摘要:

In a prospective randomized study to determine whether prevention of colonization of Gram-negative bacteria results in prevention of Gram-negative bacterial infections, 96 intensive care patients were randomly allocated into a control group and a study group. The study group received oral nonabsorbable antimicrobial agents (i.e., tobramycin, amphotericin B, and polymyxin E) in addition to parenteral antibiotics. Colonization with Gram-negative microorganisms in the oropharynx, and respiratory and digestive tracts increased in the control group during their stay, while the study group did not tend to colonize with Gram-negative bacteria. In the control group, 107 nosocomial infections were diagnosed, vs. 42 nosocomial infections in the study group. Nosocomial infections caused by Gram-negative bacteria were significantly less frequent in the study group. Mortality due to an acquired infection was significantly less frequent in the study group. We conclude that colonization, infection, and subsequent mortality by nosocomial Gram-negative bacteria can be prevented by a regime of topically applied nonabsorable antibiotics.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

In respiratory distress syndrome (RDS), PEEP improves arterial oxygenation but may impair cardiac output. The effects of PEEP on gas exchange and hemodynamics were studied in 12 mechanically ventilated newborns in the acute phase of RDS. Stepwise increase in PEEP resulted in both a) a progressive increase in PaO2and transcutaneous oxyhemoglobin saturation, and b) a depression of pulsed Dopplermeasured cardiac output that was statistically significant at 9 cm H2O PEEP. Thus, averaged systemic oxygen delivery (Do2) was maintained with improved arterial oxygenation up to 6 cm H2O PEEP. Further increase in PEEP induced a significant fall in Do2. No variation was observed in heart rate and mean arterial pressure. The combined use of oximetry and pulsed Doppler echocardiography enables noninvasive optimization of mechanical ventilation and PEEP during the clinical course.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The charts of 56 patients with chest pain who were admitted to the critical care units to rule out myocardial infarction were evaluated concurrently and retrospectively to compare the efficiency of cardiologists and internists. The number of unnecessary days used to rule out myocardial infarction, the number of unnecessary inhospital days used after ruling out myocardial infarction, the length of cardiac work-up, and the length of hospital stay were determined for 23 patients of cardiologists and 33 patients of internists. The cardiologists' patients had fewer unnecessary days after ruling out myocardial infarction (2.76 vs. 0.43 days,p< .01) and a shorter length of hospital stay (5.15 vs. 2.91 days,p< .02). We concluded that consideration should be given to increasing and refining the supplementary role of physician-experts to primary care physicians as one means of improved resource allocation.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The use of a transthoracic bioimpedance monitor to determine cardiac output was evaluated in critically ill children. The children ranged in age from 10 months to 8 yr and their height and weight ranged from the third to the 97th percentile. Each child had a thermodilution catheter in place to monitor cardiac output. The bioimpedance monitor used in this study, the NCCOM-3, required the input of a constant (L), which was obtained for each individual patient by adjusting the L setting until cardiac output measured by bioimpedance (CObi) was within 10% of cardiac output measured by thermodilution (COtd(. This method of determining L was superior to using either measured thoracic length or the manufacturer's guidelines to obtain L and resulted in an excellent correlation between COtd and CObi (r = .94;p< .05; n = 59). In children <125 cm in height, measured thoracic length alone was inadequate to use for L but provided a good approximation of L when multiplied by 1.25. This study suggests that the use of transthoracic bioimpedance to determine cardiac output compares favorably with thermodilution techniques and it is noninvasive.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We undertook a study to determine the frequency, predisposing factors, and outcome in 315 patients admitted to a medical-surgical ICU, of whom 47 (14.9%) subsequently acquired renal insufficiency (ARI) during their stay in the unit. Four well-recognized risk factors for ARI were present alone or in combination in all episodes: hypotension, sepsis, aminoglycoside antibiotics, and radiocontrast dye. Hypotension was the most prevalent factor, present in 42 (85.8%) episodes, and was the sole factor present in 18 (36.7%). Patients with ARI but without hypotension all survived their ICU stay, while only 13 (33%) of 40 with hypotension survived (p< .05). Neither initial, peak nor change in BUN or creatinine predicted mortality; oliguria was marginally associated with poor prognosis. Our findings indicate that: a) ARI was a frequent and important contributing factor to mortality in our critically ill patients, b) hypotension was the most common of wellrecognized risk factors, and c) conditions that predisposed to ARI also predisposed to mortality, although mortality did not appear to depend on the severity of renal insufficiency.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The Pediatric Risk of Mortality (PRISM) score was developed from the Physiologic Stability Index (PSI) to reduce the number of physiologic variables required for pediatric ICU (PICU) mortality risk assessment and to obtain an objective weighting of the remaining variables. Univariate and multivariate statistical techniques were applied to admission day PSI data (1,415 patients, 116 deaths) from four PICUs. The resulting PRISM score consists of 14 routinely measured, physiologic variables, and 23 variable ranges. The performance of a logistic function estimating PICU mortality risk from the PRISM score, age, and operative status was tested in a different sample from six PICUs (1,227 patients, 105 deaths), each PICU separately, and in diagnostic groups using chi-square goodness-of-fit tests and receiver operating characteristic (ROC) analysis. In all groups, the number and distribution of survivors and nonsurvivors in adjacent mortality risk intervals were accurately predicted: total validation group (x2(5) = 0.80;p> .95), each PICU separately (x2(5) range 0.83 to 7.38; allp> .10), operative patients (x2(5) = 2.03;p> .75), nonoperative patients (x2(5) = 2.80,p> .50), cardiovascular disease patients (x2(5) = 4.72;p> .25), respiratory disease patients (x2(5) = 5.82;p> .25), and neurologic disease patients (x2(5) = 7.15;p> .10). ROC analysis also demonstrated excellent predictor performance (area index = 0.92 ± 0.02).

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The aim of this study was to evaluate the concept that tissue oxygen debt reflected by inadequate oxygen consumption (Vo2) in the intraoperative and immediate postoperative periods is a common determinant of multisystem organ failure and death. We measured the cumulative tissue oxygen debt during and immediately after 100 consecutive high-risk surgical operations in 98 patients and correlated these data with the subsequent development of lethal and nonlethal organ failure complications. The tissue Vo2deficit was calculated as the measured Vo2minus the estimated Vo2requirements corrected for both temperature and anesthesia; the net cumulative Vo2deficit was calculated as the integrated area under the Vo2deficit-time curve. The maximum cumulative Vo2deficit averaged 33.5 ± 36.9 (sd) L/m2in nonsurvivors, 26.8 ± 32.1 L/m2in survivors with organ failure, and 8.0 ± 10.9 L/m2in survivors without organ failure. The time postoperatively to reach the maximal cumulative Vo2deficit and the duration of the Vo2deficit was greatest in nonsurvivors, less in survivors with organ failure, and least in survivors without organ failure. Although many associated clinical conditions as well as innumerable physiologic mechanisms and biochemical mediators play important roles in tissue injury, tissue oxygen debt reflected by insufficient Vo2appears to be the primary event as well as a major determinant of organ failure and outcome.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The role of the polymorphonuclear leukocyte in the development of acute lung injury has been the subject of much controversy. Experimental lung injury is associated with peripheral leukopenia and the intrapulmonary sequestration of leukocytes. We have previously shown that ibuprofen, a nonsteroidal anti-inflammatory drug, can improve the hemodynamic alterations of canine endotoxin shock. Ibuprofen has also been found to decrease leukocyte adherence. We investigated the dose response of ibuprofen on the increased neutrophil adherence and the extent of lung injury associated with canine endotoxin shock. Single doses of ibuprofen (1, 5, 10, and 20 mg/kg iv) were administered 15 min afterEscherichia coliendotoxin. Endotoxemia resulted in leukopenia and an increased neutrophil adherence in both aortic and pulmonary artery blood. Endotoxintreated animals exhibited increased neutrophils in the bronchoalveolar lavage fluid, a marker of lung injury. The 20-mg/kg ibuprofen dose decreased aortic granulocyte adherence at 30 min, while all ibuprofen doses decreased the aortic adherence at 120 min. The increased pulmonary artery neutrophil adherence was not affected by ibuprofen. Histologically, lung injury was manifested by intravascular leukostasis. Ibuprofen treatment did not affect the histologic or morphometric extent of the lung injury. The leukopenia and increased neutrophil adherence occur rapidly after endotoxemia and are associated with subsequent intravascular sequestration of leukocytes. These results imply that the activated neutrophils remain sequestered in the lung and that agents aimed at decreasing neutrophil adherence primarily affect the circulating pool of leukocytes. Agents designed to prevent lung injury must either be given before the insult or be able to block the effects of the toxic products released by the activated granulocytes.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The dose response of the nonsteroidal anti-inflammatory drug, ibuprofen, was evaluated in order to determine the most efficacious dose in the treatment of canine endotoxin shock. Fifteen minutes after an infusion ofEscherichia coliendotoxin, four groups of dogs were given a single iv dose of 1, 5, 10, or 20 mg/kg of ibuprofen. These groups were compared to endotoxin only and saline control groups. All ibuprofen doses significantly improved the systolic, diastolic, and mean systemic arterial BP. The improvement in systemic BP was accompanied by an increase in the systemic vascular resistance. Pulmonary vascular pressures and resistance also increased after ibuprofen administration. The lack of a dose response and the demonstrated beneficial effect of low dose ibuprofen in the reversal of the hypotension associated with experimental canine endotoxin shock lead us to recommend the use of low dose ibuprofen for future endotoxin and sepsis studies. Use of low dose ibuprofen might have less of an effect on renal perfusion and would therefore be more likely to produce the beneficial hemodynamic response without compromising renal function.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

We investigated the association between plasma catecholamines and the renal response to nonhypotensive sepsis. Arterial plasma catecholamines were measured in 16 sheep, before and 24 h after surgical induction of peritonitis. Animals were volume loaded with lactated Ringer's solution (8 L/24 h) before and after surgery; none became hypotensive. For analysis, animals were retrospectively divided into those with increased serum creatinine after 24 h of sepsis (group 1, n = 8) and those without (group 2, n = 8). Group 1 showed increased cardiac index and decreased systemic vascular resistance typical of severe sepsis, with decreased glomerular filtration rate (GFR), oliguria, sodium retention, increased plasma renin activity (PRA), decreased urinary kallikrein excretion, and increased urinary 6-keto-prostaglandin-F1αexcretion. Group 2 showed insignificant hemodynamic disturbance, and no significant renal response.Plasma catecholamines were equal in both groups at baseline. In group 1, there were uniform increases after 24 h in plasma norepinephrine (474 ± 115 to 1183 ± 158 [SEM] pg/ml;p< .01) and plasma epinephrine (108 ± 8 to 309 ± 70 pg/ml;p< .05). In group 2, neither plasma norepinephrine (343 ± 59 to 330 ± 56 pg/ml) nor plasma epinephrine (116 ± 16 to 116 ± 13 pg/ml) changed significantly. Plasma norepinephrine correlated inversely with GFR; plasma epinephrine correlated with PRA.The sympathetic nervous system may be involved in the renal response to nonhypotensive sepsis, both directly and via effects on other vasoactive hormone systems.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID