摘要:

The clinical and physiological responses to septicemia were evaluated in 59 patients with 70 septic episodes. All patients were critically ill, had similar ICU support, and had positive blood cultures as well as a clinical infection when studied by dye dilution cardiac outputs.The overall ratio of gram-negative to gram-positive sepsis was 2.6:1.0. Patients with septicemia caused by gram-positive organisms, gram-negative organisms, anaerobes, and fungi had similar fever, leucocyte, and acid-base responses. There were also no statistical differences in any physiological variables between organism group or between specific organisms. After volume loading, all patients exhibited a hyperdynamic cardiovascular response with abnormal vascular tone. Some degree of myocardial depression was a common feature of all forms of bacterial or fungal septicemia. Heart rate was the cardiac variable producing the increased cardiac output in this setting.The exact pathogenesis of the septic response remains undetermined. However, the response appears to be host determined and not peculiar to a specific pathogenic microorganism.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Flow-volume loops were obtained during the performance of crying vital capacity (CVC) maneuvers in 31 infants, 18 of whom had hyaline membrane disease (HMD). Both healthy and distressed infants had flowvolume loops resembling those found in adults with variable intrathoracic obstruction of the central airways. Flow rates during inspiration and expiration increased as the CVC increased. Infants with HMD had narrower inspiratory loops and attained peak expiratory flow later than nondistressed infants, but these differences were not statistically significant. Vocalizations, loss of lung recoil associated with loss of lung volume, and partial collapse of intrathoracic airways may all contribute to the shape of the flowvolume loop in infants.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The effects of a 20-min play intervention by a child life teacher on two observed behaviors were investigated in Pediatric Intensive Care Unit (PICU) patients at the Johns Hopkins Hospital Children's Center. Eleven subjects, ranging in age from 2–13 years, were observed using a Preintervention—Intervention—Postintervention design with a 3-min time sampling technique to measure the change occurring when structured play activities were introduced into the PICU environment. Significant positive changes were noted between Preintervention and Intervention in (1) affect and (2) interaction with materials. In the Postintervention period, these behaviors fell close to Preintervention levels, suggesting that the positive changes were not maintained in the absence of the Intervention condition. The results indicate that while play intervention in the PICU environment can have beneficial effects on patient's behavior, the effects of such intervention are short-lived. These data hold important implications for the staffing requirements needed to provide opportunities for the positive behavior changes to occur.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Sequential assessment of renal function in 50 critically ill postoperative patients was done by simultaneous determinations of osmolar, free water, creatinine and sodium clearances, and fractional excretion of sodium. The traumatic and nontraumatic critically ill surgical patients had a characteristic pattern of creatinine clearance (Ccr) which was age related. This was manifested in the trauma patient by Ccr which were initially greater than expected (140–190 ml/min 1.73 M2). In the uncomplicated postoperative patients, a positive correlation was found between increased cardiac index and the indexed glomerular filtration rate. Decreases in free water clearance and Ccr were useful in predicting the onset of renal failure before the development of the oliguric state. The authors conclude that frequent assessment of those renal functions which are most adversely affected by accidental or surgical trauma is most appropriately monitored by serial measurement of creatinine and free water clearance.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Shock was induced in 60 dogs by exteriorizing the small intestine for 3 hours in order to compare the relative effectiveness of various plasma expanders. During shock the hematocrit rose from 50–59%; mean arterial blood pressure dropped from 144–95 mm Hg; plasma volume decreased to 67% of the control values; oxygen consumption (Vo2) decreased to 59% and cardiac output to 21% of their control values. The total intravascular protein decreased to 66% and albumin to 61% of the control values. Loss of albumin from the vascular space was 4 times greater in shocked animals than in nonshocked control dogs. Return of the intestine to the abdominal cavity did not in itself improve hemodynamic values; when no infusion was given, these values remained at shock levels. Vo2and plasma volume were restored after infusion of all test fluids, but the effects were of varying duration. Ringer's acetate solution was effective up to 30 min after infusion but at 4 hours, the values did not differ from that of the untreated control animals. Gelatin and ACD-plasma had a similar effect up to 2 hours. Albumin, dextran 40, and dextran 70 increased and maintained plasma volume and Vo2at control level for at least 4 hours. The duration of the plasma volume expansion for colloids was correlated to their number average molecular weight. Plasma volume expanded 40 to 63% of the volume infused 1 hour after colloids versus 8% after Ringer's acetate. Three hours later, these values were about 20–50% after colloids versus 1% after Ringer's acetate. The expansion was greater after the dextrans and albumins than after gelatin and plasma. The plasma volume expansion was about 30 ml/g of colloid for albumin and dextran and about 20 ml/g total protein for ACD-plasma. The authors conclude that as single infusions, albumin, dextran 40, and dextran 70 are better able to restore and maintain hemodynamic function, O2transport, and plasma volume than ACD-plasma, gelatin and Ringer's acetate, when given in comparable doses and volumes.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Hemodynamic and oxygen transport measurements were made with successive increments of positive end-expiratory pressure (PEEP) in 14 episodes of ARDS in 11 patients who had normal or slightly increased blood volumes. “Preferred” or optimal PEEP was defined as the PEEP value associated with the greatest Vo2that did not compromise pulmonary function as determined by shunting (Qs/Qt). The preferred PEEP averaged 10.7 ± 2.7 (SD) cm H2O in the patients who had appreciable reduction in cardiac index (CI) by the time this level of PEEP was reached. In 6 patients, the CI fell approximately 15%; then albumin, 25 g, was given. This restored CI, improved oxygen transport, and permitted us to give additional 10–15 cm H2O of PEEP, i.e., until 20–25 cm H2O was reached; this was achieved without hemodynamic impairment. The final preferred PEEP in these patients averaged 14.1 ± 3.6 (SD) cm H2O. The authors conclude that the titration of PEEP as well as fluid therapy may be used to maximize Vo2in patients with early shock lung.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Respiratory dysfunction is a major consequence of smoke inhalation and significant surface burns. Carbon monoxide intoxication, asphyxia, and upper airway obstruction occur early, whereas pulmonary edema and bacterial pneumonia may be delayed for days or weeks. The noxious constituents of smoke are believed to stimulate irritant receptors producing bronchoconstriction and to cause chemical injury to the airway mucosa and the alveolar-capillary membrane producing pulmonary edema. Pneumonia occurs in most patients who survive the initial injury. Thorough history and physical and laboratory examinations may forecast the severity of injury. Treatment includes administration of oxygen, use of bronchodilators, and when necessary, mechanical ventilation. The long-term sequelae of smoke inhalation are unknown.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Pulmonary venous admixture (shunt) was measured in 10 mechanically ventilated patients with respiratory failure at varying oxygen tensions. All patients manifested a drop in pulmonary shunt as FIO2was increased from 0.21 to 0.4. Further increase in FIO2led to a gradual increase in the calculated venous admixture. The clinical significance of the conventional measurements of pulmonary shunt at FIO2= 1.0 is questionable because of the marked effect of FIO2on pulmonary shunt. Consequently, shunt measurements should be performed with the clinically useful FIO2.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Pulmonary vascular pressures were simultaneously measured by digital instrumentation and by analysis of graphic tracings at end-expiration. Three patients were prospectively studied to assess any discrepancies between the two methods and to assess the effect of variation in intrathoracic pressure on the digital output.In this study, it was found that spontaneous breaths tended to lower pulmonary capillary wedge pressure (PCWP) and that machine delivered positive pressure breaths tended to elevate PCWP by digital as compared to graphic analysis. The effect of variation of intrathoracic pressure on digital PCWP was variable, unpredictable, and of sufficient magnitude to make its use unreliable. Digital instrumentation recording systems have no advantage over graphic analysis.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID