摘要:

The concentrations of C3a des Arg were measured in bronchoalveolar fluid (BAL) and plasma from 12 patients with adult respiratory distress syndrome (ARDS). Compared with 32 controls, all patients had increased BAL fluid levels (p< .001), and nine of 12 had increased plasma levels (p< .001) of this split product from the third complement component. Reduced total hemolytic activity (CH50) in serum was seen in five patients (p< .01). As an indication of damage to the alveolar-capillary barrier, ten of the 12 ARDS patients had elevated albumin concentrations in BAL fluid (p< .001). These signs of complement activation and lung tissue damage are not specific for ARDS. Thus, in 15 patients investigated preoperatively and postoperatively, we found that major surgery induced a significant increase of BAL fluid C3a (p< .01) and plasma C3a (p< .02), a significant reduction of CHso (p< .001), and a significant increase of BAL fluid albumin (p< .02). Similar values of CHso and plasma C3a were seen in ARDS and after surgery (p> .05). Of the 12 ARDS patients, eight had increased BAL fluid concentrations of C3a (p< .001), and ten had increased BAL fluid levels of albumin (p< .001) compared with the post-surgical patients.Measuring complement consumption in blood by these techniques is of limited value in ARDS due to the lack of specificity. BAL fluid albumin has a similar degree of sensitivity and specificity for ARDS as does BAL fluid C3a. Measuring BAL fluid levels of albumin is a simple and fast method; therefore, it potentially has a practical and clinical value in obtaining information about the development of ARDS.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

The relationship between oxygen uptake (&OV0312;O2) and delivery (&OV0312;O2) was examined in 64 patients immediately after cardiopulmonary bypass. In 44 patients with lactate levels below 2.5 mmol/L, &OV0312;O2decreased proportionally when &OV0312;O2decreased below 300 ml/min ± m2. At a &OV0312;O2over this level, &OV0312;O2plateaued at 105 ± 13 (SD) ml/min ± m2. In a contrasting group of 22 patients with blood lactate levels above 2.5 mmol/L, &OV0312;O2changes depended on changes in &OV0312;O2both alone and below 300 ml/min ± m2.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We studied the relationship between oxygen consumption (&OV0312;O2) and cardiac output in 17 hemodynamically stable, septic and eight nonseptic ICU patients. Each received 300 ml of fresh-frozen plasma or 25% albumin with up to 500 ml of crystalloids, in addition to regular maintenance fluids; this treatment increased pulmonary wedge pressure (WP) by 3 to 4 mm Hg. Measurements were performed before and after approximately 5 h of volume loading. Because cardiac index (CI) decreased as WP increased in four septic and three nonseptic patients, we grouped the data according to the state of flow instead of the recording time sequence. From low to high flows, mean CI increased in septic patients and nonseptic patients. Oxygen delivery (&OV0312;O2) increased in septic and nonseptic patients. &OV0312;O2remained unchanged in nonseptic patients, while it increased in septic patients. Accordingly, arteriovenous oxygen difference narrowed in nonseptic patients from 4.46 ± 1.62 to 3.59 ± 1.21 ml/dl (p< .05) but did not change in septic patients. In the septic group, the difference in CI between high and low flows was significantly (p< .05) greater in survivors than in nonsurvivors.We conclude that the septic state is accompanied by a peripheral oxygen deficit, which can be partially reversed by maintaining an above-normal CI and &OV0312;O2.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

This study was done to determine whether breathing 80% oxygen would enhance edema formation in oleic acid (OA) lung injury. Rabbits breathed air (n = 51) or 80% oxygen (n = 51) for 1 to 7 days after OA lung injury (0.09 ml/kg iv). Control groups breathed 80% oxygen (n = 37) or room air (n = 8) without OA injury. Pulmonary vascular permeability was assessed by measuring131I-albumin (RISA) concentration in extravascular, extracellular lung water (EVECW) relative to plasma (RISAL/RISAPL). EVECW (ml/g dry lung) was measured by24Na, and total lung water (TLW) by wet/dry weight (g/g dry lung).Air-breathing control values were 4.53 ± 0.25 (SD) for TLW and 0.40 ± 0.09 for RISAL/RISAPL. In the air-breathing OA group, TLW and RISAL/RISAPLincreased to 8.32 ± 0.85 and 0.93 ± 0.16, respectively, 2 h after OA (p< .001) but by 24 h, were equal to air-breathing controls.TLW and RISAL/RISAPLin the oxygen treated OA group did not differ from the air breathing OA group on days 2 through 7 inclusive, suggesting that 80% oxygen had no effect on edema formation in the OA-injured lung. Breathing 80% oxygen alone, without OA injury, significantly (p< .005) increased TLW and RISAL/RISAPLon days 5 and 6. Thus, preexisting lung injury had a protective effect against edema formation from a high fraction of inspired oxygen.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We tested recently developed admission and 24-h models of hospital mortality on 1,997 consecutive admissions to a general medical/surgical ICU. This study population was independent of the group used to develop the models. The admission prediction model estimated each patient's probability of hospital mortality based on seven routinely collected admission variables. The 24-h model utilized seven variables routinely available at 24 h in the ICU. The admission model accurately described the mortality experience of the new cohort, while the 24-h model did not.Advantages of the admission model are that it is evaluable at the time of ICU admission, is independent of ICU treatment, and can be used to stratify patients by severity of illness, thereby making ICU comparisons possible. Its excellent goodness-of-fit, correct classification rate, sensitivity, and specificity suggest that this model is now ready for multihospital testing.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

One hundred eleven head-injured patients were examined for paranasal sinusitis during early convalescence. Glascow coma scale (GCS) was less than 8 in 79 patients. Ninety-three patients had sustained blunt injuries, and 18 had penetrating ones. Sixty-five orotracheal intubations (OTI) and 31 nasotracheal intubations (NTI) were performed at the scene or on hospital arrival. Fifteen patients were not tracheally intubated. Paranasal sinus air fluid levels (AFL) were present in 30 patients on their admitting computerized tomography scans.Paranasal sinusitis developed in 19 patients with a mean GCS of 5.4 ± 3.3 (SD). Sixteen of the 19 had NTI, and three had OTI (p< .05). Of 30 patients with AFL, sinusitis occurred in 13. Ten of these 13 had NTI, and three had OTI (p< .05). Penetrating injury did not increase the risk of sinusitis (p> .1). Seventeen of the 19 infections were polymicrobial. Sinusitis after head trauma is related to NTI, AFL, and severity of head injury.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We wanted to evaluate whether current screening techniques effectively determine a patient's need for hospital admission and intensive care monitoring after blunt chest trauma. Consequently, we reviewed 104 consecutive admissions for “blunt chest trauma; rule out cardiac contusion.” Neither clinical findings, cardiac enzyme levels, chest x-rays, nor ECGs predicted the high-risk patients who would subsequently develop complications related to myocardial contusion. Since only 23% of the study patients developed such complications, the plurality of study patients did not require admission and monitoring. There is, therefore, a definite need to develop new, accurate screening tests for patients at risk for myocardial contusion complications.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

We describe 15 patients whose acute respiratory failure associated with pulmonary tuberculosis necessitated their ICU admission during a 42-month period. There was a 1.5% incidence of respiratory failure in hospitalized tuberculosis patients. Eleven of the 15 patients required ventilatory assistance for a mean 17.3 days. Five patients died in ICU (early mortality = 33%), and two others died within 3 months of discharge (total mortality = 47%). We began specific anti-tuberculous chemotherapy in these patients within 3 ± 4 (SD) days after hospital admission. Pulmonary histology was available in five cases. Despite the clinical and radio-logic features compatible with the adult respiratory distress syndrome in these patients, histology showed confluent tuberculous bronchopneumonia with no evidence of the syndrome.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

Extracorporeal membrane oxygenation (ECMO) can now be used as an alternative mode of therapy for infants 2.0 kg or more with life-threatening respiratory failure. Current criteria for removal from ECMO are limited. We attempted to determine whether lung compliance (CL) could be used as a sensitive indicator of the neonates' lung improvement while they are on ECMO, as well as a predictor of their ability to tolerate removal from bypass. We obtained serial CL measurements in 13 infants, all of whom weaned successfully from ECMO. All had an initial CL on ECMO of 0.5 ml/cm H2O·kg or less (&OV0398; = 0.3), with a final CL of 0.8 ml/cm H2O·kg or more (&OV0398; = 1.7). The average change in CL from the initial to the final measurement was 0.6 ml/cm H2O·kg or more (&OV0398; = 1.5). CL findings correlated well with estimated bypass, expressed as a percent of cardiac output, and a radiographic score of pulmonary abnormality (r = -.66,p< .0001, and r = -.52,p< .0001, respectively). We conclude that CL measurements can be used to monitor clinical improvement in infants on ECMO, to predict their successful removal from bypass, and ultimately to shorten their total time spent on bypass.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID

摘要:

In a prospective randomized controlled trial involving 470 arterial catheters in 470 children, we studied the effect of changing either the concentration or the flow rate of a heparin infusion. Although catheters tended to remain patent longer with a flow rate of 2 ml/h rather than 1 ml/h, the difference was not statistically significant. Increasing the heparin concentration from 1 to 5 U/ml signficantly prolonged catheter patency.

ISSN:0090-3493    

出版商:OVID    

年代:1987

数据来源: OVID