摘要:

Balloon flotation catheterization of the central circulation provides data which may be most meaningful and important to the management of critically ill patients. It allows the measurements of the filling pressures of the right and left ventricle as well as the cardiac output. These data combined with information concerning cardiac rhythm, heart rate, arterial pressure and other variables place the principal determinants of cardiac function at the disposal of the critical care personnel. In particular, the physician may optimize left ventricular filling pressure and then alter other functional determinants of cardiac performance so as to optimize the relationship of cardiac output to the metabolic needs of the body tissues and systems. Continued hemodynamic monitoring also provides prompt objective information as to success or failure of therapeutic interventions. It thereby allows for the most rational decision making and effective alteration in the therapy applied to the individual critically ill patient.Much still needs to be done to establish completely the impact of such monitoring techniques upon patient management. However, experience thus far has been most promising. Large numbers of physicians and health care personnel now rely on pressures provided by the pulmonary capillary wedge pressure in their decisions about fluid therapy. Others are rapidly assessing the importance of the cardiac output and other parameters of cardiac function on a semi-continuous basis.Thus, balloon flotation catheterization has allowed the application of sound physiological principles to the understanding of circulatory abnormalities characterizing important patient illnesses and provides a rational basis for the selection of therapy with objective quantitative assessment of responses. The procedures are simple; the complication rate is low, and the information provided is highly relevant to clinical practice.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Intra-aortic balloon pumping (IABP) has been shown to reverse the cardiogenic shock syndrome, but the long-term results (16 to 53% survival) have, in general, been disappointing. The most productive areas for the use of IABP are in the treatment of acute myocardial ischemia where in one report of 16 patients treated with IABP and surgery 15 survived and 13 were angina free, and in the open heart surgical setting where survival ranges from 42 to 70%. The implications of these treatment modalities are discussed.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Therapeutic manipulations designed to conserve myocardium in patients with acute myocardial infarction appear to improve prognosis. To assess the role of glucocorticoids given in pharmacologic dosage in the early treatment of patients with acute myocardial infarction, serial serum creatine phosphokinase (CPK) were obtained every 1–2 hours in 39 consecutive patients admitted with acute myocardial infarction. Determination of completed infarction size (ISc) was made using all available CPK values (range 70–160 hours). Predicted infarct size (ISp) was based on early data following the rise in CPK from baseline values; projected CPK values were obtained over a 160 hour period using a curve fitting procedure based upon non-linear Gauss-Newton stepwise iterations. In 13 uncomplicated control patients ISp was 43.2 ± 11.6 (mean ± SE) CPK-gramequivalents (CPK-g-eq), based on data from the first 7 hours following the rise in serum CPK, while ISc was 44.7 ± 11.4 CPK-g-eq (r = .99, n = 13). In 7 additional control patients whose hospital courses were complicated by clinical extension ISp was 71.8 ± 18.0 CPK-g-eq while ISc was 118.6 ± 31.0 CPK-g-eq (p < .03). In 19 patients treated with 2 grams of methylprednisolone 7–14 hours following the rise in serum CPK from baseline, data from early CPK determinations (7 hours) indicated an ISp of 118.5 ± 24.1 CPK-g-eq while total CPK data indicate an ISc of 89.6 ± 13.2 CPK-g-Eq (p < .04). The exponential clearance of CPK (kd) was approximated in the controls (kd = .00095 ± .00007 min−1) and glucocorticoid treated patients (kd = .00099 ± .00006 min−1) and found to be similar. Thus, administration of a pharmacologic dose of methylprednisolone 7–14 hours following rise in serum CPK from baseline in a group of patients with acute myocardial infarctions has resulted in salvage of myocardium.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The theoretical and practical solutions to the problems of increasing oxygen transport are well understood. Unfortunately the quantitation of hypoxia, both as an absolute deficit and as a precise method of prognosis is not yet available. This may well be because regional hypoxia in a vital tissue cannot be mirrored in a total body measurement.In the low-flow state, oxygen delivery can be maintained by redistribution of cardiac output, reduction of oxygen uptake by ischemic tissue by reducing work load, by increasing oxygenation of the blood, or by decreasing the affinity of oxygen for hemoglobin. The latter provides for more oxygen to be delivered by a given amount of oxyhemoglobin before the tension falls to deleterious regions (about 20 torr). There is some evidence that pharmacologic doses of methylpredniso-lone may be beneficial in this respect.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

Our research activities have been oriented to the effect of pharmaeologic agents on tissue metabolism in the low flow state of circulatory shock. Specifically, we have been most interested in the effect of glucocorticoids on cellular metabolism because these agents exert a reproducible protective effect during septic and endotoxic shock in rats and monkeys. Further, we have studied the differences between untreated animals in shock and those treated with pharmaeologic agents in an attempt to determine which cellular metabolic changes are critical to survival. This paper will present our studies as well as those of other laboratories, which have defined the effects on tissue metabolism of certain pharmaeologic agents: those which stimulate cyclic adenosine monophosphate (AMP) (epinephrine, norepinephrine, glucagon, and prostaglandin) and those which do not (the glucocorticoids).

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

The relationship between colloid osmotic pressure (COP) and the severity of cardiopulmonary failure was investigated in 99 consecutive patients admitted to our Shock Unit including 41 survivors and 58 fatal cases. The COP was significantly lower (p< 0.001) in fatal cases in comparison to survivors. None of 21 patients in whom COP was less than 10.5 torr survived. A progressive increase in survival with typical S-shaped distribution was observed as COP increased from 10 to 19 torr, above which all patients survived. These preliminary observations demonstrated that reduction in COP in critically ill patients is associated with increases in mortality. The mechanisms by which lowering of COP may be related to fatal progression of cardiopulmonary failure is the subject of continuing study.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID

摘要:

A systematic integrated approach to the diagnostic, monitoring and fluid volume therapy was developed for use in patients with accidental and elective surgical trauma. An algorithm (patient care protocol) is proposed for expeditious resuscitation in emergency situations using: (a) BP as the criteria for initiation of rapid fluid therapy, (b) hematocrit for the choice of blood transfusion or plasma expanders, and (c) CVP, urine output, arterial pressure and wedge pressure as criteria for slowing down or stopping the rate of volume therapy. History, physical examination, laboratory work, X-rays, monitoring and diagnostic procedures are interdigitated in a systematic fashion according to priorities of the most common life-threatening aspects, of the total resuscitation problem. In chaotic emergency situations, it is impossible to plan for all possible contingencies; to try to do so results in an impossibly complex and unwieldy plan. However, we believe that almost any reasonable plan is better than no plan at all.

ISSN:0090-3493    

出版商:OVID    

年代:1975

数据来源: OVID