Critical care medicine
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Critical care medicine · Feb 1990
Left and right ventricular output in newborn infants undergoing extracorporeal membrane oxygenation.
Extracorporeal membrane oxygenation (ECMO) has gained a place as an alternative mode of treatment for newborn infants with life-threatening respiratory failure who do not respond to maximal conventional ventilatory support. To determine any possible changes in cardiac performance during the course of ECMO treatment, we evaluated left and right ventricular output in 10 newborn infants with pulsed Doppler ultrasound before, during, and after ECMO. ⋯ During ECMO, left and right ventricular output decreased proportionally to the amount of bypass flow provided (r = -.82 and -.83, respectively; p less than .001), and were accompanied by a decrease in left ventricular contractility. Pulsed Doppler echocardiography provides a noninvasive method to estimate ventricular outputs during ECMO and to evaluate the response of both ventricles to volume loading during weaning from ECMO.
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Critical care medicine · Feb 1990
Factors affecting accidental extubations in neonatal and pediatric intensive care patients.
All patients intubated in the neonatal (NICU) and pediatric (PICU) ICUs over a 3-yr period were evaluated prospectively to determine the incidence of accidental extubation (AE) and contributing factors. Two thousand two hundred patients (age range 26 wk gestation to 18 yr) were intubated for a total of 21,222 days. In the PICU and NICU, a total of 153 patients experienced 195 AE. ⋯ One death occurred as an indirect consequence of AE. The data are being reported as a function of number of days intubated in an attempt to standardize reporting techniques. The use of standardized reporting and the identification of high-risk factors may be useful for education and modification of patient care practices.
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Critical care medicine · Feb 1990
Comparative StudyEpidural analgesia in thoracic trauma: effects of lumbar morphine and thoracic bupivacaine on pulmonary function.
Changes in pulmonary function tests were compared in 14 thoracic trauma patients, of whom seven received thoracic epidural bupivacaine for analgesia and seven received lumbar epidural morphine. In both groups epidural analgesia decreased subjective pain levels when compared to parenteral narcotics which the patients received before epidural catheter placement. ⋯ Patients in the morphine group had no significant change in pulmonary function. The use of thoracic epidural bupivacaine for analgesia in post-traumatic chest injuries produced superior improvement in pulmonary function when compared to lumbar epidural morphine.
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In the development of triage and bypass protocols, many different scoring systems and triage criteria are being used. Our purpose was to evaluate the Revised Trauma Index (RTI) as a triage tool for both its severity prediction ability and triage accuracy. A total of 2,340 trauma admissions were evaluated using the RTI and the Injury Severity Score (ISS). ⋯ There is 5% death rate at an RTI level of 15, which yields a 5% undertriage rate for death and a 37.3% overtriage rate for predicting an ISS greater than 15. This compares to under and overtriage rates for the Trauma Score, CRAMS, Pre-Hospital Index, and Mechanism of Injury scales varying from 19% to 56% undertriage and 7% to 82% overtriage. We reached the following conclusions. a) The RTI is a simple, fast triage tool for predicting major trauma. b) The RTI is related to the ultimate ISS. c) Use of an RTI greater than or equal to 15 results in an acceptable undertriage rate, with a better rate for overtriage than existing scores. d) Therefore, we recommend the RTI for use in emergency medical direction and bypass protocols.
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Critical care medicine · Feb 1990
Practical use of immunosuppressive drugs in autoimmune rheumatic diseases.
Immunosuppressive drugs are frequently used in the treatment of autoimmune rheumatic diseases when more conventional therapy, including corticosteroids, fail to control the manifestations of disease. The practical use of these drugs in rheumatoid arthritis, systemic lupus erythematosus, and vasculitis (including Wegener's granulomatosis and Sjögren's syndrome) are reviewed. The focus is on the indications for the administration of these agents and proper monitoring of their effect on disease activity.