摘要:

Over a 2-year period, 14 viable ventilator-dependent patients were transferred from the Medical Intensive Care Unit (MICU) to a general ward floor for nutritional support after failing to wean from mechanical ventilation (MV) while in the MICU. These patients were retrospectively grouped based on their ultimate ability to wean from MV: group 1 (N = 6) did not wean from MV and ultimately died in the hospital; group 2 (N = 8) weaned from MV and were eventually discharged.Before transfer from the MICU, the two groups did not differ with regard to serum albumin or transferrin levels, or in total lymphocyte count. After the period of aggressive nutritional support, group 2 patients showed an increase in serum albumin and transferrin whereas patients in group 1 showed a decrease. The differences between these groups were significant (p< 0.05). The lymphocyte count did not change significantly.Ventilator-dependent patients who respond to nutritional support with an increase in protein synthesis are more likely to wean from mechanical ventilation than those who do not.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Seventeen critically ill patients were studied prospectively to determine the relationship of serum albumin, creatinine-height index (CHI) and weight-height index (WHI) to clinical outcome. Use of the conventional “normal values” as cut-offs failed to discriminate between survivors and nonsurvivors better than chance alone. A serum albumin less than 2.5 g/dl correctly separated 93% of the patients in terms of survival prognosis.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Whole serum complement (CH50) and C3, C4, and C3PA plasma values were studied in 48 patients: 9 with nonseptic shock; 20 with sepsis; 14 with septic shock caused by gram-negative bacteria; 5 with septic shock caused by gram-positive bacteria. All were compared with a control group of 25 healthy individuals. Determinations were made upon admission and again 48 and 96 h later. No significant differences in complement values were found between the patients with nonseptic shock and the control group. In the patients with sepsis, decreased CH60(p< 0.001) and increased C3PA (p< 0.02) values were observed, while C3and C4remained unaltered. In the patients with septic shock, markedly decreased levels of CH50, C3, and C4were seen (pp< 0.001, andp< 0.001, respectively) without changes in C3PA levels. There were no differences between septic shock due to gram-negative and gram-positive bacteria, or between patients who died and those who survived. After 96 h, the altered values returned to the normal range. This underlines the transitory activation of the complement system through the classic pathway and suggests its possible role in the pathogenesis of septic shock in man.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Gram-negative septicemia presents a particular problem in the ICU. Septicemia is usually diagnosed by fever, chills, and shock. Results of blood cultures become available a few days later. Major surgery induced a marked decline in antithrombin III (AT III) and plasminogen (PLG) to a mean level of 0.60 U/ml (normal value: 0.80–1.40 U/ml) on the 2nd and 3rd postoperative days. Around the 5th postop day, these values again attained mean preoperative levels. Seventy-six surgical ICU patients were investigated preoperatively and for 10 days postoperatively1to relate postop septicemia to changes in the hemostatic profile. In 15 patients with gram-negative septicemia verified by positive culture, AT III and PLG barely recovered from the postop decrease and remained significantly lower (p< 0.05) after the 3rd postop day, compared to 61 surgical ICU patients without septicemia. The behavior of α2antiplasmin (α2AP) values was equal in both groups. This difference in hemostatic profile preceded the clinical manifestations of septicemia and the results of blood culture by several days. Leucocyte or platelet counts provided no reliable information on the early development of septicemia in these surgical patients. It is concluded that persistent low plasma AT III and PLG levels in the postop phase are early indicators of a developing gram-negative septicemia.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Because approximately 20% of patients receiving mechanical ventilation have upper gastrointestinal bleeding, these patients were prophylatically treated with either antacids, cimetidine, or a placebo in a double-blind radomized fashion. The authors did not titrate gastric acidity because it is a time-consuming process that requires a nasogastric tube. When gastrointestinal bleeding developed in 9 of the 36 patients entered in the study, the treatment code was broken to assess the efficacy of prophylaxis and the frequency of complications.In the antacid group, 5 of the 11 patients were unable to ingest and tolerate their antacids (p< 0.05 when compared to the control and cimetidine groups). Gastrointestinal bleeding did not occur in any of the six subjects receiving antacids but did occur in one of the 11 subjects receiving cimetidine, in 5 of the 14 control patients, and in 3 of the 5 patients who were unable to tolerate antacids. These differences were not significant. When groups were rearranged, though, there was a significant difference between them. Only 1 of 17 patients receiving medication (antacids or cimetidine) bled, whereas 8 of 19 patients receiving no medications bled (p< 0.01). The average number of risk factors was not significantly different in the treatment groups. The authors conclude that prophylactic therapy (cimetidine or antacids) given without titration is associated with a lower frequency of upper gastrointestinal hemorrhage than when no medication is given. The authors also conclude that more subjects are able to tolerate cimetidine than antacids.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Shortening of the Q-T interval on the 12-lead ECG is often attributed to hypercalcemia and is sought in critically ill patients to confirm suspected hypercalcemia. In our experience, hypercalcemia of greater than 13 mg/dl (3.25 mM/L) was unaccompanied by ECG changes.The records of the Brooklyn VA Medical Center for a 3-year period were reviewed and yielded 125 patients with hypercalcemia. Of these, 48 (38%) had a serum calcium of greater than 13 mg/dl. Of these 48, 10 (21%) had an ECG recorded at the same time. The mean serum calcium in these patients was 13.6 mg/dl (3.40 mM/L). None had an abnormally short Q-T interval when the interval was corrected for heart rate (Q-Tc).The ionized calcium was estimated and yielded a mean of 2.26 mM/L (normal range = 0.94–1.33 mM/L). No cause for overestimation of ionized calcium was apparent. It is concluded that the Q-T interval is not a useful clue to the presence of hypercalcemia.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A patient presented with lactic acidosis and severe acidemia; sodium bicarbonate was administered to titrate the very large hydrogen ion load. Coincident with this therapy, the blood lactate concentration rose from 21 to 27 mmole/L. In order to evaluate whether this rise in lactate could have occurred without requiring additional net lactic acid production, the effect of the hydrogen ion concentration on lactate distribution was evaluated. Data obtained from animal studies support the established hypothesis that lactate is distributed like other weak organic acids at steady-state; hence, alkalemia should favor a shift of lactate from the intracellular fluid (ICF) to the extracellular fluid (ECF). The authors calculated that the blood lactate concentration could rise by 50% without requiring net lactic acid accumulation when the severe acidemia was corrected by alkali therapy. Thus, an increase in lactate concentration of the magnitude observed during alkali therapy need not indicate a worsening of the metabolic picture in lactic acidosis.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Cardiovascular interactions between dopamine and hypoxia were examined in 8 anesthetized, paralyzed dogs ventilated at constant rates. Total and hindlimb (less paw) O2uptake, blood flow, and vascular resistance were measured with and without dopamine infusion of 10 μg/kg-min during both normoxic and hypoxic ventilation. Another 8 dogs were similarly treated after β-blockade with propranolol infusion (1 mg/kg). During the baseline period, normoxic dopamine significantly increased total O2uptake, cardiac output, and stroke volume, and significantly decreased total vascular resistance in the control group. Hypoxia decreased total O2uptake, cardiac output, and heart rate but increased total vascular resistance. Dopamine reversed each of these hypoxic changes and restored total O2uptake to normoxic levels. Hindlimb measurements were not significantly changed by dopamine or hypoxia in the control group. During hypoxia, blockade abolished dopamine's effects except for the decrease in total vascular resistance. The improvement in cardiac output and O2transport by dopamine infusion resulted from increased stroke volume during normoxia and from increased heart rate during hypoxia.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

An indirect method for measuring the increment of functional residual capacity (FRC) produced by positive end-expiratory pressure (PEEP) during controlled mechanical ventilation was evaluated in 13 patients with acute respiratory failure. The actual FRC with and without PEEP was measured with a computerized nitrogen washout method. The results obtained did not show significant differences between the measured and the calculated increment of FRC.This indirect method accurately measures how much alveolar recruitment (estimated as increment of FRC) is produced by PEEP.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Blind nasal intubation often results in esophageal placement of the tube because reflex swallowing and supralaryngeal structures direct the tube posteriorly. Extrusion of the tongue, which inhibits swallowing and shifts the supralaryngeal structures anteriorly, facilitated blind placement of a nasotracheal tube in 14 of 16 critically ill patients. The technique avoids manipulation of the neck, the use of heavy sedation or anesthesia, and requires no specialized training or equipment.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID