摘要:

A new apparatus, which uses a fuel cell for measuring O2concentration and calculates O2consumption (Vo2), has been developed for use on the Servo Ventilator. Together with an IR CO2Analyzer, this equipment also provides CO2production, end-tidal CO2concentration, and the respiratory quotient.The accuracy of this equipment was evaluated by comparison with results from two standard methods: the Scholander technique in combination with a dry gas meter, and mass spectrometry combined with a wet gas meter.The results show that the differences between the Vo2calculated from this equipment and two other standard methods are less than 5%. Thus, the accuracy of the new equipment seems reliable enough to make it a valuable tool in clinical use.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The standardized stroke work, which is derived from the left ventricular stroke work (LVSW) and the pulmonary capillary wedge pressure (WP), is presented as a convenient index for tracking changes in the overall cardiac function and relating these changes to other cardiorespiratory variables. This index and its response to whole blood transfusion were used to assess cardiac function in 102 critically ill patients with hemorrhagic or traumatic shock. Survivors had greater mean values of the standardized stroke work before, during, and after transfusion than did the nonsurvivors (p< 0.05). Moreover, the maximal change in standardized stroke work in response to transfusion was greater in survivors than in nonsurvivors (p< 0.05); this response was found to be dependent on the stage of shock.The experience of the authors with this index suggests that it is a useful way to follow changes in myocardial performance in critically ill patients over time, and in quantitating changes in myocardial function after whole blood transfusion or other forms of volume therapy.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Clinical features and assisted ventilation (AV) aspects of 10 neonates with early onset group B streptococcus (GBS) septicemia were compared with those of 12 randomly selected newborns with severe respiratory distress syndrome (RDS). Initial chest radiograph in the GBS group was interpreted as RDS in seven of 10 cases. Although 9 of the 10 neonates with early onset GBS were preterm, they were of a significantly higher mean birth weight (p< 0.01) and the mean gestational age (p< 0.005). The duration of rupture of fetal membranes was not significantly different between the two groups.Contrary to neonates with severe RDS, who gradually developed hypoxia necessitating AV, the neonates with early onset GBS required AV because of persistent apnea, shock, and respiratory insufficiency. During the first 24 h of life, neonates with early onset GBS were more acidotic, had significantly higher PaCO2and lower PaO2values, and required significantly higher peak inspiratory pressure (PIP) on the respirator (p< 0.01) while on AV, although the oxygen requirement was similar.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

To evaluate radiant power received by infants under radiant warmers, 11 neonates (mean gestational age 32.2 weeks, mean weight 1.50 kg) were monitored. A wattmeter was used to evaluate warmer power (watts), and a thermopile placed at bed level was used to correlate warmer power to radiant power density received (mw/cm2). Warmer power ranged from 133–301 watts. A linear relationship existed between warmer power and radiant power density received (r= 0.97,p< 0.001). After establishing that radiant power delivery could be monitored with a wattmeter, this technique was used to quantitate radiant power in a small series of infants with and without a plastic shield. Radiant power density received decreased in all infants when shielded (mean 14.6–11.2 mw/cm2,/p< 0.01). This study demonstrates: (1) radiant wanner power can be monitored with a wattmeter; (2) warmer power correlates to radiant power density received; and (3) radiant power monitoring can be used to evaluate radiant power demands in specific clinical situations.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Analysis of 13,430 arterial blood samples demonstrated that metabolic alkalemia was the most common acid-base disturbance encountered in the hospital setting, being present in 51% of patients with abnormal acid-base status. Respiratory alkalemia was encountered in 29%, respiratory acidemia in 27%, and metabolic acidemia in only 12%. Evaluation of those blood gases with metabolic alkalemia, using 95% confidence-limit bands for acid-base disturbances, showed that the metabolic alkalemia was pure in 70% of the cases, mixed with respiratory acidemia in 18%, and combined with respiratory alkalemia in 12%. The adverse effects of alkalemia may be subtle but often significant. Alveolar hypoventilation in response to metabolic alkalemia, without evidence of primary respiratory disease, was more frequent than is generally suspected. This hypoventilation often directly results in hypoxemia, as well as atelectasis with worsened ventilation/perfusion match-up. Alkalemia shifts the oxyhemoglobin dissociation curve to the left, increasing hemoglobin's affinity for oxygen, thus, limiting oxygen release at the tissue level. The presence of metabolic alkalemia makes it more difficult to wean patients from assisted ventilation. A clearer understanding of the frequency and significance of metabolic alkalemia should lead to more appropriate therapy to prevent or correct this acid-base disturbance and should result in a decreased morbidity and mortality in critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

The occurrence of atelectasis among infants, who were intubated and mechanically ventilated for hyaline membrane disease and who survived the neonatal period, was examined after omitting atelectasis associated with obvious malposition of the endotracheal tube. Atelectasis occurred both while intubated and after extubation. There was a pronounced effect of birth weight. The incidence among 131 surviving infants increased from 9% while intubated and 15% after extubation in infants with birth weights >2000 g to 50% while intubated and 56% after extubation in those with birth weightsThe pattern of atelectasis showed a disproportionate involvement of all lobes of the right lung, both while intubated and after extubation. This suggests that the incidence of atelectasis might be lowered by minimizing traumatic damage to the mucosa of the right sided bronchi.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A “code-no code” resuscitation classification was recently instituted at Memorial Sloan Kettering Cancer Center. Physician compliance was voluntary. Of 48 subsequent cardiopulmonary arrests, 7 patients (14.6%) were discharged from hospital. They included 4 of 17 patients (23.5%) previously assigned “code” status and 1 of 27 patients (3%) whose resuscitation status had not been designated. Reluctance on the part of the primary physician to withhold resuscitation was clearly evident in this group, of whom more than half had widespread malignancy.Stage of disease did not influence the 50% rate of successful resuscitations but no patient with metastatic or uncontrolled cancer left hospital. The discharge rate among arrest patients with recently diagnosed or localized cancer was 32%. These observations justify continued efforts to restrict cardiopulmonary resuscitation (CPR) to those with a reasonable prognosis for worthwhile palliation or cure.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Administration of total parenteral nutrition (TPN) (glucose/amino acids), on the 2nd day after surgery, to a 26-year-old male with multiple fractures resulted in a rise in rectal temperature from 37.6 to 39°C. Resting energy expenditure showed a sustained 23% increase when the nutritional intake was changed from 5% dextrose to TPN. This case demonstrates that the increased metabolic rate associated with administration of TPN in acutely injured patients may be associated with an increase in body temperature.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

Cardiorespiratory measurements were made in a severely anemic patient (hemoglobin concentration of 3.5 g/dl) who was preoperatively given the perfluorochemical blood substitute (Fluosol-DA, 20%). Hemodynamic and oxygen transport variables were monitored, including arterial and mixed venous oxygen content (Cao2and Cvo2) before, during, and after infusion of 1000 ml of Fluosol as well as throughout the intraoperative period. Blood samples revealed a maximum of 2.7% of the perfluorochemical. The Cao2increased 37% above the Cao2calculated without Fluosol; i.e., 5.8 ± 0.1 to 8.1 ± 0.6 ml/dl,p< 0.01. The cardiac index (CI) decreased from 7.2 ± 0.2 to 5.9 ± 0.8 L/min M2and the left ventricular stroke work decreased from 67 ± 6 to 58 ± 13 g M/M2, while the oxygen delivery increased, and the total body oxygen consumption (Vo2) remained essentially unchanged. Intraoperatively, 27% of the O2delivery and 51% of the Vo2were transported by Fluosol. No adverse effects of the Fluosol were noted.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID

摘要:

A new method of core body temperature monitoring is introduced and compared to currently used methods. A close correlation exists between urinary bladder temperatures and each of the techniques studied. The correlation is good when compared to esophageal and rectal temperature and best when compared to pulmonary arterial blood temperature. During rapid rewarming after extracorporeal circulation, the urine temperature consistently increases faster than rectal or esophageal and seemingly is a better measure of blood temperature rather than muscle mass temperature. Urine temperature monitoring is reliable, safe, convenient, and accurate for routine intraoperative and postoperative continuous use in adult patients with urethral catheterization.

ISSN:0090-3493    

出版商:OVID    

年代:1980

数据来源: OVID