ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo examine whether the antioxidant N-acetylcysteine could ameliorate the course of the adult respiratory distress syndrome (ARDS) in man.DesignRandomized, double-blind, placebo-controlled study.SettingMedical and surgical ICU in a regional hospital.PatientsSixty-six ICU patients with ARDS.InterventionsPatients with ARDS (Pao2/FIO2ratio <250 torr) were treated with either the antioxidant N-acetylcysteine 150 mg/kg as a loading dose and then 20 mg/kg/hr, or with placebo for 6 days.Measurements and Main ResultsNo improvement could be demonstrated in the Pao2/FIO2ratio in the study group as compared with the control group on any day. Pulmonary compliance was higher in the N-acetylcysteine group than in the placebo group on all days, but this difference did not reach the chosen 5% level of significance. No difference between the two groups could be demonstrated on chest radiograph or on survival rate. We documented that N-acetylcysteine acts as an anticoagulant and perhaps decreases pulmonary fibrin uptake during ARDS.ConclusionsN-acetylcysteine might be of benefit in ARDS. Before further clinical studies are started, problems with N-acetylcysteine and coagulation have to be elucidated in order to find out whether N-acetylcysteine could have a beneficial effect in the treatment of ARDS.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo evaluate a computer-based, realtime, multibreath nitrogen washout technique in mechanically ventilated patients, incorporating an in-line flow measurement device to measure functional residual capacity and two indices of gas mixing, ventilatory efficiency, and alveolar mixing efficiency.SettingICU, Charing Cross Hospital, London.DesignWithin-patient reproducibility of a multibreath nitrogen washout technique.PatientsSeven intubated patients requiring mechanical ventilation. One patient completed two sets of readings.InterventionsPatients were connected to a pneumatically driven ventilator fitted with a switching device to be operated either by an appropriate oxygen-nitrogen mixture or equivalently blended oxygen-argon mixture. An inspiratory-expiratory, two-way valve was attached to the delivery port of the ventilator, with a pneumotachograph for flow measurement and a gas sampling probe for gas concentration measurement in line with the patient's endotracheal tube. The analog signals were digitized and handled by a microcomputer.Measurements and Main ResultsNo significant differences were found for any index, with coefficients of variation of 1.5%, 2.9%, and 2.1% for functional residual capacity, ventilatory efficiency, and alveolar mixing efficiency, respectively.ConclusionsThis method gives excellent reproducibility for biological measurements in a clinical setting and shows that these measurements can readily be made on mechanically ventilated patients.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine physicians' assessment of the therapeutic effect and patient benefit of data obtained from right heart catheterization.DesignBefore/after study.SettingOne medical and one surgical academic ICU in two medical centers.PatientsA total of 107 critically ill patients with uncertain hemodynamic status.Data CollectionPhysicians looking after the patients were asked to evaluate the extent to which results of right heart catheterization resulted in changes in therapy and outcome. The same questions were asked of academic intensivists, two of whom reviewed each chart.ResultsAgreement regarding whether right heart catheterization had changed therapy was poor (chance corrected agreement [kappas] of −0.02 to 0.33). Treating physicians were more inclined than chart reviewers to conclude that management changes based on right heart catheterization improved outcome. Agreement on which patients benefited was poor (kappas of 0.03 to 0.32).ConclusionsPhysicians' assessment of the effect of right heart catheterization on treatment decisions and patient outcomes is not reliable. Credible information regarding the benefits of right heart catheterization will require randomized trials.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectivesTo investigate the effect, if any, of the acute-phase response on blood vitamin concentrations and to test the hypothesis that these concentrations may change during stress.DesignOpen study, utilizing a volunteer sample of patients.SettingTertiary care center.PatientsTwenty-six healthy adult volunteers (14 female and 12 male); 25 volunteers underwent uncomplicated orthopedic surgery and one suffered traumatic limb fractures.InterventionsNone.Main Outcome MeasurementsThe presence of a systemic acute-phase response was documented by the determination of serum C-reactive protein concentrations. Blood vitamin concentrations were determined from sequentially collected blood samples over a 7-day period, and compared with entry values.ResultsThe presence of the acute-phase response was documented by significant and transient increases in C-reactive protein values. This response was accompanied by significant and transient decreases in the concentrations of leukocyte vitamin C, and in plasma concentrations of vitamin A, retinolbinding protein, vitamin E, total lipids, pyridoxal-5' -phosphate, and albumin. Blood concentrations of pyridoxal-5-phosphate, retinal-binding protein, and leukocyte vitamin C decreased to values below the respective normal ranges. These concentrations normalized without any therapeutic interventions.ConclusionsWe demonstrated transient, but significant, decreases in blood vitamin concentrations during the acute-phase response. Recommendations regarding daily supplementation with these vitamins in clinical practice cannot be made on the basis of these results, as the functional importance of these observations is not, at present, clear. However, what is clear is that biochemical vitamin concentrations, determined during the acute-phase response, should be interpreted with care.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo evaluate the relationship between presurgical levels of cardiac vagal tone and outcome in neurosurgical patients.DesignProspective series.SettingRespiratory ICU in a university hospital.PatientsFifty-one adults admitted to the respiratory ICU between 1982 and 1985. Forty-two patients were scheduled for elective neurosurgery, and nine patients suffered from head trauma.InterventionsTen minutes of electrocardiographic (EKG) data were recorded before medical intervention. Neurosurgical patients scheduled for surgery had EKG data recorded 24 hrs before their operation. Trauma patients had EKG data recorded immediately after arrival in the respiratory ICU.Measurements and Main ResultsCardiac vagal tone was evaluated using a vagal tone index, quantified from the EKG. Cardiac vagal tone monitored before surgical intervention significantly distinguished between the outcome groups only for the elective neurosurgical patients. Age, gender, heart rate, Glasgow Coma Scale scores, and tumor location, size, and malignancy were not related to outcome in the elective neurosurgery group. However, within the trauma group, low Glasgow Coma Scale scores were significantly related to poor outcome.ConclusionsCardiac vagal tone may offer important predictive value by alerting the physician to the functional consequence of head injury. Information relating to autonomic nervous system functioning, such as the vagal tone index used in this study, may provide additional information that will complement the computed tomography scan results. This study demonstrates that the vagal tone index is a predictive factor that may be efficiently extracted from the heart rate pattern routinely monitored in ICUs.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo measure the metabolic requirements of patients with severe tetanus who require mechanical ventilation.DesignProspective, consecutive, open study using routine monitoring.SettingA multidisciplinary ICU in a large teaching hospital.PatientsFive consecutive patients (age range 30 to 54 yrs) with severe tetanus. Four patients had clinical evidence of sympathetic nervous system overactivity.InterventionsAll patients were mechanically ventilated and appropriately treated for severe tetanus. Sympathetic nervous system overactivity was reduced by the administration of sedatives.Measurements and Main ResultsMeasurements of metabolic rates were made using an indirect calorimetry device. Each of the five patients had three 8-hr periods of continuous metabolic monitoring for each of three levels of daily enteral nutritional support. The measured metabolic rates varied from 1310 to 2050 kcal/24 hrs (predicted 1280 to 1770 kcal/24 hrs). The variations from predicted basal metabolic rates varied from −6.3% to +10.5%.ConclusionsThe measured metabolic rates of patients with severe tetanus who are appropriately sedated are relatively constant and are within 10.5% of the predicted basal metabolic rates.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo establish a prognostic scoring system for septic shock patients.DesignThe clinical, biological, and hemodynamic data of these patients were retrospectively explored to select variables independently associated with outcome. According to the risk of death, ratings from 0 to 2 points were attributed to each value.SettingMedical intensive care service of a 1,000-bed tertiary care university medical center.PatientsEighty-eight patients in septic shock in whom hemodynamic measurements were performed using pulmonary artery flotation catheters.ResultsFourteen clinical, biological, and hemodynamic variables were selected and rated for each patient. A Simplified Septic Shock Score, available immediately after admission and catheterization, was established by adding the rates of these variables. The mean Simplified Septic Shock Score was 2.5 ± 1.7 (SD) in 43 survivors and 6.5 ± 2.3 in 45 nonsurvivors (p< .0001). Some underlying diseases and characteristics of infections also correlated with the outcome. Further ratings from 0 to 2 points were attributed to these conditions. A Complete Septic Shock Score was calculated by adding these rates to the Simplified Septic Shock Score. The Complete Septic Shock Score had a slightly better prognostic value than the Simplified Septic Shock Score, but it could be determined only after the availability of the microbiological data. The mean Complete Septic Shock Score was 3.1 ± 1.9 in survivors and 8.4 ± 2.6 in nonsurvivors (p< .0001). Both Simplified and Complete Septic Shock Scores showed better association with patient outcome than the Simplified Acute Physiology Score or the Acute Physiology and Chronic Health Evaluation (APACHE II) score.ConclusionsThe Simplified and the Complete Septic Shock Scores are simple scoring systems that appear to predict the outcome of septic shock patients more accurately than general scoring systems, such as the Simplified Acute Physiology Score and APACHE II score. These septic shock scores might be useful in assessing the severity of septic shock patients.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID