摘要:

Bacterial infection often occurs after trauma and hemorrhage and is believed to be a reflection of a compromised host defense system. In the present study, the itilect of hemorrhage on phytohemagglutinin-induced lymphocyte proliferation was investigated. Lymphocytes obtained from rats 2 h after blood withdrawal in m amount equivalent to 30% of total blood volume plowed a 48% reduction in proliferative response as compared to cells obtained from the same animal before Heeding. This depression in lymphocyte proliferative, capacity appeared to be due to a serum factor or factors duced by hemorrhage. The hemorrhage-induced serum factor(s) is heat-stable, dialyzable, and has an apparent molecular weight between 13,000 and 23,000 M gel filtration chromatography. The hemorrhage-in-4aced factor seems to suppress lymphocyte proliferation in a rapid and irreversible manner. This abnormality in host defense mechanisms may contribute to the Increased incidence of sepsis present after trauma and hemorrhage.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Total lymphocyte count, lymphocyte cell-surface markers (OKT3, OKT4, OKT8, and B-1), serum complement factors (C3 and C4), immunoglobulins (IgG, IgA, and IgM), ceruloplasmin (Crl), and transferrin (Trf) were determined weekly for nine septic postoperative patients, all of whom had multiple organ-system failure. The peripheral blood total lymphocyte count, its subpopulation, T-cell subset, and proliferative responses of lymphocyte to phytohemagglutinin (PHA) and concanavalin A (Con A) decreased in all patients. OKT3 and B-l decreased progressively in the four nonsurvivors compared with the five survivors. Although immunoglobulin levels were within the normal range in both groups, they tended to increase in survivors and decrease in nonsurvivors. Serial levels of C3, C4, Crl, and Trf increased in survivors but did not change in nonsurvivors. T-cell function and antibody-producing activity diminished progressively in nonsurvivors. These changes in cellular immunity may represent another manifestation of multiple organ-system failure during sepsis.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

We evaluated extubation criteria in 48 postoperative general surgical and trauma patients receiving ventilatory support with intermittent mandatory ventilation (IMV) and continuous positive airway pressure (CPAP). Extubation criteria based on conventional respiratory mechanics demonstrated a 48% false-negative prediction of outcome, while those based on gas exchange values correctly predicted outcome in 94% of patients. Thus, conventional respiratory-mechanics extubation criteria may prolong mechanical airway and ventilatory support when used with IMV/CPAP in these patients.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The ICU has been considered a psychologically stressful environment. Although numerous studies have investigated this stress in ICU nurses, virtually none have examined how stressful the ICU is for physicians. This prospective study compares housestaff physicians'1 ratings of stress in the ICU to other medical-surgical rotations. The 26 physicians in this study rated the ICU significantly less negatively than other rotations. There was also a trend to rate the ICU more positively. Prolonged care of patients with multisystem failure and a poor prognosis was the most frequently described source of stress. Humor, communication, and activities outside the ICU were the most frequently noted coping techniques.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The Mega Code is a simulated cardiac arrest during which students practice as members of a team and learn to integrate the knowledge and skills of advanced cardiac life support (ACLS). This study used the Mega Code and American Heart Association (AHA) standards to evaluate 32 medical residents (MDs) and nine critical care nurses (RNs) in the role of ACLS team leader. All had been previously trained in ACLS. The testing sequence included ventricular fibrillation (VF) refractory to initial countershock (defib), asystole after second defib, recurrent VF after drug therapy, and finally sinus rhythm after third defib. A blood gas report indicated respiratory acidosis and hypoxemia. Assessment of patient status was poor in both groups, although MDs did significantly (p = .001) better than RNs. Other problem areas were drug therapy and troubleshooting, with no differences between MDs and RNs. These results indicate that assessment and troubleshooting are not adequately stressed in the AHA ACLS curriculum; moreover, there is no lecture that specifically addresses the team approach to resuscitation and the role of team leader. We found that the Mega Code effectively evaluated individual and group performance. Results of objective-based Mega Code testing can be used both to improve ACLS curriculum and to indicate areas to be stressed during refresher training.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Physicians' outcome predictions probably influence their treatment decisions in the ICU. The importance and accuracy of these predictions, however, are poorly defined. We asked 20 ICU physicians to rate the importance of 14 factors used for treatment decisions. Expected functional outcome rated highest. However, physicians' predictions of patient outcome, specifically survival and need for professional nursing care 45 days after ICU admission, had variable accuracy. For example, physicians predicted death for only 41% of adults who died, but survival for 87% of adult survivors. Predictions of survivors' need for professional nursing care proved 100% correct for children after heart surgery, but only 58% to 73% correct for other patient groups. These inaccuracies pose an important ethical question: what is the proper role of outcome predictions in ICU decision-making? We believe outcome predictions have an important role when they are proven accurate and used within the bounds of loyalty to the patient and respect for his wishes.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Previous studies have suggested that methylprednisolone (MP) pretreatment attenuates the usual hemodynamic response to naloxone (NAL) treatment of hypovolemic shock. In this study, both drugs were given concurrently during shock to evaluate hemodynamic changes, plasma endorphin-like activity (PELA), and survival. Twenty-six dogs were bled to a mean arterial pressure (MAP) of 40 to 45 mm Hg, which was maintained for 45 min. Animals were then treated with iv 0.9% NaCl (NS), 5 ml; NAL, 4 mg/kg; MP, 30 mg/kg; or NAL, 4 mg/kg, plus MP, 30 mg/kg. Animals treated with NAL and/or MP had significantly (p < .05) improved MAP, cardiac output, and myocardial contractility compared with NS-treated animals. NAL and MP each significantly lowered PELA levels and both NAL and NAL plus MP significantly improved survival.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

In eight anesthetized ventilated goats, the hemodynamic effect of isoproterenol (ISU), dopamine (DOP), norepinephrine (NE), nitroglycerin (NTG), and Ringer's lactate (RL) infusion was evaluated after inducing acute pulmonary hypertension (PHN) to decrease cardiac output.Therapy with ISU significantly (p< .05) increased cardiac output, but also increased transmural right ventricular end-diastolic pressure (RVEDPTM) and heart rate (HR) and decreased stroke volume (SV) and right ventricular ejection fraction (RVEF). NE increased cardiac output, mean arterial pressure (MAP), systemic vascular resistance (SVR), and RVEF. DOP decreased pulmonary vascular resistance (PVR) and increased cardiac output, MAP, and RVEF, but also significantly increased HR. NTG increased cardiac output and RVEF while decreasing SVR and PVR. Intravascular volume expansion by RL infusion increased cardiac output, SV, and RVEDPTMand decreased HR and PVR. The results of this study indicate that volume loading may be the treatment of choice to restore cardiac output in the face of acute PHN. NE and NTG may be effective as an adjunct therapy. Although ISU and DOP increase cardiac output, the concomitant elevation in HR is undesirable.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

Continuous positive airway pressure (CPAP) was used to treat severe respiratory distress in four infants with bronchomalacia. Fiberoptic bronchoscopy diagnosed the area of bronchomalacia, documented the effects of CPAP on the airway, and helped determine an effective level of CPAP. CPAP immediately decreased respiratory distress, and was correlated with improved airway patency in the formerly collapsed airways. All four infants, including three who had required prolonged mechanical ventilation, maintained spontaneous ventilation on CPAP.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID

摘要:

The interrelation between the renal tissue Po2, venous Po2, oxygen consumption, and lactate utilization was investigated in dogs subjected to graded hemorrhage. The cortical Po2measured by means of an implanted silicone elastomer tube responded immediately to graded hemorrhage. The renal venous Po2remained at the baseline level when the cortical Po2declined from the mean initial value of 36 to 15 ton*. A further decrease in the cortical Po2was followed by a sharp fall in the renal venous Po2, oxygen consumption, and lactate uptake. These three variables decreased simultaneously at the same cortical Po2level. During severe hypoperfusion the renal tissue Po2decreased progressively despite an increase in the renal arteriovenous oxygen difference. These results suggest that the renal venous Po2remains unchanged until the tissue Po2decreases to a level at which renal metabolism becomes limited by oxygen availability.

ISSN:0090-3493    

出版商:OVID    

年代:1986

数据来源: OVID