摘要:

To determine how many ICU beds are needed to serve patients within a given hospital, the authors report methods which allow hospitals to answer the following questions. (1) How are the surgical ICU facilities currently utilized? (2) How many additional overnight recovery room beds are needed? (3) What would be the ideal number of surgical ICU beds to manage patients beyond the scope of conventional care? (4) Have adverse results been reported on patients denied intensive care because of inadequate bed supply? (5) Can the need for intermediate care be defined?Data were collected for 6 months to balance seasonal variation and staffing changes. Recovery Room (RR) patients requiring intensive care (even if denied an ICU bed for lack of space) were identified and followed for 3 days or more to determine Therapeutic Intervention Scoring System (TISS) points and adverse results. ICU demographic data were obtained daily and full-service ICU patients were evaluated each day until discharged. “Triage” patients (nonelective discharges) were followed as described previously. Finally, the number of refused admissions to the ICU was obtained. Adverse results—defined as: (1) return to ICU; (2) death in hospital; (3) still in hospital 1 month or more after ICU discharge—were less than 1% in patients requiring overnight intensive care, 15% in potential triage patients (those who would have been discharged nonelectively but were able to remain in the ICU because the need for ICU beds diminished), and 23% in actual triage patients (those who were nonelectively discharged). Triaged patients averaged 17 TISS points the 1st day after ICU discharge while receiving floor care. Although the results pertain only to this hospital setting, they illustrate the methodology by which answers to the posed questions may be obtained. These methods have been used to support Certificates of Need (ultimately granted at several other large and small hospitals).

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Oliguric renal failure significantly worsens the prognosis of many critical illnesses, particularly in patients with respiratory failure. In 52 patients, a continuous infusion of dopamine, 1.5–2.5 μg/kgμmin, was administered when creatinine clearance (Cer) fell below 40 ml/ min and urinary output was less than 1 ml/kgμh despite normal intravascular volume. In 18 patients, a continuous infusion of furosemide (3–5 mg/kgμday) was also administered. Daily, two 3-h collections of urine and blood specimens were obtained to determine Ccr, osmolar clearance (Cosm), free water clearance (CHO2) and excreted fraction of filtered sodium (FENa); one collection was made during dopamine infusion and one while the infusion was suspended. Cardiac output and pulmonary venous admixture were also measured. The authors obtained 199 urine collections in 52 patients; considering the aggregate patient population, urinary output increased by 42.3% (30.2 ± 3.45 (SEM) ml/h), on dopamine infusion. Cosm, FENa, and Ccr were also higher on dopamine. CH2O and hemodynamic variables were not altered by dopamine infusion.When patients were stratified on the basis of mechanical veritilatory support, Ccr and furosemide administration, dopamine infusion essentially caused the same changes in the variables studied as described for the aggregate patient population. Diuresis and sodium excretion increased significantly on dopamine even in those patients receiving furosemide infusion.The authors conclude that fluid and osmolar load can be eliminated more effectively in critically ill patients with continuous infusion of 1.5–2.5 μg/kgμmin of dopamine.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Serratia marcescens septicemia represents a serious problem in high risk critical care patients. Treatment is difficult because Serratia is usually resistant to most antibiotics. Amikacin is at present the most effective antibioticin vitroagainst gentamycin-resistant Serratia, although significant loss of activity may occurin vivoin the group of compromised patients, whose ultimate prognosis may depend eventually upon other associated conditions.In this Medical ICU, 15 patients with Serratia septicemia who were treated within vitroeffective antibiotics (14 were given amikacin) had a mortality of 60%, while 5 patients who received ineffectivein vitroantibiotics had a mortality of 100%. In this ICU, 80% of the Serratia isolates were resistant to gentamycin, while only 2.8% were resistant to amikacin. Because amikacin-resistant strains of Serratia have already emerged, appropiate use of this antibiotic is essential in order not to promote the selection of amikacin-resistant strains.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

From July 1975 to September 1979, 6 patients were treated with truly prolonged endotracheal intubation; the duration ranged from 55–155 days. Only patients who survived after extubation and were discharged from the hospital were included in this study. Of the 6 patients, 4 were still alive as of November 1980, 2 patients died from causes not related to the intubation. The most common complication was hoarseness, which occurred in 4 patients. During the time of the study, 3 patients who were intubated in excess of 50 days did not survive. In none of these cases was the patient's death related to the intubation. The authors believe that the risk of long-term intubation has been reduced significantly by the use of nasotracheal tubes and to the newer tube materials, which are completely biocompatible, and to improved techniques of cuff inflation. Complications to tracheostomy are less frequent, but often more, serious, than complications of long-term nasotracheal intubation.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Two new catecholamines, dopamine and dobutamine, have found widespread use for cardiovascular support. The relative efficacy of these drugs in aiding resuscitation from cardiopulmonary arrest is unknown. Dogs were subjected to either asphyxial or fibrillatory cardiac arrest. Resuscitation was attempted with artificial ventilation, closed chest cardiac massage, and one of four iv drug protocols: dopamine, 40 mg; epinephrine, 1 mg; dobutamine, 50 mg; or no drug. The incidence of successful resuscitation from both asphyxial and fibrillatory arrest was significantly greater in groups receiving dopamine or epinephrine than in groups receiving dobutamine or no drug. There was no difference in success between the dopamine and epinephrine groups.The authors conclude that, in dogs, dopamine is a useful adjunct to CPR because of its α-adrenergic stimulating activity at high doses. Dobutamine does not appear to be of value as the initial therapy of cardiac arrest. If the response in man is similar to that in dogs, dopamine may provide an alternative to epinephrine during CPR.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Cardiovascular failure (shock) associated with acute alcohol ingestion and severe hypothermia (core temperature 23 and 21°C) was studied in 2 patients. In each case, perfusion failure was associated with lactacidemia, severe bradycardia, and agonal respirations. Infusion of fluids and mechanical ventilation reversed shock and prevented a fatal outcome. One case, complicated by renal failure and volume overload with pulmonary edema, was managed with peritoneal dialysis. These findings suggest that perfusion failure associated with severe accidental hypothermia after acute alcohol ingestion is due to a combination of hypovolemia, bradycardia, and respiratory depression.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Ten patients with acute respiratory insufficiency (ARI) were studied. Despite severe dysfunction (Qsp/Qt = 34%), pulmonary vascular resistance (PVR) was normal before treatment and remained so after PEEP therapy reduced shunt to 14%. No cause-effect relationship be tween PVR and ARI could be described.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Serum angiotensin converting enzyme (ACE) levels were obtained in 24 control patients who were critically ill, in 11 patients with cardiogenic pulmonary edema, in 8 patients with status postcardiopulmonary bypass, and in 12 patients with adult respiratory distress syndrome (ARDS). Mean values in cardiogenic pulmonary edema (24.3 ± 3.9 SD) in cardiopulmonary bypass (19.5 ± 3.1) and in patients with ARDS and no sepsis (n = 7, 19.0 ± 5.5) were not significantly different from controls (20.7 ± 2.8). In contrast, patients with ARDS and sepsis had markedly decreased serum ACE levels which fell outside of control range (n = 5, 8.6 ± 2.3). The authors speculate that decreased ACE levels in the combination of sepsis and ARDS are due to the presence of circulating inhibitors of ACE. The finding of decreased serum ACE can be of potential clinical usefulness by raising the possibility of sepsis as the etiology of ARDS before results of blood cultures are available.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

To provide a clinical assessment of cardiovascular dysfunction (CVD) in premature infants with patent ductus arteriosus (PDA), a scoring system (CVD score) was devised and correlated with blood gases, acid-base balance, and echocardiogram. The score consisted of evaluation of heart rate, quality of peripheral arterial pulsation, degree of precordial pulsation, duration of murmur and cardiothoracic ratio on chest roentgenogram.There were 116 observations made on 55 premature infants who had PDA and required medical or surgical treatment. Significant positive correlations were seen for CVD score with left atrial (LA)/aortic (Ao) ratio (p< 0.001), left ventricular end diastolic dimension (DD) (p< 0.001), blood pH (p< 0.01), and blood Pco2(p< 0.01). The scoring system may be used as a clinical guide when echocardiogram or angiogram is not available.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID

摘要:

Five patients were treated with dopamine in doses over 30 μg/kgμmin in severe circulatory shock and developed fixed dilated pupils. This phenomenon was most likely attributed to the use of dopamine. Further neurological examination gave no support to cerebral damage. Therefore, dilated pupils, unreactive to light, bear no relation to the neurological status during treatment with high doses of dopamine.

ISSN:0090-3493    

出版商:OVID    

年代:1981

数据来源: OVID