摘要:

Although pulmonary artery (PA) catheterization is frequently employed in the management of critically ill patients, there is little documentation that the information obtained alters patient management. This study evaluated prospectively this question in 103 PA catheterizations. Before catheterization, physicians were asked to predict the range of several hemodynamic variables, the presumed diagnosis, and their plan for therapy. After catheterization, each chart was reviewed. The hemodynamics at the time of catheterization and therapy within 8 h of catheterization were noted. Pulmonary artery occlusive (wedge) pressure (WP) was correctly predicted 30% of the time. Cardiac output, systemic vascular resistance (SVR), and right atrial pressure (RAP) were correctly predicted approximately 50% of the time. There was no significant difference in the ability to predict hemodynamics of subgroups with either hypotension or impaired oxygenation. After catheterization, planned therapy was altered in 58% of the cases. Unanticipated therapy was added in 30% of the cases. This study documents the difficulty of predicting accurately hemodynamics based solely on clinical evaluation. Thus, the information obtained by catheterization often leads to alterations in the therapeutic plan. We suggest that PA catheterization is both indicated and useful in the management of critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Sequential cardiopulmonary variables were analyzed in 32 infants and children with septic shock. Variables were staged by a system based on therapeutic efforts to control blood pressure. There were 14 survivors and 18 nonsurvivors. Systemic circulation variables (MAP, cardiac index [CI], systemic vascular resistance index [SVRI], wedge pressure [WP], left cardiac work index [LCWI]) and pulmonary circulation variables (mean pulmonary artery pressure [MPAP], pulmonary vascular resistance index [PVRI], CVP, right cardiac work index [RCWI]) were similar in survivors and nonsurvivors. Pulmonary variables (intrapulmonary shunt [Qsp/Qt], fraction of inspired oxygen [FiO2), Pao2, Paco2) revealed significantly more dysfunction in nonsurvivors than survivors during the postresuscitation (PR) and middle (M) shock stages. Even though oxygen delivery was equivalent in survivors and nonsurvivors, nonsurvivors demonstrated decreased oxygen utilization variables (oxygen consumption [Vo2], arteriovenous oxygen content difference [C(a-v)o2], O2extraction index, core temperature) during the resuscitation (RS) and PR stages.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This study evaluates the relative effects of 2 combined antibiotics, a crystalloid solution, 4 3% colloid solutions, and a pharmacologic dose of corticosteroids, given alone and in combination for the treatment ofEsche-richia coli-induced septic shock. All treatments began 5.5 after bacterial injection. Untreated septic rats had a mean survival time of 9.9 h. Antibiotics (trimethophrim and sulfamethoxazole) alone did not significantly increase mean survival time (11.0 h). No rats in either of these two groups survived 24 h. When antibiotics and dexamethasone were combined, 40% (4/10) rats lived longer than 24 h (p< .05). With Ringer's solution infusion, the mean survival time was 8.7 h and 30% (3/10) lived longer than 24 h. When a 3% colloid solution was given, 50% (20/40) lived more than 24 h and 20% (8/40) lived more than 7 days. There was no significant difference between the 4 colloid solutions (albumin, dextran-40, dextran-70, hydroxyethyl starch). When Ringer's solution was combined with dexamethasone and antibiotics, 80% (8/10) lived more than 24 h and 20% (2/10) were long-term survivors. When the antibiotic drug was combined with a colloid solution and dexamethasone, all animals lived more than 24 h and 90% (9/10) lived more than 7 days. This study demonstrates the therapeutic value of an effective antibiotic drug for control of the infective organism, a colloid solution infusion to maintain blood volume and circulation, and corticosteroids for still largely unknown reasons.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Cell-mediated immunity was examined using 4 recall antigens in 102 critically ill surgical patients treated in an ICU. There were 4 (14%) deaths in 28 patients with positive reactions (R), compared to 33 (45%) deaths in 74 nonreactors (NR) (p< .01). Thirty-seven of the patients were admitted after trauma, and mortality in this group was not significantly different between R and NR patients. Repeat testing in 40 NR patients who remained in the ICU for more than 7 days showed that 30 remained NR (70% mortality) and 10 became R (20% mortality,p< .001).Peripheral blood lymphocytes from the patients showed a reduced response to concanavalin A, but a normal response to phytohemagglutinin and pokeweed mitogen. Mononuclear cells and granulocytes both showed a small increase in chemotactic response to casein, suggesting that the reduced response to skin testing may be partly due to defective T-cell function, rather than impaired phagocyte chemotaxis.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Although cimetidine is more effective than a placebo for the prophylaxis of stress-induced ulcers, it has no advantage over titrated antacid dosing. Several comparative studies even suggest that combining cimetidine with antacid is no more effective than use of full-dose antacid. Therefore, we recommend prophylatic use of cimetidine' only when very large dosages of antacid are required, in order to minimize acid-base disturbances.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Acute alveolar injury induced by subcutaneous injection of N-nitroso-N-methylurethane (NNNMU) closely resembles the pathology of human adult respiratory distress syndrome (ARDS). However, its effects on cardiovascular function have not been evaluated. We measured hemodynamic variables and venous admixture (Qsp/Qt at FIo20.21) and shunt fraction (Qsp/Qt at Fio21.0) in 7 dogs. The measurements were repeated when a single subcutaneous injection of 8.0 mg/kg NNNMU decreased PaO2on room air to 40 torr (phase I) and 30 torr (phase II). Within 5 to 7 days after injection, Pao2decreased to 40 torr, Qsp/Qt at Fio20.21 increased from 0.18 to 0.70, Qsp/Qt at Fio21.0 increased to 0.55, and pulmonary vascular resistance index (PVRI) increased from 213 ± 37 to 407 ± 42 dyne sec/cm5m2(p< .05). However, a decrease in mean arterial pressure (MAP) from 153 ± 16 to 131 ± 32 mm Hg was the only significant hemodynamic change. At phase II, decreased systemic vascular resistance index (SVRI) was the only significant hemodynamic alteration. We conclude that single subcutaneous injection of NNNMU produces hemodynamic and pulmonary dysfunction similar to that seen in human ARDS. This acute lung-injury model may be useful for evaluating different ARDS therapies.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Persistent pulmonary hypertension of the newborn (PPHN), is a syndrome associated with high morbidity and mortality. Mechanical ventilation attempts to maintain a Paco2< 30 torr and a pH > 7.5 until pulmonary hypertension resolves. To assess whether the disease or its therapy adversely affects neurodevelopmental or cardiorespiratory outcome, 11 infants diagnosed and treated for PPHN were evaluated at a mean age of 31 months. Nine had normal developmental quotients (DQs) and 2 had mildly delayed DQs. Eight children were entirely normal neurologically, 2 had slightly increased lower-extremity tone, and 1 had unilateral hypertonia. All cardiac exams, echocardiograms, and ECGs were normal. Four children had chronic lung disease requiring either daily or intermittent bronchodilator therapy; however, their activity levels were unaffected. These results suggest that subsequent normal development with little significant medical compromise may be expected in this group of critically ill infants.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Glucagon is an important therapeutic agent in critical care medicine. Although its endogenous hormonal functions have been well described, its clinical uses are rarely discussed. Glucagon is effective in the treatment of hypoglycemia, cardiogenic shock and heart failure, propranolol overdose, esophageal meat impaction, ureteral colic due to calculi, and acute diverticulitis. It may prove useful in the treatment of endotoxin and hypovolemic shock as well as toxicity due to excesses of procainamide, quinidine, or ouabain.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Eight children with obstructive apnea were evaluated by transnasal fiberoptic endoscopy. Three children had obstructive adenoids and tonsils, 2 had pharyngeal collapse, 1 had an obstructive tongue, and 1 had a subglottic cyst. The remaining patient had no abnormality. The results of transnasal endoscopy influenced therapeutic interventions.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Two devices, a plastic heat shield and a chemically heated mattress, were evaluated for their ability to reduce the needed air temperature and the power requirements in air servo-controlled transport incubators. A single-walled transporter and a double-walled transporter were evaluated using a heated manikin modeled after a 1000-g baby. The plastic heat shield reduced required transport incubator air temperature by 0.7° in the single-walled and 0.5° in the double-walled incubator, but did not significantly reduce power consumption. The chemically heated mattress was more effective in reducing power consumption and required air temperature, but it was difficult to stabilize infant temperatures in an incubator without skin servo-control. The transport incubators tested have wide swings in air temperature even during stable operation, rendering them sub-optimal to manage small premature infants.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID