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 evaluate the attitudes of critical care professionals concerning forgoing life-sustaining treatments in critically ill patients.Design and SettingQuestionnaires (n = 1148) were distributed to all registrants at the annual Society of Critical Care Medicine meeting, and 600 (52%) were returned and analyzed.PatientsNone.InterventionsNone.Measurements and Main ResultsWhen confronted with an actual patient whose condition was deemed to be irreversible and terminal, 334 (56%) of 600 respondents were not disturbed by withholding or withdrawing treatment, whereas 156 (26%) of 600 respondents were more disturbed by withdrawing than withholding treatment. Five hundred thirty-six (89%) respondents had withheld and 519 (87%) had withdrawn life-prolonging treatments. Forgoing treatments was more common for academic physicians (329/343, 96%) and professionals responsible for the decision to forgo treatments (389/404,96%). Respondents believed the physician's professional duty to his or her patient was to preserve life foremost, but evaluate quality of life (342, 57%) or ensure quality of life foremost, but evaluate preservation of life (188, 31%).ConclusionsCritical care professionals evaluate both the preservation of life and quality of life in their patients. Despite some discomfort in forgoing treatment, the majority of critical care professionals decide to forgo treatment in irreversibly, terminally ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo study the effect of serum from patients with fungemia and control patients on sinoatrial node function.DesignProspective, observational study.SettingSurgical ICU in a university hospital.PatientsFourteen patients with fungemia and 14 control patients.Measurements and Main ResultsSerum samples from all patients were assayed in anin vitrosinus node preparation. Serum samples from 11 (78%) of the 14 fungemic patients caused a decrease in sinus node activity, while serum samples from only one (7%) of 14 control patients caused slowing of the sinus node.ConclusionsSerum from many patients with fungemia causes slowing of anin vitrosinus node preparation. Thisin vitrofinding may explain bradyarrhythmias seen clinically in the setting of fungemia.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo systematically analyze the changes in mixed venous oxygen saturation (ASvo2) during aortic operations with tube, aortobi-iliac, and aortobifemoral grafts.DesignSurvey of consecutive patients.SettingTeaching community hospital.PatientsThirty-one patients (22 male, 9 female, mean age 67 ± 10 yrs), undergoing elective operations for aortic aneurysms (n = 25) and aortoiliac occlusive disease (n = 6).InterventionsSvo2was recorded throughout the operation. Cardiac output, mean pulmonary arterial pressure, arterial oxygen saturation (Sao2), and arterial pH were measured before and immediately after the unclamping of the aortic graft.ResultsIn all patients, unclamping the aorta resulted in a marked reduction of mean Svo2, with no change in the cardiac output or Sao2. The unclamping of tube grafts was associated with a significant reduction in arterial pH (p <.01) and in Svo2(p <.001), when compared with unclamping of bifurcation grafts. A significant (p <.05) increase in mean pulmonary arterial pressure was observed after unclamping the aorta in patients with tube grafts. Despite a longer clamp time, unclamping the second limb of a bifurcation graft resulted in a smaller ASvo2, when compared with that observed after unclamping the first limb (12% vs. 6%;p <.01). The DLSvo2after unclamping limb II was only 2% in aortobifemoral grafts and 9% in aortobi-iliac grafts.ConclusionsReperfusion via extensive pelvic and lumbar collaterals in patients with aortoiliac occlusive disease reduces the DLSvo2after aortic unclamping. Monitoring the changes in Svo2during different types of aortic reconstruction helps to define precisely the physiologic alterations that occur in the course of these operations.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo determine if the administration of epinephrine changes the partial pressure of end-tidal CO2during cardiac arrest, as previously reported. Such a change could diminish the demonstrated ability of end-tidal CO2measurements to predict resuscitation from cardiac arrest.DesignThe partial pressures of end-tidal CO2of adult cardiac arrest patients who received iv epinephrine in doses from 1 to 15 mg were monitored throughout arrest.SettingEmergency department of a university hospital.PatientsAdults (n = 64) in cardiac arrest with a mean age of 70 ± 12 yrs, of whom 35 were males and 15 had a mean time of return of spontaneous circulation of 6.5 ± 11 hrs.InterventionsEnd-tidal CO2(in torr) was analyzed on arrival, before the first dose of epinephrine, and 4 mins after epinephrine was administered in varying doses chosen by the supervising physician.Measurements and ResultsThe end-tidal CO2decreased an average of 0.3 torr (0.04 kPa) after epinephrine was administered. Patients with a return of pulse had a decrease of −2 torr (-0.3 kPa) vs. an increase of 0.3 torr (0.04 kPa) for those patients with no return of pulse (p =.07). In 33% of patients, there was no change; in 28%, the partial pressure of end-tidal CO2increased, and in 39%, it decreased. There was no correlation between the change in end-tidal CO2after epinephrine and whether or not patients regained a pulse (r2=.08, p =.07), although a decrease in end-tidal CO2was most often associated with return of pulse. At a threshold of 10 torr (1.3 kPa), the first end-tidal CO2had a positive predictive value for return of pulse of 50% and a negative predictive value of 82%. Just before epinephrine administration, the positive predictive value was 71% and the negative predictive value was 83%; 4 mins after epinephrine administration, the positive predictive value was 64% and the negative predictive value was 86%. A decrease in end-tidal CO2after epinephrine had a positive predictive value of 53% and a negative predictive value of 92%. End-tidal CO2readings predicted resuscitation most accurately when taken after initial stabilization and before administration of epinephrine.ConclusionsAlthough epinephrine administration may decrease end-tidal CO2tensions in cardiac arrest, it does so unpredictably in individual patients, and it does not eliminate the predictive value of this measurement.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo compare the caloric intake with the caloric requirements in postoperative patients being fed enterally via nasoenteric tubes, parenterally, or by both enteral and parenteral methods.DesignDescriptive study.SettingSurgical ICU in a university teaching hospital.PatientsSample of 22 mechanically ventilated postoperative patients, mean age 62 ± 17 yrs, selected from among those patients routinely scheduled to receive enteral or parenteral nutrition or both, for ≥4 days. The patients were studied for a total of 144 study days.InterventionEight patients received total parenteral nutrition, eight patients received enteral nutrition, and six patients received both parenteral and enteral nutrition.MeasurementsResting energy expenditure was measured by using indirect calorimetry, and daily nutritional intake was quantitated.ResultsThe patients who received parenteral, or enteral plus parenteral nutrition received an average of 80% of their caloric requirements, while those patients who received only enteral nutrition received only 68% of their caloric requirements. There was more day-to-day variation in nutrient intake in the enteral group (40% ± 56%) than in the parenteral group (12.2% ± 24%, p <.001).ConclusionsEnteral nutrition delivered via nasoenteric tubes as the sole delivery method in postoperative critically ill patients resulted in an inadequate and inconsistent nutrient supply. The use of parenteral or parenteral plus enteral nutrition resulted in more stable and adequate feeding than feeding byenteral nutrition alone.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

ObjectiveTo evaluate the effectiveness of continuous arteriovenous hemodiafiltration (CAVHD) using citrate as the anticoagulant for the treatment of lactic acidosis in patients with renal failure.DesignCase series with careful monitoring of the clinical course of patients being treated in a medical or surgical ICU.SettingUniversity hospital ICU.PatientsTwo patients with lactic acidosis are described, along with our experience using CAVHD and citrate in other clinical settings.InterventionsCAVHD was used to manage renal failure, while a continuous infusion of citrate was administered to maintain patency of the extracorporeal circuit.MeasurementsTotal and ionized serum calcium concentrations and citrate concentrations were monitored.Main ResultsCAVHD with citrate as the anticoagulant proved to be a convenient means of managing vascular volume, serum electrolyte concentrations, acid-base balance, and replacement renal function requirements in the setting of severe lactic acidosis, oliguric renal failure, and hemorrhagic diathesis.ConclusionsCAVHD with citrate as the anticoagulant can be recommended as effective therapy for selected patients, but careful monitoring is needed to avoid serious complications.

ISSN:0090-3493    

出版商:OVID    

年代:1992

数据来源: OVID