PubMed Health⌕ Search

Biomedical subjects

B Shin

Publications and source records attributed to B Shin.

At least 37 records · Page 2Linked to original sources
PubMed1982

Evaluating outcome from intensive care: a preliminary multihospital comparison.

To contrast mortality for groups of ICU patients treated in different hospitals, we surveyed 795 consecutive ICU admissions in 5 ICUs using a general severity of illness classification system. After obtaining information from the medical record on age, sex, indication for ICU admission, and severity of illness, we used a logistic multiple regression equation to project death rates for each ICU based on data from a sixth reference hospital. There were substantial differences in severity of acute illness among the hospitals which accounted for most of the variation in death rates. In all ICUs, however, projected death rates were quite similar to observed deaths. These findings suggest that the use of a general severity of illness index and multivariate statistical techniques could, after further refinement and validation, improve interhospital comparisons of the outcome of acutely ill patients.

Critical Care↗
PubMed1980

Changes in total lung/thorax compliance following chest physiotherapy.

To quantitate and obtain objective assessment of the effect of secretion clearance following chest physiotherapy (CPT), total lung/thorax complicance (CT) was calculated immediately before and for 2 hours after one treatment with CPT. Forty-two patients who were mechanically ventilated because of respiratory failure were studied. Therapy averaged 57 minutes and included postural drainage, percussion, vibration, and endotracheal suctioning. The increase in CT following CPT was statistically significant (p less than 0.01) and remained so for at least 2 hours after CPT. There was no difference in the degree to which CT changed in patients with different indications for CPT or in patients ventilated with positive end-expiratory pressure. Largest mean values for CT were obtained 2 hours following CPT, the duration of our measurement of CT. Chest x-ray identification of affected areas of lung before CPT is necessary to allow the physiotherapist to produce the CT changes noted in this study. CT, which can be readily calculated from many recently designed ventilators, may be monitored during CPT to evaluate the efficacy of treatment and to quantitate the effect of secretion clearance following CPT. Duration of CPT should be determined by CT and auscultation.

Adolescent↗
PubMed1979

Management of lung contusion.

One hundred and thirty-two consecutive patients with lung contusion were admitted during the three-year period of 1972 through 1974. All were treated with early intubation and mechanical ventilation with positive and-expiratory pressure with the postulate that such management would minimize the progression of interstitial edema, and intra-alveolar hemorrhage. If progressive increase in the alveolar/arterial oxygen tension gradient was not observed over the ensuing 24 hours, and in the absence of other non-thoracic indications of continuance of mechanical ventilation, patients were extubated and removed from the ventilator. All other patients were further ventilated and followed by daily chest roentgenograms and blood gas studies. Mean ventilation time was 6.2 days. Progressive hypoxemia and deterioration of pulmonary function were not seen. The incidence of pneumonia and tension pneumothorax was low. Overall mortality was 10.6 per cent. The most common cause of death was brain death. No deaths were the result of hypoxemia.

Adult↗
PubMed1979

Two-year mortality in 760 patients transported by helicopter direct from the road accident scene.

Of 760 direct admissions to a specialized trauma center, 173 (22.7%) victims of motor vehicle accidents died. Excluding patients dead on arrival, the mortality rate was 14.5%. Autopsy reports were reviewed and showed that the major cause of death was head injury (49.7%). Uncontrollable hemorrhage from massive trauma was the next most common problem and usually proved fatal in the first 24 hours after admission. The incidence of sepsis and renal failure increased with prolongation of CCRU stay. Following admission, respiratory failure was not a common cause of death (3%). Because of direct helicopter rather than ambulance transport from the scene of the motor vehicle accident, earlier attention was paid to diagnosis of trauma and treatment of respiratory insufficiency with mechanical ventilation. Because of the early initiation of therapy, there was rapid restoration of circulating volume and tissue perfusion. This may account for the low mortality.

Accidents, Traffic↗
PubMed1979

Changing patterns of posttraumatic acute renal failure.

ARF will continue to occur as more severely traumatized patients survive with better resuscitation. The incidence of ARF, however, appears to be steadily decreasing and ARF occurs only in patients with severe injury and multiple organ failure. ARF developing for the past three years in MIEMS was a nonoliguric variety in the majority of patients. Management of ORF with dialysis has been disappointing. Prevention of oliguria in ARF appears possible and may be one of the most important steps to decrease the morbidity and fatality rate. Further investigation is required to find the cause and optimum management of NORF.

Acute Kidney Injury↗
PubMedDate not supplied

Pitfalls of Swan-Ganz catheterization.

In 60 patients in whom Swan-Ganz catheters apparently had been positioned correctly, the balloon was visualized by inflation with radiopaque contrast medium. Sixteen were located peripherrally; in 15 of these 16, the balloon inflated eccentrically and in each of these instances, an accurate wedge pressure could not be obtained. One patient in this group had an episode of hemoptysis immediately prior to detection of the peripheral location and eccentric inflation of the balloon. The correct placement and safe use of the Swan-Ganz catheter demand that the catheter tip be located in a large pulmonary artery and that redundant loops of catheter be avoided to prevent subsequent peripheral migration. Identification of peripheral placement and eccentric inflation should be suspected if a pulmonary wedge pressure is obtained with a significantly smaller volume of air than the balloon capacity. The use of a continuous flush system will provide an additional alert by a steady rise in the pseudowedge pressure on attempted balloon inflation.

Blood Pressure Determination↗
PubMedDate not supplied

Hyperglycemic hyperosmolar nonketotic coma following diazoxide, anesthesia and operation.

Unsuspected hyperglycemia caused prolonged postanesthetic coma in a nondiabetic patient treated with IV diazoxide and furosemide. The combined effect of these drugs with general anesthesia and surgical stress was postulated as the cause of the hyperglycemia. Blood glucose should be measured during and after general anesthesia in patients who are potential candidates for hyperglycemic hyperosmolar nonketotic coma.

Aged↗
PubMedDate not supplied

Selection of the source of mixed venous blood samples in severely traumatized patients.

The technic of balloon flotation catheterization represents a significant advance in providing an additional aid to diagnosis, clinical assessment, and management of the critically ill. The fact that such patients are admitted to an intensive care unit (ICU) invariably presumes that their management will include close and accurate monitoring of the cardiovascular and respiratory systems. In a prospective study of 51 patients, not in clinical shock, in an ICU, the authors demonstrated that superior vena cava samples are not a reliable index of mixed venous blood saturation in the critically injured patient, and that a pulmonary arterial catheter is essential for obtaining true mixed venous samples for valid estimations of intrapulmonary shunts and arteriovenous O2 content differences.

Blood Gas Analysis↗