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Biomedical subjects

A B Peitzman

Publications and source records attributed to A B Peitzman.

At least 55 records · Page 3Linked to original sources
PubMed1994

Efficacy of inhaled nitric oxide in a porcine model of adult respiratory distress syndrome.

OBJECTIVE: To assess the efficacy of inhaled nitric oxide (NO) in reducing pulmonary hypertension in a porcine model of adult respiratory distress syndrome. DESIGN: Nonrandomized, controlled experiment without blinding. SETTING: Surgical research laboratory. PARTICIPANTS: Twelve pigs, matched equally for body weight. INTERVENTION: Acute lung injury was induced by intravenous injection of oleic acid. Animals were then divided into either a control group, for monitoring without any further intervention, or a NO-treatment group, in which NO was administered at concentrations of 10 to 80 ppm, with each step separated by a NO-free interval to assess duration of effect. MAIN OUTCOME MEASURES: Pulmonary artery pressure, systemic blood pressure, PaO2, intrapulmonary shunt fraction, and extravascular lung water. Nitrosylated hemoglobin, arterial methemoglobin, and plasma nitrite and nitrate concentrations. RESULTS: All animals responded to oleic acid injection with rapid development of pulmonary hypertension and deterioration of PaO2 and intrapulmonary shunt fraction. Inhaled NO reversed these changes in a concentration-dependent manner. Cessation of NO administration led to a prompt return of pulmonary hypertension. A small but significant drop in systemic blood pressure was observed only at the highest concentration of NO administered (80 ppm). Extravascular lung water almost doubled following oleic acid injury. This increase was sustained in all animals for the remainder of the experiment. Significant increases in circulating methemoglobin and plasma nitrite and nitrate concentrations were measured during NO inhalation. CONCLUSION: Inhaled NO appears to be a selective pulmonary vasodilator and may prove to be useful in improving gas exchange in adult respiratory distress syndrome.

Administration, Inhalation↗
PubMed1994

The acute management of hemodynamically unstable multiple trauma patients with pelvic ring fractures.

The management of hemodynamically unstable patients with displaced pelvic ring fractures and associated abdominal, thoracic, or head injuries is controversial. We studied 312 consecutive trauma patients with pelvic fractures admitted from July 1, 1989 through June 30, 1993: thirty-six of these patients were in shock (SBP < or = 90 mm Hg) and were treated by a protocol including volume resuscitation, and treatment of the associated injuries, without use of acute external fixation. Evaluation of the pelvic fractures revealed 39% to be rotationally unstable; 61% were both rotationally and vertically unstable. The mean injury Severity Score was 27 +/- 12, the average Glasgow Coma Scale score was 12 +/- 5, and the Abbreviated Injury Scale (AIS) scores stratified for the abdomen and the thorax were 1.9 +/- 1.7 and 1.6 +/- 1.8, respectively. Eighteen patients required thoracotomy, laparotomy, or both. The total blood requirement in the initial 24 hours postinjury was 4.0 +/- 4 Units. Deaths of four patients (11%) were a function of associated injuries and comorbid factors, not the result of uncontrolled pelvic hemorrhage. The data suggest that aggressive resuscitation of these patients and treatment of extrapelvic injuries in conjunction with early or delayed ORIF, without application of acute external fixation, resulted in a low overall mortality rate.

Adult↗
PubMed1994

Hemodynamic effects and metabolic fate of inhaled nitric oxide in hypoxic piglets.

We describe the hemodynamic effects and metabolic fate of inhaled NO gas in 12 anesthetized piglets. Pulmonary and systemic hemodynamic responses to incremental [NO] (5-80 ppm) were tested during ventilation with high- [0.30 inspired O2 fraction (FIO2)] and low-O2 (0.10 FIO2) mixtures. In six animals, inhalation of 40 ppm NO was maintained over 6 h to test effects of prolonged exposure (0.30 FIO2). In the other six animals, pulmonary hypertension was induced by hypoxic ventilation (0.10 FIO2) and responses to NO were tested. Inhaled low [NO] partially reversed pulmonary hypertension induced by alveolar hypoxia; mean pulmonary arterial pressure decreased from 31.4 +/- 2.3 mmHg during hypoxia to 18.2 +/- 1.2 mmHg during 5 ppm NO. Mean pulmonary arterial pressure at 0.10 FIO2 did not fall further at higher [NO] (10-40 ppm) and never reached control levels. Pulmonary vascular resistance increased with institution of hypoxic ventilation and fell with subsequent administration of NO, ultimately reaching control levels. Inhaled NO did not affect systemic vascular resistance. Plasma levels of NO2- + NO3- and methemoglobin (MetHb) levels increased with increasing [NO]. Over 6 h of NO administration during high-O2 ventilation, MetHb equilibrated at subtoxic levels while NO2- + NO3- increased. Nitrosylhemoglobin, analyzed by electron paramagnetic resonance spectrophotometry was not detected in blood at any time. At the relatively low concentrations (5-80 ppm) that are effective in relieving experimental pulmonary hypertension induced by alveolar hypoxia, inhaled NO gas causes accumulation of NO2- + NO3- in plasma and a small increase in MetHb but no detectable nitrosylhemoglobin.

Administration, Inhalation↗
PubMed1993

Avulsion of the internal mammary artery caused by blunt trauma.

Injury to the subclavian artery or its branches is uncommon after blunt trauma. We report a case of blunt thoracic trauma resulting in avulsion of the right internal mammary artery from its origin on the subclavian artery. This presented as an atypical mediastinal hematoma in a patient with multiple injuries.

Accidents, Traffic↗
PubMed1993

Nitric oxide production is inhibited in trauma patients.

Elevated levels of nitrates/nitrites, the stable endproducts of nitric oxide (NO), were recently observed in septic patients. In this setting, NO maintains blood flow by vasodilation and inhibition of platelet aggregation. Trauma patients were found to have low plasma levels of nitrates/nitrites, even when they developed sepsis. The current study substantiated that trauma patients have suppressed production of NO; reductions in plasma nitrate/nitrite levels correlated with low urinary excretion of these endproducts. Nitric oxide production was upregulated in trauma patients with clinical infection compared with trauma patients without infection, but was still significantly suppressed compared with nitric oxide production in normal controls. The inability of trauma patients to produce NO may be an important component of the susceptibility of these patients to infection.

Adolescent↗
PubMed1992

Increased circulating nitrogen oxides after human tumor immunotherapy: correlation with toxic hemodynamic changes.

BACKGROUND: Toxicity to interleukin-2 (IL-2) tumor immunotherapy is manifested principally by the vascular leak syndrome, hypotension, and a hyperdynamic response with low systemic vascular resistance. Nitric oxide (.N = O), a recently discovered biological mediator of vascular smooth muscle relaxation, is produced in increased amounts by numerous cell types exposed to a number of inflammatory cytokines. PURPOSE: Our purpose was to determine if there is an increased production of .N = O in patients receiving IL-2 tumor immunotherapy, and, if so, whether increases in .N = O production correlate with hemodynamic instability. METHODS: Twelve patients undergoing immunotherapy trials with IL-2 and anti-CD3 monoclonal antibody-activated lymphocytes (T-AK cells) were studied. Plasma levels of nitrate (NO3-), the stable end metabolic product of .N = O synthesis, were measured before and at the end of IL-2 treatment cycles. RESULTS: We observed a ninefold increase in plasma levels of NO3- in patients after 7 days of treatment (P less than .0001). A significant decrease in both systolic and diastolic blood pressures was observed in all patients (P less than .001). CONCLUSIONS: We propose that mediated induction of .N = O synthase enzyme leads to progressive increases in .N = O production which, in turn, produces clinically significant hypotension. IMPLICATIONS: Since .N = O synthesis can be competitively inhibited by L-arginine analogues, a possible pharmacologic modulation of .N = O production could potentially contribute to better management of toxic side effects seen in IL-2 cancer therapies.

Amino Acid Oxidoreductases↗
PubMed1991

Nitrogen oxide levels in patients after trauma and during sepsis.

The mediators responsible for maintenance of the hyperdynamic state and the low systemic vascular resistance (SVR) observed in sepsis have not been elucidated. Nitric oxide (.N = O) is a mediator with numerous functions, including regulation of vascular tone and a role in macrophage-mediated cytostasis and microbiostasis. Thirty-nine critically ill trauma and septic patients were studied to determine the relationship between .N = O production and the hyperdynamic state. high plasma levels of NO2-/NO3- (the stable end products of .N = O) were observed in septic patients (p less than 0.02). Low SVR and high endotoxin levels were associated with high NO2-/NO3- values (p = 0.029, p = 0.002). Changes in .N = O levels may mediate the vasodilation seen in sepsis. Low NO2-/NO3- levels were observed in trauma patients (p less than 0.001) and remained low even in the presence of sepsis (p = 0.001).

Adult↗
PubMed1991

Bacterial translocation in trauma patients.

Sepsis and multiple system organ failure (MSOF) are major causes of morbidity and mortality in trauma patients. Bacterial translocation induced by hypotension, endotoxemia, or burns is a reproducible phenomenon in the laboratory. The incidence of bacterial translocation to mesenteric lymph nodes (MLNs) in 29 critically ill patients was evaluated to determine its relationship to subsequent sepsis and MSOF. Bacterial translocation was documented in 3 of 4 patients who underwent laparotomy for gastrointestinal (GI) disease. No trauma patient (25 patients), even at second exploration 3-5 days after injury, had a positive MLN culture. Five patients died; 4 trauma patients, one with GI disease. Forty percent of the trauma patients had major complications, predominantly pulmonary infections with gram-negative bacteria. However, infectious complications and outcome were not related to MLN culture results. The classical progression of bacteria from the gut to the bloodstream via the MLNs may require time and gut mucosal injury. The data suggest that bacterial translocation to the MLNs is not a common occurrence in acutely injured trauma patients.

Bacterial Physiological Phenomena↗
PubMed1991

Computed tomography in the evaluation of blunt abdominal trauma.

The role of computed tomography (CT) in the evaluation of victims of blunt abdominal trauma remains controversial. This study was done to assess the reliability of CT in the evaluation of blunt abdominal trauma at our institution, to determine if the incidence of nontherapeutic laparotomy has decreased with the use of CT scan and to review the time necessary to complete the scans. Of the 325 patients studied, 37 per cent were found to have abdominal injury on CT scan. Thirty patients required laparotomy; ten of these were nontherapeutic. Excluding transport time, abdominal CT scan required 55 +/- 20 minutes to complete. Abdominal CT was accurate when read by attending physicians (97.5 per cent). Major shortcomings included the commitment of time and personnel, transfer of the patient from a critical care area and reliance on experienced interpretation.

Abdominal Injuries↗
PubMed1989

Inflammatory aneurysms of the abdominal aorta.

Inflammatory aneurysms of the abdominal aorta (IAAAs) have distinctive clinical and physical characteristics that separate them from typical atherosclerotic aneurysms. They were identified in 19 (7.2%) of 265 patients undergoing abdominal aortic aneurysm repair. Symptoms were present in 12 (63%) of 19, with one patient presenting with rupture, and multiple symptoms were present in six (32%). Intraoperatively, all aneurysms exhibited dense periaortic inflammation. Adjacent structures most frequently involved were the duodenum in 15 (79%) of 19 patients, the left renal vein in six (32%) of 19, and the ureter in five (26%) of 19. Seventeen (94%) of the 18 patients who underwent elective aneurysm resection survived. The involvement of retroperitoneal structures varied in number and severity, demonstrating that a wide spectrum of inflammation is present in IAAAs, making diagnosis and definition difficult.

Aged↗
PubMed1989

Blunt rupture of the myocardium.

With the evolution of regional trauma systems, patients with severe cardiac injury are arriving in emergency departments with the potential for survival. This paper reviews the 61 survivors of nonpenetrating rupture of the free walls of the myocardium reported in the English-language literature. The chambers were involved in the following frequency: right atrium, 36; left atrium, 11; right ventricle, 12; and left ventricle, four. Most victims were young males, and 85% were involved in motor vehicle accidents. Seventy percent had an admission systolic blood pressure less than 80 mm Hg, 78% had distended neck veins or a central venous pressure greater than 20 cm H2O, 67% had a widened mediastinum on admission chest roentgenogram, and 48% had fractures of the bony thorax. More than one hour elapsed before initiation of repair in 59%. Forty-eight percent of the repairs were performed via a median sternotomy. Cardiopulmonary bypass was used in only 10%.

Europe↗
PubMed1989

Rupture of the left ventricle and interventricular septum by blunt trauma.

We report a survivor of blunt trauma with rupture of the left ventricle and the interventricular septum. A review of the literature revealed no previous report of a survivor of this combination of nonpenetrating injuries, and only four previous survivors of left ventricular rupture due to blunt trauma.

Adult↗
PubMed1989

Transection of the inferior vena cava from blunt thoracic trauma: case reports.

Blunt thoracic trauma is a frequent cause of death in multiple trauma victims. Myocardial rupture may occur in up to 65% of patients who die with thoracic injuries. Two cases are presented with intrapericardial transection of the inferior vena cava, pericardial rupture, and myocardial rupture from blunt thoracic trauma. Both patients died.

Adult↗
PubMed1989

Smoke inhalation injury: evaluation of radiographic manifestations and pulmonary dysfunction.

Inhalation injury is a frequent complication in burned patients. Upper airway injury is reliably diagnosed endoscopically, but early diagnosis of pulmonary parenchymal injury is less reliable. Radiographic diagnosis in such cases is inconsistent. This study correlated degree of chest X-ray (CXR) change with pulmonary function in 29 adult patients during the first 5 days after inhalation injury. Daily CXRs were graded: 0 (normal), 1+ (peribronchial cuffing or perivascular edema), 2+ (edema involving one third of the lung field), 3+ (edema involving two thirds of the lung field), and 4+ (edema involving the entire lung field). Extravascular lung water volume (EVLW) was measured in vivo with the thermal/green dye double indicator technique. Twenty-five of the 29 patients were intubated on admission. Of these patients with serious inhalation injury, 84% showed some abnormality on CXR within 48 hours after injury. When abnormalities were present on CXR, pulmonary dysfunction (increases EVLW, increases Qs/Qt, decreases compliance) was clinically important. These data suggest that this grading scale may have utility in reports of CXR findings in inhalation injury.

Adult↗
PubMed1989

Left-sided perinephric hematoma associated with rupture of the left hemidiaphragm: a marker for renal artery injury.

Renal artery injury is an uncommon consequence of blunt abdominal trauma and probably is often missed. We recently saw three patients with rupture of the left hemidiaphragm associated with renal artery injury. The finding of a perinephric hematoma in a multiply injured patient with an ipsilateral diaphragmatic rupture prompted evaluation of the renal artery. With massive injury, the kidney may be displaced superiorly when the diaphragm ruptures, producing injury to the ipsilateral renal artery. This association has not been emphasized in the literature. The finding of a perinephric hematoma on the left should prompt full evaluation of the renal arteries if seen in association with diaphragmatic rupture.

Accidents, Traffic↗
PubMed1989

Hemodynamic consequences of Foley catheter control in experiment penetrating cardiac wounds.

Insertion of the Foley catheter has been recommended to control bleeding from penetrating cardiac wounds. Potential complications from this maneuver include enlargement of the tear in the myocardium or further impediment to cardiac function by the balloon. This study was done to evaluate the hemodynamic consequences of the balloon catheter when it was used to control bleeding in cardiac stab wounds created in pigs. A significant decrease in cardiac function occurred with control of the bleeding by the balloon catheter. This effect was dependent on the size of the balloon and cardiac location.

Animals↗