ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The fluorocarbon emulsion Fluosol-DA (20%) is an acellular O2carrier that has potential as a red cell substitute. Clinical evaluation of efficacy requires knowledge of the ability of the perfluorochemical (pfc) phase to both load and unload O2. A method is described to measure the oxygen dissolved in the pfc and aqueous phases, and the oxygen chemically bound to hemoglobin, during use of this drug. These O2contents are used to calculate the contribution of the pfc phase to total O2delivery and O2consumption (&OV0312;2) and the fractional extraction of O2in the pfc phase. The technique requires a blood gas analyzer, a microhematocrit centrifuge, and a standard co-oximeter found in many blood gas laboratories. This technique appears to be simple and reliable, and should facilitate the evaluation of efficacy of fluorocarbon emulsions.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The authors continuously administered prostaglandin E1(PGE1) iv to 2 infants with tetralogy of Fallot (TOF) and esophageal atresia with tracheoesophageal fistula (TEF) for more than 30 days, and observed side effects which could be attributed to the long-term administration of PGE1. After division of the TEF and anastomosis of the esophagus, leakage from the anastomosis developed in both cases. Because of the infectious foci in the thorax, Blalock's procedure was postponed and PGE1was continued for 49 and 37 days. The authors believe radiographs of long bones and ribs demonstrated cortical hyperosteosis in both cases. Bone abnormalities became apparent approximately 30 days after the start of PGE1and were associated with increases in serum alkaline phosphatase (peak value of about 2000 IU/L). Roent-genographic changes reverted toward normal and alkaline phosphatase values decreased after the cessation of PGE1in both cases.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The effects of fluid resuscitation with 6% hetastarch, 5% albumin, or 0.9% saline solutions on plasma colloid osmotic pressure (COP) were examined in 26 patients with hypovolemic circulatory shock. One liter of hetastarch produced a 36% increase in COP compared to an 11% increase after 1 L of albumin (p < 0.001). One liter of saline resulted in a 12% decrease in COP (p < 0.05). The mean COP increased from 16.3 ± 1.6 (SE) mm Hg to a maximum of 23.7 ±1.4 mm Hg during the first 24 h of hetastarch resuscitation (p < 0.01), and from 17.0 ± 1.1 to 22.3 ± 1.5 mm Hg with albumin (p < 0.001). Saline resuscitation decreased the COP from 17.1 ± 1.1 mm Hg to a minimum of 12.7 ± 1.1 mm Hg (p < 0.02). These changes persisted from 2–5 days after resuscitation. Saline resuscitation required significantly larger amounts of fluid. The authors conclude that fluid resuscitation of circulatory shock with colloid solutions increases COP and requires less volume of resuscitative fluid.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

SUMMARYMalnutrition and weight loss are among the signs of a poor prognosis in the natural history of patients with COLD.123, 124Patients whose only source of daily nutrition is 2–31 of 5% dextrose suffer malnutrition and weight loss. This has been documented to be detrimental.Currently, there are insufficient data to propose the optimum form and amount of nutritional intake. Thus, it is appropriate to suggest moderation in nutritional support of patients with compromised pulmonary reserve. Glucose infusions may be expected to replenish tissue glycogen and, hence, be associated with improved work performance; however, CO2production is significantly increased. However, an increased RQ may provide a more favorable alveolar Po2which could be important in patients with COLD during room air breathing. Fat emulsions are commercially available, can minimize CO2production, and have been shown to be N sparing. However, serum hyperlipemia may compromise pulmonary diffusing capacity. Increasing nitrogen intake can increase ventilatory drive, but this may lead to a feeling of dyspnea and be detrimental in patients unable to increase minute ventilation.Parenteral nutrition should be guided by whether the goal is to: (a) preserve lean body mass in patients who are in satisfactory nutritional condition but whose return to oral intake is not imminent, or (b) restore lean body mass in patients who have lost greater than 10% of normal body weight. In patients where the intent is maintenance of lean body mass, nutritional support should be designed to attain calorie and nitrogen equilibrium. Practically speaking, this means: (1) energy intake of 1–1.2 χ energy expenditure; (2) nitrogen intake of 200–300 mg/kg. At this institution, 50% of the nonprotein calories are given as fat emulsions. In patients where the goal is restoration of lean body tissue, the nutritional regimen should be designed to achieve a distinctively positive calorie and nitrogen balance. Energy intake is set at 1.4–1.6 χ energy expenditure. Nitrogen intake is between 250–400 mg/kg body weight. One-half of the nonprotein calories are given as lipid.These recommendations are based upon limited data and indirect evidence. Further studies of nutrition and respiration are needed to construct more definitive guidelines in this important area of clinical care.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

The ventilatory response in acute lactic acidosis was assessed in 39 patients. In 18 patients, the acidosis was associated with phenformin ingestion and in 21, with other causes such as shock and sepsis, but not pulmonary edema. Arterial blood CO2tensions and plasma bicarbonate concentrations were compared to those previously found in patients with uncomplicated diabetic ketoacidosis. In most of the lactic acidosis patients, arterial blood CO2fell within the 95% confidence band calculated from the data in the ketoacidotic patients. Only 1 lactic acidotic patient had a triflingly lower CO2tension. Shock was present in 8 of the 9 lactic acidotic patients whose CO2tensions were more than 2 torr above the 95% confidence band.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Pulmonary complications, particularly atelectasis, occur frequently after coronary artery bypass (CAB) surgery. To determine the effect of early postoperative immobility on pulmonary complications, the authors randomly assigned 35 patients into two groups. One group remained in the supine position for the first 24 h. The second group had their body position systematically turned every 2 h for the first 24 h. Turning resulted in a significant decrease in postoperative fever (p < 0.001) and a 32% reduction in the duration of the stay in the Surgical Intensive Care Unit (SICU). Turning did not affect the patient's hemodynamic stability or arterial blood gas measurements. The authors conclude that systematic turning of CAB patients can reduce postoperative morbidity.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

It was traditionally assumed that ethanol, as part of an intentional drug overdose, will increase morbidity and mortality. The authors prospectively studied the effect of ethanol on the outcome of intentional drug overdose in 468 adults, 196 of whom required hospital admission. Ethanol was detected in significantly fewer patients who required admission. Ethanol ingestion was not related to coma, impaired vital signs or mortality. Indeed, the duration of coma was significantly shorter in patients in whom ethanol was detected, but this group had a lesser incidence of multiple drug and nonbarbiturate hypnotic ingestion and a greater incidence of chronic ethanol use. Thus, it seems that ethanol is not associated with a worse clinical course if the drug overdose patient reaches medical care before an irreversible event.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Most tracheal tubes sold today are arcuate in shape while the human airway is S-shaped. In situ, the tubes exert different forces on the posterior larynx depending on their stiffness. Laryngeal damage after prolonged intubation is recognized as the result of these forces.The authors tested 8 types of size 8.0 tracheal tubes to determine the magnitude of laryngeal loading in a model approximating the geometry of the human airway. The force each tube exerted on the posterior larynx was measured in conditions simulating both, immediately after intubation and after prolonged intubation of 24 h. The force was converted into an integer number, an index of laryngeal loading, that can be used to compare various types of tracheal tubes. The airway model and test procedure can be utilized by manufacturers, designers, and others to provide valuable information on tracheal tube performance and to develop improved tracheal tubes in the future.The results indicate that the polyvinylchloride tubes (PVC) and the silicone rubber tubes had the lowest index of laryngeal loading after long-term conditioning and would be preferable for prolonged intubation. The red rubber tube had the highest index of laryngeal loading after long-term conditioning, yet its stiffness would facilitate intubation.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

To investigate the effects of operator variability on thermodilution cardiac output determinations, a group of physicians and nurses made a series of manual indicator injections and automatic injections using a gas powered injector in a simulated clinical situation. The data show significant variability in injection time, injectate flow rate, consistency of injection, and cardiac output values obtained during manual injections. There was little variability in these parameters during automatic injections.When other variables are properly controlled, the automatic injector may improve the precision of cardiac output measurements by controlling the consistency of injection and variables introduced by different operators performing manual injections. However, despite significant variation in parameters associated with manual injection, it is interesting to note that 8 out of 10 operators obtained cardiac output values by hand injection using room temperature injectate, which did not differ significantly from those obtained by automatic injection.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID