摘要:

Circulating phospholipase A2(PLA2) has been recognized as a mediator of circulatory collapse in experimental endotoxic shock. To assess the role of serum PLA2in septic shock in man, we determined serum PLA2profiles in a prospective study in 12 patients with septic shock. During the hypotensive phase of sepsis, serum PLA2 levels were consistently elevated as high as 33,428 U/ml (normal range 115 ± 12 [SE]; n = 101). In all 12 patients, PLA2 levels correlated directly with the magnitude and duration of circulatory collapse (p< .001), with a progressive fall of serum PLA2levels during convalescence. In contrast, serum PLA2levels in patients with cardiogenic shock secondary to myocardial infarction remained low. In pancreatitis, PLA2levels paralleled fluctuations of serum amylase and lipase, whereas in septic shock without pancreatic involvement, PLA2changes were discordant with changes in pancreatic enzymes. As well, septic shock serum PLA2 failed to crossreact by radioimmunoassay with antiserum against human pancreatic PLA2. These data are consistent with an extrapancreatic source of intra-vascular PLA2release during sepsis. Since endogenous serum PLA2levels correlate directly with the magnitude of hypotension in both experimental endotoxic shock and clinical septic shock, and since parenteral administration of purified exogenous PLA2reproduces hypotension in experimental models, we conclude that high levels of intravascular PLA2 may contribute similarly to the circulatory collapse in septic shock in man.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Ranitidine, a furan H2receptor antagonist, is increasingly prescribed in the ICU setting. Before the availability of parenteral ranitidine, cimetidine had been the sole H2 blocker used to decrease gastric acidity in this setting. However, cimetidine has recently been shown to transiently, but significantly, reduce mean arterial pressure due to direct vasodilation in a critically ill population. Therefore, this double-blind prospective study was designed to examine the hemodynamic effects of iv ranitidine in an ICU population. Twenty-six critically ill hemodynamically stable patients were studied; all patients were already receiving ranitidine and had an arterial line and a pulmonary artery catheter in place. This study demonstrated that an iv infusion of ranitidine did not produce clinically significant hemodynamic effects in this patient population.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Data from two 3-morith time periods before and after the arrival of a pediatric intensivist were collected prospectively and compared to determine the intensivist's impact on ICU mortality, use of monitoring and therapeutic modalities, and efficiency of ICU bed utilization. Severity of illness and care modalities were determined daily for all patients with the Physiologic Stability Index and the Therapeutic Intervention Scoring System. The only major organizational change in the postintensivist period was the organization and implementation of a daytime ICU team. Case mix variables, including sex; medical/surgical, emergency/elective, and diagnostic distributions; and nursing hours/patient day, were equivalent in the preintensivist and postintensivist samples. After the intensivist's arrival, there was a significant decrease in admissions with very low severity of illness (Physiologic Stability Index <4; 52% vs. 34%; p < .05) and a significant decrease in bed utilization by patients who received only monitoring services (27% vs. 17% of bed days;p<.001). The severity of the illness-adjusted ICU mortality rate was significantly higher in the preintensivist period than in the postintensivist period (weighted mean mortality difference 5.3 ± 2.6%;p< .05). The incidence of both therapeutic and monitoring modalities increased in the postintensivist period. These results indicate that a pediatric intensivist can improve mortality rates and efficiency of bed utilization in the pediatric ICU.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Energy metabolism was measured at the bedside in 22 uncomplicated surgical patients in the early (24 to 48 h) postoperative period with the use of continuous computerized indirect calorimetry with a canopy system. Energy production rates were higher than those predicted by the Harris-Benedict formula both in absolute value (1516 ± 61 vs. 1387 ± 49 kcal/day,p< .05) and when normalized by body weight (BW; 23.5 ± 0.5 vs. 21.7 ± 0.5 kcal/day kg BW,p< .01) or by lean body mass (LBM; 32.8 ± 0.8 vs. 30.2 ± 0.9 kcal/day kg LBM,p< .01). Furthermore, surgical patients had higher energy production rates than those measured in 22 overnight fasted, resting healthy subjects matched for age, sex, and body size (23.5 ± 0.5 vs. 21.8 ± 0.6 kcal/day · kg BW,p< .05). In both the patients and the control group, measured energy production bore a direct relation to LBM.We conclude that the early postoperative period of uncomplicated surgery is associated with a small (about 7%) but consistent increase in energy metabolism above the level observed in the overnight fasted, resting healthy individual. This increase appears to be an effect of surgery itself, and is not predicted by Harris-Benedict equations.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The therapeutic use of iv immunoglobulins of the G class in association with antibiotics in patients with severe sepsis is reported. As compared to the randomized control group of patients treated with antibiotics alone, patient survival was only slightly improved (from 25% to 42%; NS); however, the defervescence time was significantly shorter (10 vs. 16 days), and a greater? percentage of microbiologically positive cultures became negative (40% vs. 8%;p< .01). The percentage of days on antibiotic treatment during ICU hospitalization was consequently reduced (38% vs. 95%;p< .01). The therapeutic use of iv immunoglobulin G is discussed in terms of antibody substitution and modulation of the immune system.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Meningococcal shock still is associated with high mortality. Along with antibiotics and control of metabolic derangements, standard therapy involves monitoring and maintaining numerous cardiorespiratory variables. From 1980 to 1985, 39 children with meningococcal shock were treated in our pediatric ICU. We obtained full hemodynamic monitoring in 18 (12 survivors, six nonsurvivors). Two hemodynamic patterns were observed: hypovolemia and cardiac failure. Early death was generally related to refractory hypovolemia, probably secondary to severe capillary leak. Survival usually occurred when noticeable cardiac failure was controlled with early use of catecholamines and judicious fluid management. Because cardiac failure only slowly recovered, a therapeutic approach that aims not at normal variables but, rather, at survival variables seems appropriate.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Daily APACHE II assessments to reflect the dynamic pathophysiologic processes affecting ICU patients were carried out prospectively on 212 adult ICU admissions for the purpose of predicting hospital outcome. Trend analysis of daily APACHE II scores was used to develop the first set of criteria for predicting deaths among the ICU patients. The analysis took into account the absolute value of APACHE II score of each day and the rate of change relative to that of the previous day. One hundred consecutive adult ICU admissions were used to determine the criteria that were tested on the following 112 consecutive adult ICU admissions. Daily APACHE II scores identified correctly 16 of the 34 patients who died. A second set of criteria was next derived by raising the values of the original limits in order to build-in greater margins of safety without too great a loss of sensitivity. The predictive power of daily APACHE II scores using the second set of criteria was superior to that of a single APACHE II score by a factor of 4. Predictions were not used to influence clinical decision-making during this study.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Between January 1979 and October 1986, 349 patients with epiglottitis were admitted to the Royal Children's Hospital, Melbourne, Australia. Forty-five (13%) patients were not intubated, 291 (83%) were managed by nasotracheal intubation and spontaneous respiration without sedation, three (1%) received continuous positive airway pressure, and ten (3%) were ventilated. The 294 patients who were not ventilated were intubated for a mean of 18 ± 9.5 (SD) h; 90% were extubated within 24 h. Criteria for extubation included resolution of fever (<37.5°C), passage of time (12 to 16 h), and improvement in the general appearance of the child. Laryngoscopy was not performed before extubation. Providing there is always a doctor present who can reintubate if accidental extubation occurs, routine use of sedation, paralysis and mechanical ventilation, and preextubation laryngoscopy are not required for the management of children with uncomplicated epiglottitis, and their use may prolong the period of intubation.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

The ability of the calcium entry blocker verapamil to ameliorate the effects of renal ischemia was studied in ten sheep. Postanesthesia, bilateral cutaneous ureterostomies were placed in each sheep to facilitate urine collection and analysis. Both kidneys were made ischemic for one hour by occluding each renal artery. However, immediately before occlusion of the right renal artery, 0.05 mg/kg of verapamil was injected into the artery. Comparison of urinary creatinine excretion and urine volume for 72 h after reversal of ischemia demonstrated that those kidneys pretreated with verapamil had greater functional preservation (p< .05). In this study, verapamil appeared to provide protection against renal damage after an ischemic insult.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID

摘要:

Recent studies of acute respiratory failure suggest that PEEP causes increased pulmonary interstitial fluid collection and therefore increased extravascular lung water (EVLW). We examined the effect of increasing levels of PEEP on EVLW in 20 to 25-kg pigs with acute respiratory failure induced by continuous infusion of live Pseudomonas aeruginosa (2 × 108organisms/20 kg-min). Animals were intubated, paralyzed, and ventilated at 15 ml/kg tidal volume and an Fio2of 0.4. Pigs in group 1 were given 4 ml/kg · h of iv fluid (lactated Ringer's solution) with no PEEP administered. Animals in groups 2 through 5 were given 0, 4, 17, and 44 ml/ kg h of lactated Ringer's solution, respectively, and PEEP was added at 5-cm H2O increments per half-hour, starting one hour after beginningP. aeruginosa infusion. EVLW in PEEP animals was less than or equal to that in controls despite variation in the administration of lactated Ringer's solution. This suggests that PEEP may slow EVLW accumulation over time and provide a protective effect that allows increased amounts of crystalloid fluids to be administered.

ISSN:0090-3493    

出版商:OVID    

年代:1988

数据来源: OVID