摘要:

Intracranial volume-pressure response was assessed in 6 children suffering from metabolic coma and ranging in age 2 months-13 years. No untoward pressure or infectious complications occurred. The relationship between baseline mean intracranial pressure (MICP) and volume-pressure response assessment (VPRA) in these patients seems to be exponential rather than linear. By itself, the test is no better than baseline MICP at identifying patients at greatest risk of developing significantly increased intracranial pressure (ICP). When used in conjunction with baseline MICP, this method of VPRA identifies a population with an 80% risk of developing serious ICP elevations within a 4 h time period. Patients with the best overall prognosis had significantly lower mean VPRA values than those with poorest overall prognosis.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

A retrospective study of subdural hematoma was conducted in 36 patients ranging in age from 2 months to 9 years. Hypotension occurred in 41% of the children during the evacuation of the subdural hematoma. This study suggests that hypovolemia was caused, in part, by the blood loss into the subdural hematoma. In patients with hematoma larger than 8% of the intravascular volume, the frequency of the hypotension was high (88%). Infants, in particular, had larger hematomas, ranging in size from 8–27% of intravascular blood volume and, therefore, were at high risk to develop hypotension. These larger hematomas may be due to the infants' higher ratio of subdural space to the body weight. The study also suggests that the preoperative infusion of adequate fluid and blood is a significant factor in preventing hypotension during the hematoma evacuation.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

One hundred and seventy-eight infants with birth weights ≤ 1500 g born in 1973–1975 were followed for a period of 1–3 years, and the physical, neurological, and developmental outcome evaluated. Although there was a high incidence of maternal problems, these did not correlate with outcome. Asphyxia at birth followed by neonatal complications leading to ventilatory assistance was significantly correlated with poor outcome. Over 50% of infants < 1000 g birth weight required assisted ventilation, but the outcome in small ventilated infants was comparable to that of ventilated infants of 1001–1500 g birth weight. Infants with neurological abnormality showed a high incidence of associated abnormalities in growth, vision, hearing, and development. Spastic quadriplegia emerged as the most common neurological diagnosis. Despite the many perinatal problems, 82% of the group were normal neurologically and 66% developmentally. The overall outcome was generally favorable in these infants even for those requiring ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Oxygen tension, oxyhemoglobin saturation, and pH were measured in arterial and in venous blood from heart, brain, kidney, liver, gut and pulmonary artery in anesthetized hypoxemic dogs during a reduction of blood oxygen affinity due to increasing acidosis caused by the administration of CO2and NH4Cl (pH range 7.40–6.80). In dogs with hypoxemia due to right to left shunt (anastomosis between inferior vena cava and left atrium), a reduction in blood oxygen affinity was followed by increasing PaO2and PvO2at unchanged SaO2. In dogs with hypoxemia caused by alveolar hypoxia, or a combination of alveolar hypoxia and right to left shunt, a reduction of blood oxygen affinity was followed by arterial and venous desaturation at unchanged PaO2values.Infusions of sodium bicarbonate or blood transfusions with reduced 2,3-diphosphoglycerate (2,3-DPG)-concentrations, if given to patients suffering from hypoxemia due to right to left shunt, may reduce the PaO2. Such therapy should be prescribed with caution.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

During a consecutive 17 month period, 15 trauma patients were diagnosed as having a myocardial contusion on the basis of abnormal ECG in 14 patients, elevated creatinine phosphokinase (CPK) in 13 patients, and elevated CPK-Muscle Brain (CPK-MB) isoenzyme determination in 11 patients. Using these screening modalities, the incidence of myocardial contusion in patients with blunt chest trauma increased from 7% when viewed retrospectively to 15% when viewed prospectively.Five patients had determinations of cardiac index of which 4 were less than 2.9 L/min M2. An additional 9 patients underwent a standard fluid challenge of 500 ml of 5% plasma protein faction infused over 30 min allowing construction of a Starling myocardial performance curve. Of these patients, 6 had biventricular dysfunction, 1 had isolated abnormal left ventricular function, and 2 had isolated abnormal right ventricular function in the absence of chronic obstructive pulmonary disease or preexisting heart disease. Multiple gated acquisition scans (MUGA) were abnormal in 6 patients and normal in 4 patients. Of the latter group, 3 had biventricular dysfunction and 1 had depressed cardiac index.Morbidity and mortality for myocardial contusion occurred in 40% (6 of 15) of patients in this series. Direct hemodynamic measurement with construction of a Starling curve was useful in monitoring the degree of impairment and subsequent recovery of myocardial function. This information was important in delaying semiurgent operations or in determining the best alternative of otherwise equally acceptable methods of patient management.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

In 32 major burn patients, routine respiratory measurements and blood gases analysis were performed. Striking differences were found between survivors and nonsurvivors in these variables. Marked increases in minute volume and respiratory rate were observed in nonsurvivors starting from the 6th day postburn, while PaCO2increased with larger tidal and minute volumes. At the same time, PaO2was lower than in survivors. In survivors, the closing volume, maximum mid-expiratory flow rate, and peak flow rate were lower than the predicted normal values. This may indicate that after major burn injury, ventilatory power decreased and some pathological changes occurred in small airways and alveoli without apparent pulmonary complications. Marked differences in the changes of respiratory rate and min volume between survivors and nonsurvivors may indicate the value of simple respiratory measurements for prediction of outcome in burn patients.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Two hundred routine chest x-rays were evaluated to determine their value in the management of critically ill patients in a Medical ICU (MICU). Seventy-four x-rays (37%) were of suboptimal value or were delivered to the MICU too late for inclusion on morning rounds. Of the remaining 126 films, 54 (43%) showed worsening of a known, or development of a new, cardiopulmonary abnormality, or an unexpected misplacement of an invasive device. On the basis of these findings, routine daily chest radiographs were judged to be valuable in identifying abnormalities in critically ill patients. However, the system for providing this service was only 63% efficient, and improvement must be sought in this regard.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Computerized gamma scintigraphy revealed a significant (p< 0.001) rising lung:heart radioactivity ratio, which has been called "slope of injury" or "slope index", with both99mTechnetium-tagged human serum albumin (99mTc-HSA) and99mTechnetium-tagged red blood cells (99mTc-RBC) after 0.05 or 0.2 ml/kg iv oleic acid administration to dogs. This slope index was significantly greater with99mTc-HSA than99mTc-RBC (p< 0.001). These findings verify that the scintigraphic99mTc-HSA slope of injury is a result of a pulmonary capillary protein leak and not oleic acid induced changes in pulmonary blood or air volume. The leak of red blood cells noted with scintigraphy was confirmed by light microscopy and examination of the tracheal edema fluid. The leak of albumin, however, was much greater than the leak of red blood cells by microscopy and tracheal fluid examination, confirming the scintigraphic data. This study provides further evidence that computerized gamma scintigraphy will be of value for the diagnosis of permeability pulmonary edema and its response to treatment.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Four hundred sixty-one consecutive admissions to the Pediatric Intensive Care Unit (PICU) were evaluated using the Therapeutic Intervention Scoring System (TISS). Patients requiring an increased level of care, defined as TISS points ≥ 10, accounted for 75% of patient days in the ICU. Within this group, the primary reason for admission to the ICU was congenital heart disease, trauma, malignancy, respiratory failure, and sepsis. Survival was inversely related to TISS points, though TISS itself could not differentiate between survivors and nonsurvivors. The mortality rates for children who had a congenital malformation, a cardiac arrest before admission, or who developed acute renal failure secondary to other disease processes were significantly increased. Comparison of critically ill children and adults using TISS showed mortality rates that were similar.Assuming that the cost of intensive care is related to both seriousness of illness (assessed by TISS) and length of hospitalization, in this pediatric population the cost of hospitalization was not disproportionately high for non-survivors compared to survivors.Reduction in mortality rates in a PICU population will be dependent on factors largely uncontrollable by ICU practitioners. This will come about by reduction in the numbers of congenital malformations and the prevention of childhood trauma.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID

摘要:

Hemodynamic responses to transurethral prostatectomy (TURP) were studied in 9 patients with severe cardiac disease. This group of patients tolerated spinal anesthesia and TURP in an unpredictable manner. One adverse effect was the high pulmonary capillary wedge pressures (WP of 21 mm Hg or higher) in 4 of the 9 patients during operation. All nine cases were considered. Attention was directed toward significant cases. The high WP was not always indicated by high CVP either before or during operation, and it did not necessarily relate to the amount of fluid utilized or amount of prostate resected. Another adverse effect was the marked changes in systemic resistance in 6 patients.Because of the unpredictable hemodynamic responses, thermodilution flow-directed pulmonary artery catheter was valuable in several cases. It made it possible to select specific therapeutic agents and direct them at isolated hemodynamic dysfunctions.

ISSN:0090-3493    

出版商:OVID    

年代:1982

数据来源: OVID