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

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo measure the effect of human albumin supplementation during parenteral nutrition on serum albumin concentrations, colloid oncotic pressure, free water clearance, electrolyte-free water resorption, and sodium excretion.DesignProspective, randomized, controlled trial.SettingTertiary care center.PatientsThirty adult, hypoalbuminemic patients who required parenteral nutrition.InterventionsParenteral nutrition (control) or parenteral nutrition plus human albumin 25 g/L as a continuous infusion (treatment) for a 5-day study period.MeasurementsOn days 1 and 5, serum albumin concentration, colloid oncotic pressure, free water clearance, electrolyte-free water resorption, and sodium excretion were measured.ResultsSerum albumin concentrations increased significantly from day 1 to day 5 in both groups (control: 2.0 ± 0.1 [mean ±SEM] vs. 2.3 ± 0.1 g/dL [20 ± 1 vs. 23 ± 1 g/L],p= .02; treatment: 2.2 ± 0.1 vs. 3.5 ± 0.2 g/dL [22 ± 1 vs. 35 ± 2 g/L],p= .0001). Day 5 serum albumin concentrations were significantly higher in the treatment group compared with control (p= .0001). Colloid oncotic pressure increased significantly from day 1 to day 5 in the treatment group (17.8 ± 0.8 vs. 25.1 ± 1.0 mm Hg,p= .0001), and was significantly higher than control at day 5 (p= .0001). No significant differences were found for free water clearance, electrolyte-free water resorption, or sodium excretion within or between groups.ConclusionsIn hypoalbuminemic patients, human albumin supplementation during parenteral nutrition results in significant increases in serum albumin concentrations and colloid oncotic pressure, but has no apparent effect on free water clearance, electrolyte-free water resorption, or sodium excretion.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Objectivesa) To determine the frequency of perforations in latex surgical gloves before, during, and after surgical and dental procedures; b) to evaluate the topographical distribution of perforations in latex surgical gloves after surgical and dental procedures; and c) to validate methods of testing for latex surgical glove patency.DesignMultitrial tests under in vitro conditions and a prospective sequential patient study using consecutive testing.SettingAn outpatient dental clinic at a university dental school, the operating suite in a medical school affiliated with the Veteran's Hospital, and a biomechanics laboratory.PersonnelSurgeons, scrub nurses, and dental technicians participating in 50 surgical and 50 dental procedures.MethodsWe collected 679 latex surgical gloves after surgical procedures and tested them for patency by using a water pressure test. We also employed an electronic glove leak detector before donning, after sequential time intervals, and upon termination of 47 surgical (sequential surgical), 50 dental (sequential dental), and in three orthopedic cases where double gloving was used. The electronic glove leak detector was validated by using electronic point-by-point surface probing, fluorescein dye diffusion, as well as detecting glove punctures made with a 27-gauge needle.ResultsThe random study indicated a leak rate of 33.0% (224 out of 679) in latex surgical gloves; the sequential surgical study demonstrated patency in 203 out of 347 gloves (58.5%); the sequential dental study showed 34 leaks in the 106 gloves used (32.1%); and with double gloving, the leak rate decreased to 25.0% (13 of 52 gloves tested). While the allowable FDA defect rate for unused latex surgical gloves is 1.5%, we noted defect rates in unused gloves of 5.5% in the sequential surgical, 1.9% in the sequential dental, and 4.0% in our electronic glove leak detector validating study. In the sequential surgical study, 52% of the leaks had occurred by 75 mins, and in the sequential dental study, 75% of the leaks developed by 30 mins. In terms of the anatomical localization, the thumb and forefinger accounted for more than 60% of the defects. There were no differences in the frequency of glove leaks between the left and right hand. Leak rates were highest for the surgeon (52%), followed by the first assistant (29%) and the scrub nurse (25%). No false negatives were noted using the electronic glove leak detector; one false positive was seen out of 225 gloves tested (0.44%), as noted in our validation studies.ConclusionsSignificantly high glove leak rates were noted after surgical and dental procedures, indicating that the present day latex surgical gloves can become an incompetent barrier once they are used. Unused latex surgical gloves demonstrated a higher rate of defects than allowed by the Food and Drug Administration standards, indicating substantial noncompliance of quality control standards by manufacturers as well as inadequate governmental oversight. Double gloving, or the use of thicker latex surgical gloves, would probably reduce the frequency of glove leaks. Latex surgical gloves should be tested for patency before use and during surgical and dental procedures.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo study the patterns of plasma concentrations of endotoxin, tumor necrosis factor-α (TNF), interleukin-6 (IL-6), plasminogen activator inhibitor-1, C-reactive protein, and serum amyloid A during the treatment of human sepsis.DesignA prospective case series study.SettingICU of the Department of Internal Medicine, University Hospital Groningen, The Netherlands.PatientsTwenty consecutive patients (11 female, 9 male, mean age 67 yrs) with clinically defined sepsis. Eighteen patients were admitted from the outpatient emergency ward; two patients were already inpatients. The control group (n = 7) comprised patients with nonseptic shock.Measurements and Main ResultsTen (50%) septic patients had detectable endotoxemia (>5 ng/L). TNF concentrations on admission were increased in 94% of the septic patients, whereas IL-6 and plasminogen activator inhibitor plasma concentrations were increased in all septic patients. The septic group showed significantly (p< .05) higher concentrations of TNF, IL-6, plasminogen activator inhibitor-1, C-reactive protein, and serum amyloid A compared with the nonseptic patients. In the septic group, we found a correlation of both IL-6 and plasminogen activator inhibitor concentrations with severity of illness (r2= .33,p< .05; r2= .22,p< .05, respectively). After the start of antibiotic treatment, high concentrations of TNF and plasminogen activator inhibitor persisted in the nonsurvivors in contrast to decreasing concentrations in most of the survivors. After an initial increase in seven patients, IL-6 concentrations decreased in all septic patients and also in nonsurvivors.ConclusionsThis study confirms previous findings that: a) TNF is a major mediator involved in the pathogenesis of septic shock; b) plasminogen activator inhibitor activity is significantly increased in septic patients and might be involved in the pathogenesis of disseminated intravascular coagulation associated with sepsis; and c) IL-6 is involved in the pathophysiology of septic shock, although further studies are needed to determine whether IL-6 is directly involved in mediating the lethal complications of septic shock or whether it should be considered an “alarm hormone” that reflects endothelial cell injury. Our findings also suggest that the concentrations and trends of these mediators during treatment are valuable for monitoring septic patients.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo assess the frequency of complications of endotracheal intubation and mechanical ventilation.DesignProspective cohort study.SettingPediatric tertiary multidisciplinary ICU.PatientsEight hundred sixty-nine serial patients, of whom 500 were endotracheally intubated and 431 were mechanically ventilated.InterventionsDaily clinical observation.Main Outcome MeasuresAge, diagnosis, endotracheal tube size, type of ventilator and humidification, duration of intubation and mechanical ventilation, ventilatory settings, and complications (accidental extubation, tissue damage, endobronchial intubation, postintubation stridor, endotracheal tube blockage, pulmonary airleak, bronchopulmonary dysplasia, pulmonary atelectasis) were recorded.ResultsThe median patient age was 10 months (25th and 75th quartiles: 1 month and 15 yrs). The median duration of endotracheal intubation and mechanical ventilation was 4 days and 2 days, respectively. A total of 186 complications were recorded in 119 (24%) patients. No deaths were due to intubation or ventilation. The overall frequency of accidental extubation was 3.2% of patients at a rate of 1.26 extubations/100 intubation days. In nonventilated, unsedated patients with croup or epiglottitis, the frequency of accidental extubation was 23% at a rate of 11.83 extubations/100 intubation days. Lung atelectasis occurred in 7.8%, airleak in 6.8%, and infection in 2.3% of patients. Other complications included tissue damage (3.4%), endobronchial intubation (2.4%), postintubation stridor (2.4%), bronchopulmonary dysplasia (2.3%), and endobronchial tube blockage (0.8%).ConclusionsComplications were related to the duration of intubation and mechanical ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Background and MethodsWe compared a hypertonic saline-dextran solution (7.5% NaCl/6% dextran-70) with 0.9% NaCl (normal saline) for treatment of intraoperative hypovolemia. Fourteen anesthetized pigs (mean weight 36.3 ± 2.1 kg) underwent thoracotomy, followed by hemorrhage for 1 hr to reduce mean arterial pressure to 45 mm Hg. A continuous infusion of either solution was then initiated and the flow rate was adjusted to restore and maintain aortic blood flow at baseline levels for 2 hrs.ResultsFull resuscitation to initial values of aortic blood flow was achieved with both regimens, but the normal saline group required substantially larger volumes and sodium loads to maintain stable hemodynamic values. Normal saline resuscitation produced increases in right ventricular preload (central venous pressure) and afterload (pulmonary arterial pressure and pulmonary vascular resistance), resulting in increased right ventricular work.ConclusionsHypertonic saline-dextran solution resuscitation of intraoperative hypovolemia is performed effectively with smaller fluid and sodium loads, and is devoid of the deleterious effects associated with fluid accumulation induced by a conventional isotonic solution regimen.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Background and MethodsThe effects of iv infusions of 6% hetastarch or 10% pentastarch on blood glucose concentrations were tested in 12 nondiabetic and 12 streptozotocin-induced diabetic pentobarbital-anesthetized Sprague-Dawley rats weighing 313 to 473 g. All rats were paralyzed and mechanically ventilated. After control measurements of blood glucose concentrations were taken, rats were divided into four groups. Groups 1 (n = 6) and 2 (n = 6) comprisednondiabetic ratsthat received iv infusions of hetastarch or pentastarch, respectively, at a rate of 2.0 mL over 30 mins. Groups 3 (n = 6) and 4 (n = 6) compriseddiabetic ratsthat also received iv hetastarch or pentastarch, respectively, at the same rate and duration of infusion.ResultsNeither hetastarch nor pentastarch infusions significantly altered blood glucose values over the 3-hr study period, regardless of whether the rats were diabetic or nondiabetic.ConclusionsAssuming these data are transferable to humans, the authors conclude that hydroxyethyl starch solutions do not produce or exacerbate hyperglycemia, and furthermore, that their use is not contraindicated in subjects having hyperglycemia from diabetes mellitus or iatrogenic causes.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID