摘要:

Real-time cranial ultrasonography (cranial sector [CS] scan) was prospectively evaluated for its usefulness in identifying irreversible cerebral injury in critically ill children admitted to the neonatal and pediatric ICUs at our institution. Absence of pulsatile movement of the anterior and middle cerebral arteries was determined to represent absent cerebral perfusion and thus profound irreversible injury. Of 800 consecutive patients representing 1900 CS scans, 12 met the criteria. Six were neonates and 6 were older infants. Mechanisms of injury included severe hypoxia, head trauma, and CNS infection. Absence of brain function by clinical examination and EEG confirmed CS findings in 11 who expired. One neonate survived with intact brainstem function but no identifiable cerebral function or growth. No false positives were demonstrated. We found the CS scan to be a reliable bedside adjunct in the determination of irreversible cerebral injury or cerebral death.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

During administration of ketanserin, a selective 5-HT2-receptor blocker, intracranial pressure (ICP) was measured in dogs without (group 1) and with (group 2) intracranial hypertension (ICP > 20 mm Hg). A bolus of 1 mg/kg body weight and subsequent infusion of 13.25 ± 1.2 mg/kg of ketanserin decreased mean arterial pressure 35% ± 18% in group 1 and 35% ± 19% in group 2. In both groups, there was no change in ICP or in ventricular volume-pressure response curves (intracranial compliance [ICC]) after the administration of ketanserin. Ketanserin may be a safe antihypertensive drug for avoiding and treating hypertension in neurosurgical patients.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

This study compared percutaneous transtracheal jet ventilation (PTJV) at a frequency (f) of 20/min, with high-frequency positive-pressure ventilation (HFPPV) at f of 60/min, and endotracheal intubation and intermittent positive-pressure ventilation (ET IPPV) at f of 10/min in apneic dogs. Fifty-four emergency medicine trainees (EMTs) attempted PTJV via a 14-gauge Angiocath attached to a hand-held jet ventilator, f of 20/min, and ET IPPV using an Ambu bag, f of 10/min. Twenty-nine other EMTs attempted cricothyrotomy using a prototype nonkinkable catheter (Arrow) and a new jet ventilator, Bronchovent, f of 60/min, equipped with a pressure sensor which stops ventilation at pressures greater than 20 cm H2O. Adequate oxygenation was achieved by all 3 groups, but only the HFPPV group avoided respiratory alkalosis. There was a higher equipment failure rate (catheter kinking and dislodgment) in the PTJV group. In the HFPPV group, the Bronchovent's pressure-limiting sensor stopped ventilation when the catheter was kinked or out of position, reducing the extent of subcutaneous emphysema and barotrauma. With further catheter improvements, HFPPV Bronchovent may offer a safe and reliable method of ventilating patients during CPR in the field.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Circulating levels of lactoferrin, a specific granule protein of neutrophilic leukocytes, and eosinophil cationic protein (ECP), a specific granule protein of eosinophilic leukocytes, were serially measured in 19 patients at risk for adult respiratory distress syndrome (ARDS). Those patients who developed ARDS had significantly higher concentrations of both proteins than the patients without signs of ARDS. High ECP levels were observed in spite of peripheral eosinopenia. The lactoferrin levels were also increased in relation to circulating numbers of neutrophils. These findings are consistent with an enhanced turnover and/or activity of eosinophils and neutrophils in ARDS and thereby support other clinical and experimental observations suggesting a central pathophysiologic role for granulocytes in ARDS. No relation was found between ARDS or serum concentrations of lactoferrin or ECP and degree of complement consumption, suggesting that other mechanisms besides complement activation may underlie granulocyte activation in ARDS.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

A prospective study is reported to examine the incidence of aspiration in 50 infants and children intubated with a noncuffed endotracheal tube in a multidisciplinary PICU. Aspiration was assessed by applying Evans blue dye on the tongue and searching for the dye during suctioning, in the endotracheal aspirate. Twenty-nine (58%) were medical patients and 21 (42%) surgical; ages ranged between 25 h and 4 yr (mean 18.5 months). Respiratory failure was the major indication for endotracheal intubation and mechanical ventilation in 26 (52%) of the patients, hyperventilation for increased intracranial pressure in 12 (24%), congestive heart failure in 8 (16%), and protection of airway in deeply comatose patients in 4 (8%). The patients remained intubated from 18 h to 12 days (mean 70.4 h). Evidence of aspiration was found in 8 (16%) of the patients, accompanied by changes in chest x-ray in 5 (63%) patients and a significant fall in Po2in 3 (37%). Aspiration was not significantly affected by the presence of a nasogastric tube, level of consciousness or ventilator setting. We conclude that noncuffed endotracheal tubes of proper size that adequately seal the trachea and effectively prevent clinically significant aspiration in endotracheally intubated infants and children.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

We studied hemodynamic and renal effects of increasing the dosage of dopamine (DP) by 5 μg/kg·min, in 7 patients with peritonitis and clinical findings of septic shock, all of whom were already receiving variable dosages of DP. Stroke index (SI) (p<. 01), except in 3 cases, and mean arterial pressure (p< .01) were significantly elevated without significant increases in HR and systemic vascular resistance index (SVRI). Changes in mean pulmonary artery pressure (MPAP) and pulmonary wedge pressure (WP) were insignificant (<3 mm Hg). Renal response showed augmentation of diuresis (p< .01), inulin clearance (Cin) (p< .05), and fractional excretion of sodium (FENa) (p= .02) without significant changes in either paraminohypurate clearance (Cpha) or filtration fraction. There was no correlation between hemodynamic or renal changes and initial dosage of DP. We conclude that increasing the DP dosage in septic shock patients may be useful even when the patient is already receiving large doses. Increased natriuresis was not due to changes in plasma renal flow.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

The development of acute respiratory failure (ARF) in patients with hematologic disorders (HDs) is a life-threatening condition which does not respond well to intensive therapy. We present our experience in the use of intensive therapy for a group of 30 patients suffering from leukemia (21 cases), bone-marrow aplasia (6 cases), or lymphoma (3 cases). Seven had undergone bone-marrow transplantation. All 30 patients were hypoxemic and responded poorly to the administration of high oxygen concentrations via face mask. All were admitted to our intensive respiratory unit (IRU), where 26 received oxygen via mechanical ventilation, and 4 received continuous positive airway pressure (CPAP). Definitive diagnosis was established in 19 (63%) patients. A premortem diagnosis obtained in 8 (26%) cases did not change therapy. The diagnostic accuracy of serology and transbronchial biopsy was low. Of the 6 (20%) patients who recovered from ARF, only 2 were discharged from the hospital. The remaining 24 (80%) patients died in the IRU.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Intravenous metoprolol, 0.2 mg/kg, was given to 11 patients with stable, partially reversible chronic obstructive pulmonary disease (COPD) and frequent ventricular ectopic depolarizations (VEDs). The frequency of VEDs during 8 h of continuous ECG recording was reduced from a mean of 214/h to 86/h (p< .001). Four/11 patients had a greater than 90% reduction in VEDs. There were no adverse clinical effects during the period of drug administration. However, metoprolol produced small declines of 14% in the forced expiratory volume in 1 sec (FEB1) and 21% in the forced expiratory flow rate between 25% and 75% of the forced vital capacity (FVC) (FEF25–75). These data suggest that iv metoprolol is effective in reducing the frequency of VEDs in patients with COPD, although the extent of reduction in VEDs shows considerable interindividual variation. Metoprolol can be administered iv without inducing clinical bronchospasm in most patients.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

We studied the effects of an isoproterenol infusion on cardiac output and the distribution of blood flow in 5 preterm newborn lambs. Cardiac output and regional organ blood flow were measured by injecting radionuclide-labeled microspheres into the superior vena cava and left ventricle.We found that an average infusion of 0.5 μg/kg·min of isoproterenol increased cardiac output 73% which correlated closely with an increase in stroke volume, but not with HR. The increase in systemic blood flow was distributed exclusively to the myocardium and skeletal muscle, bone, and skin.We conclude that isoproterenol increases cardiac output in preterm newborn lambs similarly to adults and that the stroke volume of the immature heart is more changeable than previously thought.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID

摘要:

Hemodynamic, arterial O2tension (Pao2) and transcutaneous O2tension (PtcO2) changes associated with the infusion of 500 ml of Fluosol-DA were evaluated in 14 decerebrated patients. Flow-directed pulmonary artery catheters and the Clark-type oxygen electrode manufactured by Hoffmann-La Roche were utilized. The marked improvement of cardiovascular variables along with marked increases in Pao2and PtcO2may indicate a marked increase in skin circulation by the infusion of Fluosol. One patient exhibited a hypotensive episode during the infusion, which lasted only a short time, disappeared spontaneously, and did not prohibit the further infusion of Fluosol. We still consider that Fluosol will be clinically useful for increasing oxygen capacity and improving overall hemodynamic status as well as individual organ circulation.

ISSN:0090-3493    

出版商:OVID    

年代:1984

数据来源: OVID