摘要:

This study evaluates the effects of ethanol (blood levels of 200 mg/dl for one hour) and dimethyl sulfoxide (DMSO) on cerebral lesion volumes after pressureinduced focal ischemia during normotension and induced hypotension in the canine. This experimental design simulates the situation where an individual imbibes two to four alcoholic drinks over a one-hour period, then drives a motor vehicle, and suffers a head injury either without significant blood loss or where the cerebral perfusion pressure is reduced to the lower limits of autoregulation (mean arterial pressure of 50 mm Hg). Ethanol was shown to increase brain lesion volumes in both the normotensive (4.5 ± 0.7 cm3) and hypotensive (14.9 ± 2.2 cm3) groups when compared to controls (0.8 ± 0.3 and 2.9 ± 0.4 cm3, respectively). DMSO markedly attenuated this response in the normotensive and hypotensive ethanol groups. It is thought that the intermediate metabolites of ethanol provide a large source of hydroxyl-free radicals in the presence of neuronal tissue damage and that these free radicals are effectively scavenged by DMSO.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Injury impairs cell-mediated immune function by depressing mitogen-induced lymphocyte proliferation and decreasing interleukin-2 (IL-2) production. In this study, we examined the ability of exogenous, recombinant IL-2 to restore lymphocyte proliferation after trauma. Recombinant IL-2 was added to cultures of phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells obtained from seven healthy volunteers and from 21 victims of accidental trauma. In comparison to the healthy group, lymphocyte proliferation was reduced approximately 20% in patients with minor and moderate injuries, and 50% in patients with severe injuries. The addition of recombinant IL-2 to PHA-stimulated lymphocytes from injured patients did not substantially improve cellular proliferation. These results suggest that the depressed response of lymphocytes to mitogen stimulation after trauma is not due to decreased IL-2 generation.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We examined biventricular performance on two occasions in 28 patients with acute hypoxemic respiratory failure (ARF), using a combination of invasively determined pressures and flows as well as radionuclide scin-tigraphy to measure the right and left ventricular ejection fractions (RVEF and LVEF, respectively). From the FF and concurrently measured thermodilution stroke volumes, we calculated right and left ventricular end-diastolic and end-systolic volume indices (FDVI and ESVI, respectively). Regression analysis demonstrated that changes (Δ) in global right ventricular function (RVEF) were inversely correlated with concurrent changes in the mean pulmonary arterial pressure (MPAP): Δ RVEF = 0.015 – 0.015 Δ MPAP (r2= 0.60;p<.005), while an increase in right ventricular preload (RVEDVI) was positively correlated with changes in MPAP: Δ RVEDVI = 2.68 ± 6.27 Δ MPAP (r2= 0.46;p<.005). Global left ventricular function (LVEF) was related to changes in systemic pressures as well as to right-sided events: Δ LVEF = −0.01 −0.0015(Δ RVESVI) + 0.001(Δ BP systolic) −0.42(CVP/RVEDVI) (r2= 0.35;p<.01). These data confirm the significant influence of right ventricular afterload on RVEF in ARF patients and an apparent interrelationship between altered right ventricular systolic function and global left ventricular performance.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Left ventricular (LV) performance was assessed by echocardiography in 19 premature infants with severe respiratory distress syndrome. Measurements of LV size and function were made from digitized M-mode echocardiographic data in 14 babies (group 1) before and during treatment with mechanical ventilation and positive end-expiratory pressure. During ventilation, maximum LV dimension decreased (p=.001) as did peak filling rate (p=.01). LV shortening fraction decreased slightly (p=.05). There were marked reductions in calculated stroke volume (SV) (p=.001) and cardiac output (p=.0001) but systemic BP was unchanged, presumably due to peripheral vasoconstriction.The effect of simultaneous volume loading was studied in five other babies (group 2) who were ventilated under similar conditions. Blood transfusion with packed cells (10 mg/kg) prevented the fall in LV filling rate, while LV dimensions (max,p=.01; min,p=.02), SV (p=.05), cardiac output (p=.05), and systolic BP (p=.05) increased. This indicates that a low preload was responsible for the decreases observed in group 1.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

This study was designed to examine prospectively the incidence of perioperative complications associated with elective tracheostomy in critically ill patients. An experienced surgeon and anesthesiologist participated in every tracheostomy procedure. In 81 procedures, there was no loss of airway control for greater than 20 sec, no airway obstruction, no blood loss exceeding 50 ml, and no aspiration. One patient (1.2%) had cardiovascular instability. During the next 48 h, two patients (2.4%) required wound packing to control hemorrhage but did not require blood transfusion and two patients (2.4%) had evidence of supraclavicular subcutaneous emphysema that was physiologically inconsequential. There was no perioperative mortality or major morbidity associated with the tracheostomy procedure. We conclude that, under controlled conditions, elective tracheostomy can be performed safely in critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Twelve patients with an endotracheal tube and a new infiltrate were assessed for differences in the bacterio-logic information that could be obtained by routine tracheal suctioning (RTS), a double-lumen protected-sheath brush passed through a flexible fiberoptic bron-choscope (B-FFB), and suctioning through a flexible fiberoptic bronchoscope (S-FFB). Gram stains and cultures were performed on all specimens. There was 100% agreement for the culture results obtained by RTS and S-FEB. It is concluded that RTS obtains comparable information to that obtained by the more expensive and more personnel-intensive B-FFB.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We compared utilization of a 14-bed respiratory ICU before and after establishing an intermediate care area (ICA) for patients recovering from cardiac surgery. Availability of the four-bed ICA significantly reduced the duration of ICU stay in patients who had undergone aortocoronary bypass or valvular cardiac surgery, and no potentially preventable deaths resulted from early ICU discharge. Use of an ICA should also decrease ICU utilization for other low-risk monitored patients.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We examined the ventilatory response to inhaled CO2in 77 infants at postconceptional ages ranging from 31 to 50 wk, 43 of whom were also evaluated with a 12-h pneumocardiogram (PCG). Infants were tested after sedation with chloral hydrate, and monitored with ECG and transcutaneous oxygen and CO2monitors. Sleep state was evaluated by visual inspection of the infant's behavior. Among the 43 infants examined with the PCG, 22 had abnormal PCGs. Of these, 27% had significantly (p<.05) abnormal CO2response slopes, compared to 9% of those with normal PCGs. Breathing frequency did not change after CO2inhalation in 82% of the abnormal PCG and in 33% of the normal PCG groups.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Endotracheal intubation is generally performed to facilitate the treatment of respiratory failure or to control the airway during general anesthesia. We electively intubated 14 children with undiagnosed pneumonia to obtain tracheobronchial secretions for microbiologic diagnosis. Three were intubated awake, three with sedation, and eight with sedation and neuromuscular blockade.Mycobacterium tuberculosiswas isolated in four of six patients suspected of having tuberculosis. Other bacterial pathogens were isolated in three patients and viral pathogens in three patients. The procedure proved useful in 11 (79%) of the 14 patients, with no complications. We conclude that elective orotracheal intubation is a safe, simple, fast, and effective method of obtaining secretions for the culture of organisms responsible for lower airway and lung parenchymal infections in children.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

A system has been developed to monitor continuously the components of the oxygen Fick equation: oxygen consumption by a gas exchange analyzer and arterio-venous oxygen difference by pulse and fiberoptic oximetry. A computer-based system was developed which calculates cardiac output and other variables every 20 sec. Continuous Fick (CF) cardiac output was compared to thermodilution (TD) cardiac output in 21 ventilated post-cardiac surgery patients. A total of 237 simultaneous cardiac output measurements had a range between 2 and 11 L/min. The correlation between CF and TD cardiac outputs was r =.86, with an equation of TD cardiac output = 0.92 CF cardiac output + 1.16. There was a significant (p<.001) difference between the two methods of cardiac output estimation. The CF method was consistently lower than TD; this difference was greater at lower flows. CF cardiac output measurement is practical; it offers distinct advantages in viewing cardiac output together with oxygen demand and oxygen extraction.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID