摘要:

The Therapeutic Intervention Scoring System (TISS) introduced in 1974 has become a widely accepted method of classifying critically ill patients. In response to requests to update the system because of recent innovations in critical care, some items have been deleted, some have been added, and certain point scores have been adjusted. Explanations of items within the system and guidelines for the user are included. A comparison of the new 1983 system to the old 1974 system in 100 consecutive patients reveals no difference in total point scores. We hope this updated explanation will ease the task of assessing use of intensive care services.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To investigate the possibility of improving the accuracy of prognostication in early hypoxic brain damage, 12 patients with global cerebral ischemia (GCI) due to circulatory arrest outside hospital were followed until death or for 1 yr. Five who survived for more than 2 weeks displayed better values on coma scoring from 16 h-3 days, compared to those who succumbed within 2 weeks. In 2 week-survivors, lumbar puncture revealed consistently lower adenylate kinase (AK) activity in cerebrospinal fluid (CSF) at 24 h than in the other patients, whereas glutathione and lactate values overlapped to some degree. The CSF-AK activity at 48–72 h was less correlated to clinical outcome. It is concluded that the results from coma scoring, based upon clinical observation, and from determination of AK activity in CSF at 24 h reinforce each other in discriminative power to predict prognosis in these patients.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

There has been an impression that diarrhea occurs commonly in seriously ill patients treated in ICUs. In view of the sparsity of published work on the problem, we embarked on a prospective study of all patients admitted to the ICU for more than 48 h over a 12-month period.Three factors were examined in detail: nasogastric feeding, cimetidine administration, and antibiotic treatment. Other factors also were considered, notably the nature of the underlying illness and the spread of a possible infective agent by cross-infection.There was a 41% incidence of diarrhea. A significant increase in the incidence of diarrhea occurred in patients on nasogastric feeding (p< 0.01) and in those receiving cimetidine (p< 0.05); there was no increased incidence in those receiving antibiotic therapy.The cytotoxin ofClostridium difficilewas specifically looked for in all patients with diarrhea, but was not detected.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The primary goal of an interhospital critical care transport program is to provide quality medical care during transit as close as possible to that available in the receiving ICU. Critically ill pediatric patients are transported between hospitals by a variety of transport teams. The skills possessed by physicians, nurses, respiratory therapists, and paramedics overlap. To determine the criteria for selection of the team members for these patients, we reviewed the medical records of 115 pediatric patients transported to this facility in 1978 and 1979. Patients were categorized by diagnosis, severity of illness at the time of transport, and the monitoring and life support required during transport. Our data indicate the medical transport team members should have skills required for pediatric critical care diagnosis and management including endotracheal intubation and assisted ventilation; insertion of peripheral, central venous, and arterial catheters; fluid and electrolyte therapy; antibiotic therapy; cardiovascular monitoring; and pharmacological life support. The team members should be chosen based on the particular skills needed for a transport with a goal of providing the patient care required on a consistent basis.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

Differential lung ventilation (DLV) may be necessary in the supportive care of patients with severe unilateral or asymmetrical lung disease. The best method for allocating tidal volume between the 2 lungs is unknown. Eighteen mongrel dogs were given a unilateral hydrochloric acid (HCI) aspiration injury. A computer-controlled differential lung ventilation system was used to ventilate 6 dogs with equal volumes in each lung, 6 dogs with equal end-inspiratory pressure in each lung, and 6 dogs with equal end-tidal CO2fraction in each lung. The computer allocated volume between the 2 lungs by these 3 schemes on a breath-by-breath basis and maintained Paco2at 35 torr and total tidal volume at 15 ml/kg. Oxygen tension fell and pulmonary venous admixture increased after aspiration. There were no differences in gas exchange among the groups. Without PEEP, differential partitioning of tidal volume is of little consequence in differential lung ventilation of asymmetrical injuries.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

To determine the rate of intravascular catheter infection and the incidence of associated septicemia, we evaluated prospectively over an 8-month period, 291 catheters (172 arterial catheters (ARC), 82 central venous catheters (CVC), and 37 pulmonary artery catheters (PAC)) inserted in critically ill patients at University Hospital, Saskatoon.The technique of insertion, dressing, and removal of the catheters was standardized for all of the patients. Upon removal of the catheter, 2 portions 5 cm in length from the tip and the subdermal segment were rolled on the surface of agar plates and incubated overnight. A semiquantitative culture technique was used. A catheter culture was considered positive for infection if it grew 15 or more colonies. Blood cultures were obtained routinely from the catheters. Blood cultures were obtained from clean venipunctures if the temperature of the patient was greater than 38.5°C.Of 291 catheters cultured, 268 (92%) had less than 15 colonies/plate, or no growth, and were considered non-infected; 23 (8%) catheters were infected (greater than 15 colonies/plate). Only 3 patients had positive blood cultures from a clean venipuncture and grew the same organisms as the catheter culture.Staphylococcus epidermidiswas a common isolate from infected catheters and from the blood drawn from the lines (80% of all infected catheters). An increase in line duration corresponded with an increase in infection rates for all catheters.ARCs had a 4% infection rate with no significant difference when femoral, pedal, or radial arterial sites were compared. Infection rates were highest (20%), for CVCs inserted in the antecubital vein, lower (12%) in the internal jugular vein, and lowest (7%) in the subclavian vein. PACs showed a higher (29%) infection rate at the internal jugular site compared with subclavian veins (7%).We conclude that our rate of catheter infection and associated septicemia is below other rates published in the literature. Careful catheter insertion and strict adherence to maintenance protocol seems to decrease the rate of catheter infection and associated septicemia.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

We examined the specifications and design of the inspiratory pressure regulating valve of 8 continuous flow, pressure-limited infant ventilators. Two pressure regulating designs are currently available; one placing the primary pressure regulating valve on the inspiratory limb, the other placing it on the expiratory limb. Seven ventilators incorporate the latter design to limit inspiratory pressure and must have a safety pressure-relief valve located on the inspiratory limb to vent pressure in case of circuit occlusion. These pressure-relief valves are generally set by the manufacturer far in excess of pressures normally used for infant ventilation. Alarm systems are often absent or inadequate to warn of high pressure conditions during circuit obstruction. A case report detailing the fatal complication of prolonged excessive airway pressure during circuit occlusion is presented. Improvements in the pressure-relief valve designs currently available are possible, and may be necessary to provide adequate protection from barotrauma. The majority of infant ventilators currently available expose the patient to unnecessary excessive airway pressures in the case of expiratory limb occlusion, and the lack of alarm systems may leave the operator unaware of malfunction.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The effects of the ventilatory patterns of a conventional ventilator (SV-900) and a low-compression ventilator (system H) were studied in 12 patients with respiratory failure (RF). Volume-controlled ventilation at frequencies (f) of 20 breath/min (SV-20) with SV-900, and 20 (H-20) and 60 (H-60 = high-frequency positive-pressure ventilation, HFPPV) breath/min with system H was given. Inspiration constituted 25% (with an inspiratory pause of 10%) of the ventilatory cycle with SV-900 and 22% with system H. Intratracheal (ITP), intrapleural, systemic and pulmonary arterial (PAP), and central venous (CVP) pressures were measured at normoventilation. During H-60, normoventilation was provided with smaller tidal volumes and lower mean intratracheal pressures than during SV-20 and H-20. Cardiac index and oxygen transport were not affected by changes in ventilatory pattern. The respiration-synchronous variations in CVP, PAP, and pulmonary capillary wedge pressure (WP) during ventilation at 20 breath/min were abolished during HFPPV. In the most severely ill patients, long-term HFPPV was uneventful. Airway suctioning during ventilation with oxygen was an important feature of the pneumatic valve principle (system H). The results of this study indicate that volume-controlled HFPPV is as efficient and as well accepted by the patient as conventional ventilation (SV-20).

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID

摘要:

The ventilatory patterns of a conventional ventilator for volume-controlled ventilation (SV-900) and a low-compression ventilator utilizing the pneumatic valve principle for pressure/flow-generated, volume-controlled ventilation (system H) were studied in a lung model and in 10 patients with respiratory failure. System H was used at frequencies of 20 (H-20) and 60 (H-60 = high-frequency positive-pressure ventilation [HFPPV]) breath/min, and SV-900 at a frequency of 20 (SV-20) breath/min. With system H, inspiration constituted 22% (no inspiratory pause) and with SV-900, 25% (with 10% inspiratory pause). System H delivers an instantaneous accelerating flow which rapidly decelerates during the second part of the inspiratory phase. Maximal flow rates studied were 1.3 (H-60), 0.9 (H-20), and 0.7 (SV-20) L/sec. Thus, HFPPV delivers an effective tidal volume with highest linear velocity. This increased velocity increases gas mixing by increasing turbulence in conducting airways.In the 10 patients with respiratory failure, intrapulmonary gas distribution (measured as the nitrogen washout delay) was improved from 106% during SV-20 to 74% with H-60 (p< 0.05). H-60 also increased carbon dioxide elimination in the 2 patients with the most severe pulmonary dysfunction.

ISSN:0090-3493    

出版商:OVID    

年代:1983

数据来源: OVID