摘要:

This paper presents results of the first study explicitly designed to compare three methods for predicting hospital mortality of ICU patients: the Acute Physiology Score (APS), the Simplified Acute Physiology Score (SAPS), and the Mortality Prediction Model (MPM). With respect to sensitivity, specificity, and total correct classification rates, these methods performed comparably on a cohort of 1,997 consecutive ICU admissions. In these patients from a single hospital, the APS overestimated and the SAPS underestimated the probability of hospital mortality. The MPM probabilities most closely matched the observed outcomes. Each method holds considerable promise for assessing the severity of illness of critically ill patients. The MPM should be particularly useful for comparing ICU performance, since it is independent of ICU treatment and can be calculated at the time a patient is admitted.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Recent studies have been conducted to evaluate the relationship between plasma beta-endorphin (END) levels and the hemodynamic changes that occur in severely stressed animals. Using our canine hypovolemic shock model, END levels were analyzed during the baseline period, at the beginning of treatment (after a period of fixed-pressure hypovolemic shock), and at the end of treatment. Mean arterial pressure (MAP) and cardiac output were also measured at these intervals. Animals were given iv 5 ml of 0.9% NaCl, 4 mg/kg of naloxone (NAL), 30 mg/kg of methylprednisolone (MP), or 4 mg/kg of NAL and 30 mg/kg of MP. A fifth group was composed of nonsteroid-treated animals. Scatterplots were generated and linear regression lines were drawn comparing END with cardiac output and MAP.In the nonsteroid-treated animals, a significant correlation was found between decreases in both MAP and cardiac output and increasing levels of END. The addition of MP did not seem to alter the relationship, suggesting that MP did not affect END release.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We serially measured creatine kinase (CK), lactate dehydrogenase, aspartate aminotransferase (AST) and lactate from the lumbar cerebrospinal fluid in 14 patients with neurologic complications after open heart surgery with cardiopulmonary bypass (CPB). These analyses revealed a correlation between worsening neurologic deficit and the peak CK (r = .87,p< .001), AST (r = .75,p< .01), and lactate (r = .93,p< .001) levels. Lactate increased before enzymes did. In 12 patients without complications, only lactate was significantly (p< .005) elevated; however, within this group, CK but not lactate could be used to differentiate patients who later developed subtle mental changes. Although CPB appeared to induce metabolic changes in the brain that could possibly disturb function, severe cerebral damage appeared to require additional global or focal anoxic-ischemic factors. Short hypothermia during bypass did not influence CK, but it was falsely elevated after prolonged hypothermic periods. The testing of these enzymes may be a reliable indicator of the degree of brain damage and the prognosis.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Twenty ICU patients, with varying diagnoses and degrees of catabolism, were studied prospectively to determine whether somatomedin-C/insulin-like growth factor I (SMC/IGFI) is related to the conventional nutritional indices, plasma prealbumin, transferrin and albumin, and nitrogen balance (NB) in critical illness. Mean SMC/IGFI concentration in these critically ill patients was below the lower limit of the reference range. SMC/IGFI concentrations correlated with NB for the 24 h before measurement (r = .38,p< .01) and with cumulative NB for the previous 2 (r = .50,p< .01), 3 (r = .34,p< .05), and 5 days (r = .46,p< .05). Prealbumin correlated with cumulative 5-day NB (r = .39,p< .05). Plasma albumin and transferrin concentrations did not correlate with NB for any of these time periods. SMC/IGFI concentrations correlated with cumulative protein (r = .59,p< .01), carbohydrate (r = .63,p< .01), and energy intake (r = .64,p< .01). SMC/IGFI was the only index which consistently correlated with NB. We conclude it is a useful index of nutritional status in critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The effects of 20% albumin (2.5 ml/kg) on plasma volume (PV) and hemodynamics, as well as albumin pharmacokinetics, were studied in ten spontaneously breathing patients 20 h after coronary bypass surgery. The albumin was infused over 20 min, and serial changes in PV were followed for 60 min using131I albumin dilution. Plasma albumin (P-Alb) and total protein concentrations, as well as oncotic pressure, hemodynamic, and oxygen transport variables, were followed for 90 min. Eleven patients served as controls. At baseline, 7.5% and 5.5% reductions in blood volume were found in the albumin and control groups, respectively. The maximal PV gain (4.5 ml/kg) was reached 15 min after the infusion. Coincidentally, 7.7 ml H2O was linked to 1 g of albumin retained in the circulation. The half-life of P-Alb was 16.2 h. and the distribution volume of the infused dose exceeded PV. An increased pulmonary capillary wedge pressure produced an increase in cardiac index. The right and left ventricular stroke work indices also increased. Pulmonary shunt flow, Pao2, and urinary output did not change appreciably.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Quality of life was examined in 717 individuals 1 yr after their admission to a multidisciplinary ICU. Of these, 87% were able to live at home 6 months after their admission. Of patients 65 yr and older, 90% had been living independently before admission compared to 80% 1 yr afterward. Of those younger than 65 yr, most of the 65% who had been working before admission could return to work. The length of hospitalization during the first year after admission varied greatly; 10% of the patients stayed more than 145 days. The patients who needed mechanical ventilation or who stayed 1 wk or more in the ICU tended to have worse outcomes than others. These data indicate that there is no great deterioration in quality of life among long-term survivors of intensive care.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We compared the speed of cooling and treatment efficacy for evaporative cooling vs. iced gastric lavage in a canine heatstroke model. Nine random-source, mongrel dogs were anesthetized, shaved, and internally heated until the core temperature reached 43.0°C. The animals were then randomly assigned to be cooled to 37°C either by iced (1°C) tap water gastric lavage (n = 5200 ml/min) through a large (32-Fr) orogastric tube, or by spraying with tap water (n = 4, 15°C, 12 L/min) before a large fan blowing room temperature air (23°C) across the dog at 0.5 m/sec from a height of 50 cm. Temperatures were monitored by thermocouples in both tympanic membranes and the pulmonary artery. BP, pulse, and cardiac output were measured every 5 min.Evaporative cooling was twice as fast as iced gastric lavage (0.16 ± .05° vs. 0.08 ± .01°C/min m2,p< .01). Animals in the evaporatively cooled group also experienced a quicker and more complete return to baseline cardiac indices than the lavage-treated group. Moreover, all animals treated with evaporation survived and were neurologically intact 48 h later, while only one lavage-treated dog was neurologically intact over the same period. The others in the lavage group died one hour after cooling (n = 1), were grossly ataxic (n = 1), or were persistently comatose (n = 2). A simple evaporative cooling technique, readily available in the emergency department, appears to be the most rapid and effective means for cooling and treating heatstroke in the dog.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Naloxone, a commonly used narcotic antagonist, may be beneficial in reversing the hemodynamic alterations seen in septic shock. In normal subjects, naloxone pharmacokinetics are characterized by rapid distribution and elimination. We investigated the pharmacokinetics of high-dose naloxone in four patients with septic shock and multiorgan failure. The pharmacokinetics of naloxone in these patients can be described by a two-compartment model with a rapid alpha distribution similar to that observed in normal humans. However, in these critically ill patients there was virtually no drug elimination as levels were followed for 5 h post-termination of a 6-h infusion of 2.4 mg/kgh. This dramatic accumulation of naloxone may explain why responses have been reported by others to small doses of naloxone in septic shock patients. No significant side-effects were seen in our patients with plasma naloxone levels as high as 3.78 μg/ml. Caution is warranted when one administers naloxone to patients whose ability to eliminate this drug is minimal.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The activation of macrophages is accompanied by release of 2-amino-4-oxo-6(D-erythro-l′,2′,3′-trihy-droxypropyl)-dihydropteridine (D-erythro-neopterin). The neopterin levels of 21 patients were measured with radioimmunoassay. The patients were classified according to the clinical course and outcome. We found highly significant differences between survivors and nonsurvivors for each of the evaluated days of the observation period. In addition to a sustained increase, patients with fatal outcome always showed a higher percentage of neopterin levels (88.2 ± 28 [sd]%) exceeding the upper confidence limit (27.4 nmol/L) than survivors (31.8 ± 29.9%). We conclude that the assessment of D-erythro-neopterin might be an easily available aid for an early evaluation of the immunologic status of a patient at risk for septic complications.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Three modes of ventilation during the transport of 30 ventilator-dependent patients were compared using blood gas variables. Ten were ventilated with a manually operated, ventilation bag (group C) and ten with a tidal volume meter at the exhalation valve of the ventilation bag (group V). Another ten patients (group O) were ventilated with a portable ventilator set to the minute volume (Ve) given in ICU. Ve was measured by volumetry as described above. Blood gases were analyzed in the ICU before and at the end of transport. In group C, significant decreases occurred in arterial (p< .01) and central venous (p< .05) Pco2, as well as in central venous Po2(p< .01). Arterial (p< .05) and central venous (p< .01) pH increased. Group V showed no statistically significant changes. In group O, arterial (p< .01) and central venous (p< .05) Pco2decreased whereas arterial (p< .01) and central venous (p< .05) pH increased. We conclude that Ve should be monitored during transport of ventilated patients.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID