摘要:

A retrospective study was performed to assess the therapeutic efficacy of cimetidine and antacid, alone and in combination, for the control of gastric acidity and bleeding in pediatric burn patients. The frequency of pH values no greater than 3.5 was significantly greater in the cimetidine group than in the antacid group, and the combined regimen did not enhance the effectiveness of therapy. In all groups, pH values no greater than 3.5 were associated with a significantly higher incidence of positive guaiac tests. In four patients studied prospectively, 63% of the administered dose was detected in the urine 8 h later, compared to the previously reported 24-h delay for normal, healthy adults. Rapid clearance of cimetidine might explain the decreased efficacy of this drug in burn patients. Dosage and schedules for antacid prophylaxis in pediatric burn patients require further study.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The expiratory time constant of the respiratory system (Trs) and the total respiratory system compliance (Crs) were measured from the analysis of a flow-volume loop during relaxed expiration, and the total respiratory system resistance (Rrs) was derived from the relationship: Rrs = Trs/Crs. In ten intubated and mechanically ventilated very low birth weight infants, the values obtained for compliance (0.21 to 0.71 ml/cm H2O) were similar to those found using an occlusion technique during spontaneous breathing. The values of Trs were 0.03 to 0.14 sec. These Trs values were altered by adding known resistive loads. The corresponding derived values for Rrs were close to the values of the added resistance loads, suggesting that resistance values found in this group of ventilated babies (120 to 380 cm H2O/L.sec) were accurate.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Instantaneous heart rate, indices of long-term and short-term heart-rate variability (HRV), and transcutaneous O2(PtcO2) and CO2(PtcCO2) tensions were recorded simultaneously on 164 occasions in 16 neonates. There was significant inverse correlation between PtcCO2and both HRV indices, while no linear correlation was detected between HRV and PtcO2. The heart rate was positively related to PtcO2and inversely correlated with PO2. It is suggested that increasing PCO2decreases medullary pH, thus increasing heart rate and decreasing HRV. We conclude that each of these monitoring variables is unique: the transcutaneous measurements display the efficiency of respiration, whereas the heart-rate patterns reflect the dynamic condition of the autonomic nervous system.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Three patients with respiratory failure resulting from miliary tuberculosis had a characteristic clinical presentation that included a long history of a prominent cough, dyspnea, weight loss, tachycardia, tachypnea, pulmonary adventitious sounds, and hepatomegaly. Hematologic investigation showed a normal white cell count with marked left shift in the morphology of white cells in all three patients, and evidence of disseminated intravascular coagulation in one patient.In only one patient was the initial sputum positive for acid-fast bacilli; in the others, invasive diagnostic procedures including lumbar puncture, bone marrow trephine, and open-lung biopsy were necessary for diagnosis. Miliary tuberculosis should be suspected in patients with adult respiratory distress syndrome of unknown etiology. Simple diagnostic procedures such as sputum, bronchial brushings, and urine examination should be followed by bone marrow trephine, liver biopsy, transbronchial lung biopsy, and lumbar puncture if physical signs of meningitis are present.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

A 4-h infusion of 310 to 465 mg (10 to 15 mMol) phosphorus given to 28 of 31 consecutive seriously ill hypophosphatemic patients increased the serum phosphorus level above 1.2 mg/dl in all but one patient. There was no significant change in the mean serum calcium, potassium or blood pressure, no patient deteriorated, and six patients were stronger and more alert after the infusion. In seriously ill patients we recommend a 4-h infusion of 15 mg/kg (0.5 mMol/kg) phosphorus if the serum phosphorus is less than 0.5 mg/dl, or a 7.7-mg/kg (0.25 mMol/kg) infusion if the serum phosphorus is between 0.5 and 1.0 mg/dl.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

The serum magnesium level was measured in 94 consecutive patients admitted to the medical ICU of Los Angeles County/University of Southern California Medical Center over a 2-month period. Sixty-five percent of patients with serum creatinine concentrations of 1.1 mg/dl or less were hypomagnesemic. Of these, one third had hypocalcemia that was corrected with magnesium supplementation. Physicians should be alert to the high incidence of magnesium deficiency in critically ill patients.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

Oleic acid (OA) administered to experimental animals increases pulmonary vascular permeability and produces a condition that pathophysiologically resembles adult respiratory distress syndrome (ARDS) in humans. The present study examined the sequence of cardiorespiratory changes after OA infusion and their similarity to ARDS. After a baseline period, mechanically ventilated and anesthetized dogs were administered 0.18 ml/kg body weight OA into the pulmonary artery while hemodynamic and respiratory changes were monitored. After OA infusion, cardiac output fell by 39%, paralleling a 26% decrease in heart rate. Pulmonary vascular resistance (PVR) increased over 200% without a change in pulmonary capillary wedge pressure and initially without an increase in pulmonary artery pressure (PAP). Within 30 min after OA infusion, dynamic pulmonary compliance (Cdyn) was reduced 32% from baseline values, with a coincident increase in the alveolar-arterial PO2gradient (P[A-a]O2) but without a significant change in the pulmonary shunt fraction (Qsp/Qt). This was followed in 30 min by a further 27% decrease in Cdyn, with a Qsp/Qt in excess of 50%. Both the hematocrit and hemoglobin concentration increased progressively after OA infusion, without a change in plasma protein concentration. The results suggest that the sequence of cardiopulmonary changes after OA injury are initially marked by a decrease in Cdynand an increase in PVR and P(A-a)O2. This is followed by an increase in Qsp/Qt, PAP, hemoglobin concentration and PCO2. The changes appear related to progressive flooding of the alveolar air space with edema fluid. These findings parallel the sequential cardiorespiratory changes reported to occur in ARDS.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

We evaluated the effectiveness and safety of iv naloxone in 12 septic patients who remained hypotensive despite volume replacement, appropriate antibiotics, and vasopressor therapy. Only four patients responded positively to naloxone, by increases in mean arterial pressure of between 10 to 15 mm Hg that lasted for 15 to 60 min. These patients could not be distinguished from the others on the basis of underlying illness, laboratory or physical findings, length of preceding hypotension, or glucocorticoid therapy. Four patients had adverse reactions: one developed pulmonary edema, one patient had a grand-mal seizure, and two patients became severely hypotensive. We conclude that in patients with well-established septic shock, naloxone does not reliably improve mean arterial pressure or other physiologic variables, and may cause severe adverse reactions.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

To investigate the effects of both positive end-expiratory pressure (PEEP) and mean airway pressure (Paw) on gas exchange, we used lung lavage to induce severe respiratory insufficiency in six lambs. The animals were then mechanically ventilated at constant tidal volume, respiratory rate, and inspired O2fraction. PEEP levels were varied −5, +5 and +10 cm H2O around the pressure (Pflex) corresponding to a major change in slope of the inspiratory limb of the respiratory volume-pressure curve. In each animal the effects of the three PEEP levels were studied at two Paw levels, differing by 5 cm H2O.Increasing Paw significantly improved PaO2and reduced venous admixture. A 5-cm H2O PEEP increase from +5 to +10 did not affect oxygenation; however, oxygenation was significantly better when PEEP was greater than Pflex. Both PaCO2and anatomic dead space were higher at higher PEEP, and decreased with increasing Paw. Hence, Paw was a major determinant of oxygenation, although a PEEP greater than Pflex appeared necessary to optimize oxygenation at a constant Paw.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID

摘要:

During continuous positive airway pressure (CPAP) the work of breathing is least when there is no change of airway pressure measured at the mouth (ΔPaw) during respiration. In this study we consider the physical properties of CPAP circuits which determine the magnitude of ΔPaw, and apply this information to the design of a simple, reliable CPAP system that minimizes ΔPaw and incorporates the additional advantages of low-flow rates and the use of commonly available proven components. Using a weighted reservoir bag and threshold CPAP valve to maintain pressure, we found that ΔPaw may be reduced to less than 1.0 cm H2O during quiet breathing, at a tidal volume of 700 ml and maximum inspiratory flow of 1.35 L/sec. ΔPaw was dependent on both the resistance and the reactance of the circuit components; it was increased when resistance or flow rates were high, and when delivery pressure depended on the elastic tension in the wall of the reservoir bag or on compression of the bag with springs or elastic bands.

ISSN:0090-3493    

出版商:OVID    

年代:1985

数据来源: OVID