摘要:

We evaluated the effects of deep inspiration, expiration, and the Valsalva maneuver on composite cardiac (left and right ventricular) and pulmonary volumes using equilibrium radionuclide angiography in 15 adult males without left or right ventricular dysfunction. The additional effects of nitroglycerin during these maneuvers were also examined. Midexpiration was used as the control point and data analyzed as a ratio (e.g., inspiration counts divided by midexpiration counts). Left ventricular volume (LVV) declined with inspiration (0.90 ± 0.08 inspiratory/midexpiration) and with the Valsalva maneuver (0.89 ± 0.08 Valsalva/midexpiration). Similar changes occurred after nitroglycerin, although the effects of the Valsalva maneuver on LVV were exaggerated when compared to the initial control intervention (0.79 ± 0.09, vs 0.88 ± 0.07,p<.05). Right ventricular volume (RVV) increased with inspiration and decreased with the Valsalva maneuver; these changes were similar after nitroglycerin. Pulmonary blood volume (PBV) was greater with inspiration than expiration (1.02 ± 0.10 vs 0.95 ± 0.05,p<.05), and was reduced with the Valsalva maneuver. Nitroglycerin reduced significantly all volumes and the reduction was similar for each compartment when respiratory interventions were compared.We conclude that blood pool imaging can be used to characterize abrupt fluxes in central circulatory volumes. Blood pool imaging of the heart and lungs should be considered a technique for monitoring the distribution of blood volume during acute pharmacologic and physiologic alterations.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Left ventricular (LV) function and extent of coronary artery disease (CAD) are important prognostic factors in patients with ischemic cardiac pain (ICP). This study was designed to compare LV function in patients with ICP admitted to our coronary care unit (CCU). Patients with previous transmural myocardial infarction (TMI) or who were over age 75 were excluded. Group 1 (n = 17) developed their 1st TMI; group 2 (n = 14) were diagnosed as unstable angina (UA). All patients demonstrated significant CAD on arteriography; i.e., at least 70% stenosis of at least 1 major coronary vessel. LV function was evaluated by single plane ejection fraction (EF), end-diastolic volume index (EDVI) (ml/m2), and the slope of a modified LV function curve (S) utilizing change in CI divided by change in end-diastolic pressure at rest and post-LV angio (ml · min · M−2· mm Hg) (normal ± SD: 176 ± 39). Both TMI and UA patients had LV dysfunction; although group 1 had more severe abnormalities, they were not statistically significant. Eleven (65%) in group 1 and 10 (71%) of 14 in group 2 had multivessel CAD. We conclude that in patients without previous TMI admitted with ICP: (1) Those who do not develop TMI have similar LV dysfunction compared to those with TMI; and (2) TMI and UA patients have similar multivessel CAD.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The time interval from the onset of the R wave of the ECG to the onset of the cutaneous capillary pulse wave, i.e., cutaneous R-pulse interval or RPIC, was evaluated in 21 full-term and 22 preterm infants as a measure of cardiovascular function. RPICshowed a significant linear relationship with birth weight (r = .58,p<.001) and gestational age (r = .62,p<.001) for healthy infants. At similar gestational ages, the sick infants showed a significant prolongation of RPICwhen compared to their healthy counterparts (mean prolongation 18.5 msec,p<.01). The infusion of calcium gluconate, an inotropic agent, consistently and significantly shortened the RPICfrom its preinfusion value (p<.01). In 7 infants, simultaneous measurement of intra-aortic R-pulse interval accompanied parallel changes in RPIC. These preliminary observations suggest that continuous monitoring of RPICmay provide a reliable noninvasive measure of neonatal cardiovascular function.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The EEGs of 40 infants paralyzed with D-tubocurarine or pancuronium during the neonatal period were reviewed retrospectively. The 23 infants who survived were re-examined at 1–3 yr of age. Sixteen infants had normal or mildly abnormal EEGs in the neonatal period; 3 died of nonneurologic causes; the remainder were normal at follow-up. Three of 8 infants with moderately abnormal EEGs in the neonatal period died, 2 had neurologic sequelae at follow-up, and 3 were normal at follow-up. Eleven of 16 infants with markedly abnormal EEGs died, and 5 had neurologic deficits at follow-up. Seizures occurred in 16 infants. Ten (63%) of the 16 died, whereas only 7 (29%) of 24 infants without seizures died (p<.1). Eight infants had seizures only during paralysis.The EEG was statistically the best predictor of neurologic outcome when compared with the following variables recorded before paralysis: estimated gestational age (EGA), birth weight, Apgar score at 1 and 5 min, lowest Po2and pH and highest Pco2. This study establishes the value of the EEG in the neurologic assessment of iatrogenically paralyzed newborns in the detection of seizures, and confirms previous studies which showed the value of EEG in predicting outcome.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The effect of positive end-expiratory pressure (PEEP) on plasma renin activity (PRA), renal function, and cardiovascular (CV) hemodynamics during high frequency jet ventilation (HFJV) was observed in 7 patients. The addition of PEEP during HFJV increased PRA while decreasing stroke index (SI) and cardiac index (CI). These changes were associated with decreased urinary flow, creatinine clearance, and fractional excretion of sodium. In contrast, HFJV at zero end-expiratory pressure (ZEEP) maintained normal PRA, renal function, and CV hemodynamics. The authors conclude that the alteration of renal function during HFJV is a function of airway pressure rather than the effects of the ventilatory frequency. The deterioration of renal function may have been due to changes in PRA or CV dynamics.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Pulmonary capillary wedge pressure (WP) values obtained after catheterization of a pulmonary artery (PA) totally occluded by thrombus may be erroneously interpreted. The left lower lobe PA was catheterized in 13 anesthetized dogs. Measurements of mean pulmonary artery pressure (MPAP) and WP were performed before and after total occlusion of the PA by a clamp located 1 cm from the tip of the catheter. There was a difference between pulmonary artery occluded pressure (PAoP), MPAP, and WP, both in normovolemic and overload conditions (p<.01). The PAoP was not equivalent either to WP or to MPAP. In massive pulmonary embolism, WP may not reflect left ventricular end-diastolic pressure (LVEDP).

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Prospective evaluation of 178 radial (RAD) and 114 femoral (FEM) artery catheters inserted in 231 critically ill adults in 2 ICUs was performed. FEM catheter duration (5.8 days) was greater than RAD (3.9 days,p<.001). Most catheters were removed when no longer needed. Complication rates of RAD (7.5%) and FEM catheters (6.9%) were similar. Digital ischemia was the most common complication (3.5%) yet no digital necrosis occurred. Peripheral vascular disease (PVD), greater age, and greater catheter duration were not associated with more complications. Difficult percutaneous and surgical cutdown insertion of RAD catheters was associated with much greater complication rates. In conclusion, FEM and RAD artery catheters have acceptably low complication rates of 7%. Percutaneous FEM catheterization is recommended as a safe alternative to difficult RAD cannulation.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We examined the effects of various colloidal solutions on cardiovascular and oxygen transport variables for 26 patients undergoing gastrectomy under general anesthesia. Fluosol-DA, whole blood, 3% Dextran-40 (Saviosol), and 6% hydroxyethyl starch (hetastarch, Hespan) affected the right side of heart, but only whole blood and Fluosol-DA significantly increased cardiac output and oxygen delivery (Do2). Fluosol-DA may prove useful for critical care of hemorrhagic shock during operation or resuscitation in the immediate postoperative period.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The hemodynamic effects of 2 plasma volume expanders were compared in postoperative open heart surgery patients. Albumin 5% (A) or hydroxyethyl starch 6% (HES) solutions were infused according to indications based on cardiac index (CI) and pulmonary wedge pressure (WP), and their effects evaluated by physiologic profile measurements.Both groups demonstrated significant increases with volume infusion in CI (A from 2.37 to 2.84; HES from 1.97 to 2.49 L/min-m2) and WP (A from 9.4 to 13.7 mm Hg; HES from 11.9 to 13.2 mm Hg). Stroke index and stroke work increased similarly. Mean systemic arterial pressure (MAP) and mean pulmonary arterial pressure (MPAP) remained unchanged. No significant difference for any variable was demonstrated between the A and HES groups. In the volume used, from 250 to 750 ml, HES caused no bleeding abnormalities. HES is as effective as A as a plasma volume expander in postoperative cardiac surgery patients.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

A new device for measuring conjunctival oxygen tension (PcjO2) was used for intraoperative monitoring during carotid endarterectomy. The PcjO2measures local tissue oxygenation and, thus, reflects the oxygen delivery to the areas supplied by the internal carotid artery. PcjO2was found to be sensitive to manipulation, clamping, and obstruction of the carotid artery; it provided a useful monitoring system for assessment of the cerebral circulation during carotid surgery.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID