摘要:

We report a new clinical rating system which assesses septic patients' ongoing disease course and its severity. Our system incorporates the Therapeutic Intervention Scoring System (TISS) and Acute Physiology and Chronic Health Evaluation to measure discrete organ system abnormalities, plus a multiple system organ failure scale to quantify the number of abnormal organ systems. The resulting score, which reflects the severity of multiple organ dysfunction and grades responsiveness to therapy, was validated against the actual disease course. Retrospective and prospective profiles of individual surgical ICU patients demonstrated that this tracking method was a more effective indicator of severity of sepsis and more sensitive to the day-to-day changes in clinical status than either the TISS or APACHE II components alone. We also demonstrate that a graphic illustration of daily system scores yields clinically useful information relevant to the patients' septic course.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Five patients undergoing orthotopic liver transplantation were investigated for changes in acid-base homeostasis secondary to large volume transfusions. All patients developed a transient acidemia during the operative period, followed by alkalemia which persisted into the early postoperative period. The patients received an estimated mean of 750 mEq of citrate, which appeared to cause metabolic alkalosis. The biochemical basis underlying the regulation of citrate metabolism that may have led to the timing, extent, and duration of the subsequent metabolic alkalosis is presented. Finally, the time course for the development of metabolic alkalosis may be a potentially sensitive indicator of early allograft function.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study used the Acute Physiological and Chronic Health Evaluation (APACHE II) system to select two groups of ICU patients with comparable risk of hospital death to evaluate the importance of GI dysfunction, defined as failure to tolerate enteral nutrition (EN), as a prognostic factor. In our ICU, patients who have not undergone recent bowel surgery are treated by EN. Those patients who cannot tolerate EN are treated by total parenteral nutrition (TPN). One hundred and eleven patients who tolerated EN (functioning gut) and 97 TPN patients who failed to tolerate EN (GI dysfunction) were studied. The mean APACHE II scores of the two groups were 17.7 ± 6.5 (sd) and 17.7 ± 5.1, respectively. The observed mortality of patients with GI dysfunction (51%) was significantly higher (p< .0005) than that of patients with a functioning gut (25%). This was associated with significantly poorer APACHE II mean BP, oxygenation, and creatinine scores among the GI dysfunction patients. Our results suggest that shock, ischemia, and hypoxemia, in addition to causing impairment of renal function, may bring about changes in the GI tract, evident clinically only as a failure to tolerate EN, which have an adverse effect on the prognosis of ICU patients so affected.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In order to compare the differences of high-frequency jet ventilation (HFJV) synchronized with the cardiac cycle (sync) to that nonsynchronized with the cardiac cycle (async), ten stable postoperative ICU patients, without heart failure, in sinus rhythm were ventilated randomly in either mode. The async mode was HFJV at 100 cycle/min, white the sync mode was HFJV triggered by the R-wave of the ECG tracing. The heart rate ranged between 64 and 127 beat/min. Synchronization was studied at one of two periods, sync 0 and sync 60. Sync 0 consisted of inspiration triggered by the R-wave, with jet ventilation occurring early in systole; sync 60 represented a 60% delay of the time between the succeeding R-waves, with jet ventilation occurring in mid-diastole. There was no significant difference in the cardiorespiratory data when async was compared to either sync 0 or sync 60. Therefore, in these patients without heart failure, the selection of async vs. either sync mode appeared to have neither adverse nor beneficial hemodynamic effects.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study was designed to evaluate whether the ventilatory maneuvers associated with surfactant replacement would, per se, influence oxygenation in newborn infants with severe respiratory distress syndrome. Eight patients (700 to 1400 g), all requiring mechanical ventilation with fraction of inspired oxygen >0.6, were included in the trial; four were randomized to receive surfactant, and the others served as controls. Porcine surfactant (2 ml/kg; phospholipid concentration, 100 mg/ml) was instilled via a naso-endotracheal tube at end-expiration and dispersed into the lungs during a period of standardized “sighing” mediated by the ventilator: two prolonged ventilatory cycles (10 sec each) with an inspiration/expiration ratio of 4:1, followed by a 6-min ventilation with a frequency of 60 breath/min and an inspiration/expiration ratio of 4:1. Control babies received no surfactant but were otherwise subjected to the same ventilatory maneuvers. Surfactant-treated infants showed a rapid increase in transcutaneous oxygen associated with improved lung aeration in chest x-rays; the response was transient in three babies and persistent in one. No improvement was observed in control babies. We conclude that the beneficial effect of surfactant replacement cannot be attributed to the ventilatory maneuvers associated with the instillation procedure.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Forty-eight septic shock patients with positive blood cultures had conventional serial hemodynamic evaluations until recovery or death to identify early cardiovascular variables that predicted outcome. There were 19 (40%) survivors and 29 nonsurvivors. At the initial evaluation, both survivors and nonsurvivors demonstrated an elevated cardiac index (CI), low systemic vascular resistance index (SVRI), and normal stroke volume index. However, only an initial heart rate (HR) <106 beat/min significantly predicted survival. Twenty-four hours after the onset of shock, both an HR <95 beat/min and an SVRI > 1529 dyne ċ sec/cm5ċ m2predicted survival. Comparing the hemodynamic profiles from the initial to the 24 h time point, a decrease in HR > 18 beat/min or a decrease in CI > 0.5 L/min ċ m2predicted survival. Twenty-two deaths occurred in the first week of study, of which 18 (82%) were due primarily to low SVRI and four (18%) to low CI. Seven deaths occurred after 1 wk, all of which were due to multiple organ failure.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We conducted a prospective multi-institutional study of nosocomial and community-acquired pneumonias in 1378 patients admitted to the ICUs of six hospitals. We also investigated 1005 of these patients who were intubated and mechanically ventilated for a reason other than pneumonia, the risk of developing pneumonia, and the relationship between the incidence of pneumonia and the length of time during which the patients were mechanically ventilated. A bacteriologic diagnosis was made in 38% of the nosocomial and 21% of the community-acquired pneumonias. The total mortality rate was 40%; 47% of the patients with nosocomial and 17% of the patients with community-acquired pneumonias died. Because it was difficult to make an etiologic diagnosis in two-thirds of the cases, the treatment had to be based on an assumed causative organism.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To examine whether reverse triiodothyronine (rT3), generally considered devoid of biological activity, could influence outcome in circulatory collapse, 23 anesthetized mongrel dogs were subjected to hemorrhagic shock. In 10 dogs, 15 μg/kg of rT3were administered in 30 min before hemorrhage. In 13 other dogs, an equal volume of saline was injected. The dogs were bled rapidly to a mean arterial pressure of 40 mm Hg, and after 60 min the reservoir line was clamped for 30 min. The shed blood was then reinfused over 30 min. After one hour of hemodynamic monitoring, the dogs were returned to the kennel and observed for at least 3 days. During shock there were few significant intergroup hemodynamic-metabolic differences. In the control group, six of 13 dogs died, whereas nine of ten dogs given rT3died (p< .03). This study strongly suggests that rT3exerts detrimental biological activity in canine hemorrhagic shock, Hence, rT3may play a causative role in the euthyroid sick (“low T3”) syndrome.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The recommended rates for closed-chest cardiac compressions during CPR are based on physiologic variations with increasing age rather than experimental data. Using puppies, we compared mean arterial pressure, cardiac index (CI), and cerebral blood flow (CBF) at a slow (40/min, group 1) and a rapid (120/min, group 2) rate. CBF was measured in all experiments by N2O uptake before and during CPR from cardiac arrest induced with KCI. Both CI and CBF were measured in half of the subjects with radiolabeled mcrospheres. Groups 1 and 2 were similar in terms of baseline mean weight, mean arterial pressure, CI, CBF, and arterial and venous blood gases. During resuscitation for group 1, the mean CI was 221 ml/min m2, and the mean CBF was 4 ml/100 gċmin determined by N2O uptake (2 ml/100 gċmin by microspheres); in group 2, the respective means were 248 ml/minċm2and 4 ml/100 gċmin with both techniques. The values for mean CI and CBF (N2O or microspheres) did not differ significantly at either rate of compression. The N2O uptake and microsphere techniques for measuring CBF correlated closely during spontaneous cardiac contractions and mechanical chest compressions. We conclude that a) closed-chest cardiac compressions at either rate studied provided inadequate CBF, and b) the N2O uptake and microsphere techniques give similar measures of CBF under conditions of normal and low flow.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

To learn modes of CO2elimination during cardiac arrest, we continuously measured end-tidal CO2concentration (ETco2) in acutely arrested dogs with constant ventilation. A decrease in peak ETco2during cardiac arrest in each dog showed a washout biexponential function when graphed on semilog paper. The average half-times of each compartment were 19.2 ± 3.1 (sd) sec for the fast compartment and 108.1 ± 23.8 sec for the slow compartment; the fast compartment of the CO2elimination curve suggested that CO2was eliminated from the functional residual capacity, while the slow compartment Indicated CO2elimination from the pulmonary capillary blood and tissue stores. Neither pretreatment with sodium bicarbonate (1 mEq/kg iv) nor a 5-min cardiorespiratory arrest altered the mode of CO2elimination. The ETco2also reflected the potential effects of external cardiac compressions on pulmonary blood flow, as previously reported. Besides mixed venous blood CO2flowing back to the lungs by cardiac compressions, it should be noted that both alveoli and pulmonary capillary blood CO2are also reflected in the ETco2during the first minute of CPR.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID