21 research outputs found
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Arterial, central venous pressure, and pulmonary artery catheter monitoring
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RELATIONSHIP OF DURATION OF VENTILATORY SUPPORT WITH LATE MORTALITY IN MEDICAL INTENSIVE CARE PATIENTS
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VALUE OF THE ANION GAP AND SERUM LACTATE LEVELS IN REVERSAL AND OUTCOME OF SEVERE SEPTIC SHOCK
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A COMPARISON OF THE PREDICTIVE EFFICIENCY OF APACHE II AND THE SYSTEM OUTCOME SCORE IN MEDICAL INTENSIVE CARE
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Pulmonary Edema Associated with Electrical Injury
The occurrence of cardiogenic pulmonary edema following alternating current electrical injury has not been reported. A patient developing severe pulmonary edema immediately following an electrical injury-induced episode of ventricular fibrillation is described. Evidence that the etiology of the pulmonary edema was cardiogenic is derived from both hemodynamic data and the calculation of the pulmonary edema fluid to serum colloid osmotic pressure ratio
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Clinical Antecedents to In-Hospital Cardiopulmonary Arrest
While the outcome of in-hospital cardiopulmonary arrest has been studied extensively, the clinical antecedents of arrest are less well defined. We studied a group of consecutive general hospital ward patients developing cardiopulmonary arrest. Prospectively determined definitions of underlying pathophysiology, severity of underlying disease, patient complaints, and clinical observations were used to determine common clinical features. Sixty-four patients arrested 161±26 hours following hospital admission. Pathophysiologic alterations preceding arrest were classified as respiratory in 24 patients (38 percent), metabolic in 7 (11 percent), cardiac in 6 (9 percent), neurologic in 4 (6 percent), multiple in 17 (27 percent), and unclassified in 6 (9 percent). Patients with multiple disturbances had mainly respiratory (39 percent) and metabolic (44 percent) disorders. Fifty-four patients (84 percent) had documented observations of clinical deterioration or new complaints within eight hours of arrest. Seventy percent of all patients had either deterioration of respiratory or mental function observed during this time. Routine laboratory tests obtained before arrest showed no consistent abnormalities, but vital signs showed a mean respiratory rate of 29±1 breaths per minute. The prognoses of patients’ underlying diseases were classified as ultimately fatal in 26 (41 percent), nonfatal in 23 (36 percent), and rapidly fatal in 15 (23 percent). Five patients (8 percent) survived to hospital discharge. Patients developing arrest on the general hospital ward services have predominantly respiratory and metabolic derangements immediately preceding their arrests. Their underlying diseases are generally not rapidly fatal. Arrest is frequently preceded by a clinical deterioration involving either respiratory or mental function. These features and the high mortality associated with arrest suggest that efforts to predict and prevent arrest might prove beneficial
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PATHOPHYSIOLOGIC ABNORMALITIES PRECEDING IN-HOSPITAL CARDIOPULMONARY ARREST
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MULTICENTER TRIAL OF ANTIENDOTOXIN ANTIBODY E5 IN THE TREATMENT OF GRAM-NEGATIVE SEPSIS (GNS)
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Relationship of Baseline Glucose Homeostasis to Hyperglycemia During Medical Critical Illness
To elucidate the relationship of baseline glucose control and acute stimuli with hyperglycemia during medical critical illness.
Prospective cohort study.
Medical ICU (MICU) of a university affiliated hospital.
Convenience sample of 100 medical patients meeting criteria for severity of illness and anticipated length of stay and not admitted to the hospital for diabetic ketoacidosis or a hyperglycemic hyperosmolar state.
None.
Patients were categorized as having normal, abnormal, or unevaluable baseline glucose control based on history and glycosylated hemoglobin (HbA1c). Data collection included blood glucose measurements within 120 h of MICU admission, and dosing of norepinephrine, corticosteroids, propofol, and carbohydrates. Average blood glucose and times over glycemic thresholds were calculated using linear interpolation. Hyperglycemia (glucose > 110 mg/dL) was pervasive in all groups. Among the 51 patients with normal baseline glucose control, HbA1c was correlated with hyperglycemic time (p 110 mg/dL. Among normal subjects, HbA1c was independently predictive of peak and average glucose, and the fraction of time glucose was > 150 mg/dL and > 200 mg/dL (p < 0.05 for each). Patients with abnormal baseline glucose control had significantly more hyperglycemia than patients with normal baseline control.
Even in patients without evidence of abnormal glucose homeostasis at baseline, hyperglycemia is common during critical illness. Time exposure to hyperglycemia is correlated with acute stressors and baseline glucose regulation, as characterized by HbA1c. Patients with low HbA1c levels are less disposed to hyperglycemia during severe illness than patients with higher, but still normal, HbA1c