows (252 ± 14 and 6.8 ± 1.1 ml/min vs. 178 + 12 and 0.96 ± 0.08 ml/min at 1 Hz, respectively:p< .005).The validity of the present American Heart Association recommendation for 1-Hz CPR rate would benefit from further studies.

ISSN:0090-3493    

出版商:OVID    

年代:1989

数据来源: OVID