ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine if increased gut permeability within 48 hrs after burn injury correlates with the extent of injury, before sepsis and pulmonary disorders have complicated the clinical course.DesignNonrandomized, controlled study.PatientsConsecutive patients admitted with burn injuries on >20% of body surface area.InterventionsIntestinal absorption and renal excretion of polyethylene glycol 3350 was used as the macromolecule to determine gut permeability; polyethylene glycol 400 intestinal absorption was used as an internal control for abnormal motility and malabsorption. Polyethylene glycol 3350 (40 g) and polyethylene glycol 400 (5 g) were administered enterally.Measurements and Main ResultsGut permeability was significantly increased early after the injury. The patients excreted 0.56 ± 0.34% (n = 11) of polyethylene glycol 3350, compared with the amount (0.12 ± 0.04%) (p< .05) previously reported in normal volunteers. There was no significant difference in the excretion of polyethylene glycol 400 in the patients (27.0 ± 4.6%, n = 11) vs. the normal volunteers previously reported (26.3 ± 5.1%, n = 12), suggesting normal intestinal motility and absorption. The percentage of excretion of polyethylene glycol 3350 correlated with the percentage body surface burned; patients with smaller injuries excreted 0.32 ± 0.17% (n = 6), which was greater than normal and less than those values from patients with larger injuries, 0.84 ± 0.25% (n = 5) (p< .001 by Tukey test).ConclusionsUsing our newly developed method to separate and quantify polyethylene glycols in urine, gut permeability was found to be increased early after burn injury, which confirms a previous study using lactulose as the permeability probe. Furthermore, this increased gut permeability to polyethylene glycol 3350 correlated with the extent of the burn injury.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo evaluate the necessity for post-procedural chest radiographs after catheterization of central veins, insertion of pulmonary artery catheters, and placement of endotracheal tubes.DesignProspective, controlled study.SettingTwo academic tertiary adult ICUs.PatientsConsecutive patients (n = 316) requiring central vein cannulation or endotracheal intubation in the ICUs.InterventionAfter each invasive procedure, the physician was instructed to complete a detailed evaluation sheet. Criteria based on the details of the procedure and immediate postprocedural clinical evaluation of the patient were used to determine the likelihood of a radiologically detectable complication. Actual radiologic findings were subsequently compared against clinical predictions.Main Outcome MeasurementsAbility of housestaff to correctly predict the absence of radiologically detectable postprocedural complications (predictive negatives).ResultsAbility to predict the absence of complications after cordis catheter insertions via the subclavian vein or internal jugular vein was very high (151/152;p< .001). Unsuspected complications were more frequent with central vein multilumen catheter insertions (3/24;p< .001). Ability to predict uncomplicated pulmonary artery catheterization was also high (110/111;p< .001). Physicians were unable to predict the majority of complications associated with endotracheal intubations (28/32;p> .50).ConclusionsThe use of a protocol that includes an evaluation of the characteristics of the procedure and postprocedural physical examination can greatly reduce the need for routine chest radiographs after subclavian and internal jugular vein cordis catheterizations and pulmonary artery catheter placement. Chest radiographs should be performed after endotracheal intubation and multilumen catheter insertion.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine the occurrence of, and risk factors for, the development of upper gastrointestinal (GI) tract bleeding in critically ill pediatric patients.DesignProspective, descriptive, comparative study.SettingICU in a tertiary care pediatric hospital affiliated with a university.PatientsAll patientsInterventionNone.Measurements and Main ResultsPatients were evaluated for overt upper GI bleeding as indicated by coffee ground material or bright red blood in gastric aspirates or black, tarry stools. Excluded were patients who were transferred out of the ICU within 24 hrs of admission, were receiving medications that would alter their risk for upper GI bleeding, or had a GI tract surgical procedure. Patients were categorized by diagnoses and analyzed for relative risk for upper GI bleeding. Of the 208 patients included, 25% had evidence of upper GI bleeding. There was no association between upper GI bleeding and age, weight, race, or sex. Diagnoses independently associated with an increased risk for upper GI bleeding were: circulatory shock, an operative procedure 3 hrs in duration, and trauma. No clinically important sequelae were directly attributable to upper GI bleeding in this group of patients; however, intervention with antacids and histamine-2 receptor (H-2) antagonists likely decreased the progression of GI bleeding.ConclusionsOvert evidence of upper GI bleeding is not uncommon in critically ill pediatric patients. Certain diagnoses or risk factors may predispose these patients to develop upper GI bleeding.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo assess the effects of heart rate, right ventricular systolic performance (ejection fraction), chamber dimensions, and flow rate (cardiac index) on the reproducibility of algorithm-derived triplicate thermodilution right ventricular ejection fraction measurements.DesignProspective study; combined hemodynamic and echocardiographic clinical evaluation.SettingOperating room in a university hospital.PatientsTwenty-one coronary artery bypass graft patients.Measurements and Main ResultsThe right atrial delivery site was positioned by analysis of transduced pressure waveform and echocardiographic imaging of tracer agitated saline cavitations. Measurement reproducibility was quantified by determining the variation (standard deviation) within 101 triplicate thermodilution measurement sets. There was no significant relationship between measurement reproducibility and estimates of right atrial area (21.6 ± 6.9 cm2), diameter (5.1 ± 0.8 cm) and supero-inferior length (5.1 ± 0.9 cm) and right ventricular maximal minor axis diastolic diameter (4.21 ± 1.05 cm). Reproducibility was also unrelated to right ventricular end-diastolic volume index (97.9 ± 32.7 mL/m2) and cardiac index (2.9 ± 0.9 L/min/m2). Measurement reproducibility was directly related to mean right ventricular ejection fraction (0.39 ± 0.14) and inversely related to heart rate (80.8 ± 18.6 beats/min) (p< .01 and < .001, respectively).ConclusionsThermodilution-derived right ventricular ejection fraction measurement reproducibility was unrelated to estimates of right atrial and ventricular dimensions and cardiac index. Measurement reproducibility was a direct function of right ventricular systolic performance and an indirect function of heart rate. Measurement should be interpreted with these constraints in mind.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectivesTo evaluate the right ventricular systolic time interval as an index of right ventricular function and also to ascertain whether the right ventricular ejection fraction may be determined by means of a conventional pulmonary artery catheter.DesignProspective study.SettingIntensive care unit.PatientsEight, consecutive critically ill adult patients.MethodsSimultaneous blind measurements, performed by two investigators, of the right ventricular systolic time interval and right ventricular ejection fraction, determined by means of a pulmonary artery catheter. Two studies, separated by an interval of 24 hrs, per patient. Linear regression analysis. Multiple regression test.ResultsOf the 16 studies performed, two determinations of right ventricular systolic time intervals were technically inadequate. In the remaining 14 valid studies, we found one close linear correlation between the right ventricular ejection fraction and the preejection period/ejection time quotient measured using the simultaneous display of the electrocardiogram (EKG) and pulmonary arterial pressure curve (r2= .90,p< .001, right ventricular ejection fraction a 68.96 – 60.59 [right ventricular preejection period/right ventricular ejection time]). The method proved to be simple, very accurate, with little interobserver variation (8.09 ± 10.6% interobserver variation for right ventricular preejection period/right ventricular ejection time) and provided adequate information regarding situations in which the performance of the right ventricle is modified in a given patient. The right ventricular preejection period/right ventricular ejection time quotient was the only variable that displayed a significant relationship with the right ventricular ejection fraction in the multivariate analysis (p< .001).ConclusionsRight ventricular systolic time intervals, measured using the simultaneous display of the pulmonary artery catheter curve and EKG, provide adequate information regarding right ventricle performance in critically ill patients. The close linear correlation between the right ventricular preejection period/right ventricular ejection time quotient and the right ventricular ejection fraction enables the investigator to estimate, with a high degree of accuracy, the right ventricular ejection fraction and the values derived from the preload of the right ventricle, without the need for a modified pulmonary artery catheter.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo evaluate the usefulness of extra-corporeal clearance techniques in the treatment of organophosphate poisoning, particularly hemoperfusion.DesignRetrospective study.SettingAn ICU of a general hospital.PatientsTen patients with organophosphate poisoning initially received classic treatment with gastric lavage and washing of the whole skin surface, as well as the administration of cathartics, activated charcoal, atropine, and obidoxime or pralidoxime. All patients underwent one to three hemoperfusions.Measurements and Main ResultsPlasma insecticide concentrations and cholinesterase activity were determined daily. Two to three biopsies of fat tissue were carried out at 1− to 2-wk intervals. The amount of the insecticide removed during hemoperfusions was also determined. Five patients presented with a prolonged nicotinic syndrome. Two of these patients showed sequelae of delayed neurotoxicity. Another two of the five patients died and the remaining patient recovered without sequelae. In none of the patients could >0.1% of the total absorbed poison be removed by hemoperfusion. No changes in symptoms were observed after these procedures. Fat tissue concentrations of the insecticide were 20 to 50 times higher than the concentrations in plasma. Atropine decreased the intestinal transit time, and 10 days after poisoning, a powerful cathartic treatment indicated the persistence of gut content, which probably caused prolonged absorption of the toxin.ConclusionsExtracorporeal cleansing mechanisms did not remove any clinically important amount of insecticide from our patients due to the high lipid solubility of these agents and no changes in symptoms were observed after these methods. The use of atropine decreases bowel peristalsis. Early use of powerful cathartics could avoid protracted absorption of the poison stored in the gut, although the potential benefits of this therapy require confirmation by the performance of prospective, controlled investigations.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID