摘要:

Fifty-seven cancer patients, who had had an 8–15% loss of body weight in the previous 6 months, were studied to establish the reliability in wasted individuals of presently available nomograms correlating serum creatinine with creatinine clearance. Other predictors of renal function, such as osmolar clearance, free water clearance, and excreted fraction of filtered sodium, were also considered. In all patients, and especially in those with a measured creatinine clearance 10–50 ml/min, the use of standard nomograms based on serum creatinine resulted in gross overestimation of renal function. None of the other tests of renal function proved reliable for clinical purposes. It is concluded that in wasted patients administration of nephrotoxic drugs that are renally excreted should be adjusted to measured creatine clearance. Using other common predictors of renal function may result in overdosage.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

We compared assisted mechanical ventilation with controlled mechanical ventilation with and without PEEP in 10 anesthetized swine. Catheters were placed to measure airway, intrapleural, and blood pressures; Pao2and Paco2; arterial pH; total minute ventilation; and mixed exhaled oxygen and carbon dioxide tensions. We calculated the ratio of physiological dead space to tidal volume, alveolar minute ventilation, co2production, Vo2, and RQ. We found no clinically or statistically significant difference between assisted and controlled ventilation.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Hemodynamic, pulmonary, and renal variables were measured in 24 patients scheduled for major abdominal aortic operations. Control values were obtained before preoperative medications were given. All patients received 5% dextrose in Lactated Ringer's solution intraoperatively. Postoperatively, group 1 patients received 5% dextrose in water plus albumin, group 2 received 5% dextrose in 0.45 sodium chloride solution, and group 3 received 5% dextrose in lactated Ringer's solution. There were significant increases in Qs/Qtand AaDO2, 48 hours after operation in group 3. Oxygen consumption and cardiac output increased in all groups 24 hours after operation. Twenty-four hours later, these two variables returned to control values in group 1 but continued to rise in the other two groups. Significant diuresis occurred in group 1, 48 hours postoperatively, whereas the other two groups continued to retain water. Use of albumin and 5% dextrose in water in the postoperative period seemed to produce less deviations from control values of most measured variables, than the other two groups.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

PEEP has been advocated for use in patients with the acute respiratory distress syndrome characterized by a marked reduction in FRC. It has not been advocated for patients with apparently normal lungs requiring prolonged mechanical ventilation. We have done inert gas washouts on five young patients comparing no PEEP to 10 cm H2O PEEP. Four of the five showed a significant improvement in PaO2, a decrease in AaDO2and Qs/Qt, the fifth a slight improvement on PEEP. Arterial washouts were significantly faster on PEEP in all patients suggesting a decrease in intrapulmonary shunting. Airway washouts in the initial phase were faster off PEEP suggesting an increase in lung volume and FRC with PEEP. Later portions of the curve were faster on PEEP suggesting improved distribution of ventilation. These findings suggest that PEEP might be of significant value in treatment of patients requiring prolonged mechanical ventilation for reasons other than lung abnormalities.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

The enormous cost of intensive multiple organ system support is apparent from patient or third party charges of $1500–$2000 per day exclusive of physician fees sampled during a retrospective review of 700 consecutive recent admissions to the Critical Care Facility of Memorial Cancer Center. Mortality rates of 49% for general medical, 54% for lymphoma or leukemia, and 20% for surgery patients suggest the need for a selective admission and discharge policy which concentrates financial and personnel resources on those for whom there remains a reasonable chance of worthwhile palliation, if not cure, of their malignancy.An informal policy of this kind may have contributed to a 10% increase in hospital discharges and a reduction of in-unit mortality from 22–18% when compared to 1035 earlier unselected admissions.A modified version of the classification suggested by the Critical Care Committee of the Massachusetts General Hospital has been adopted for use at this institution. A similar approach by other cancer centers is urged so that predictive indices based on prognosis of the underlying disease as well as physiological status may be developed. Otherwise, cost-benefit analysis by third party payers or government will become an unavoidable, and less satisfactory, alternative.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

Little is known about the effect of blood pH on the electrical activity of the heart. Covino and Hegnauer1reported the effects on the cardiac cycle relative to pH changes in an experimental model. Changes in the PR interval, QTc interval and “J” waves of the electrocardiogram (ECG) have been described in the presence of both acidosis and hypothermia.2,4,6We wish to report a case in which the degree of metabolic acidosis correlated significantly with alterations in the ECG, in the absence of hypothermia and significant serum potassium or calcium abnormalities.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

After central venous catheter placement via the right subclavian route, a hydromediastinum was produced. Aberrant placement of the catheter was undiscovered for 13 1/2 hours despite clinical and radiographic signs. Careful interview of the patient and analysis of postcatheterization chest radiographs are imperative in order to avoid catastrophic consequences of aberrant catheter placement.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A nonpyrogenic polyethylene sheath system with a hemostatic valve assembly and side port extension developed by the Cordis Corporation is now routinely used for central venous access in critically ill patients. It is inserted percutaneously via the subclavian or internal jugular vein and allows rapid and efficient catheterization for hemodynamic monitoring, infusion of multiple solutions simultaneously, and uniflow hemodialysis. This system represents a significant advance in catheter technology.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID

摘要:

A technique is described to perform multiple determinations of cardiac output: two 150 ml bottles of 5% dextrose in water, stored in identical conditions, are immersed in an ice slush, contained in a styrofoam cooler. Comparison of cardiac output determinations obtained with this technique and with multiple syringes indicates very close duplication of results. The technique is very inexpensive and allows one to follow patients for up to four hours with as many as 30 consecutive determinations of cardiac output.

ISSN:0090-3493    

出版商:OVID    

年代:1979

数据来源: OVID