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Biomedical subjects

C G Durbin

Publications and source records attributed to C G Durbin.

8 recordsLinked to original sources
PubMed1992

Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.

OBJECTIVE: To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN: Blinded, concurrent data collection, retrospective chart review. SETTING: Surgical ICU. PATIENTS: All patients (n = 308) for whom a surgical ICU bed was requested were studied during a 3-month period. MEASUREMENTS AND MAIN RESULTS: Admitting patterns did not change and no attempts were made to limit admissions to more severely ill patients during times of the greatest shortage of surgical ICU beds. Contrary to findings in previous reports, the severity of illness of patients admitted to the surgical ICU decreased as bed availability and bed census decreased. Bed allocation across surgical services was influenced by factors other than medical suitability. Of major users, cardiothoracic surgery experienced the highest percentage (59%) of all patient admissions and lowest percentage (1.6%) of all denied admissions. General surgery experienced the lowest percentage (15%) of all admissions and highest percentage (10.4%) of all denied admissions, although these patients had the highest average Acute Physiology and Chronic Health Evaluation (APACHE II) scores for all patients admitted (17.7) and for patients denied admission (15.8). CONCLUSIONS: Surgical attending physicians rarely used other open inhouse ICU beds when surgical ICU beds were unavailable. Political power, medical provincialism, and income maximization overrode medical suitability in the provision of critical care services.

Adult↗
PubMed1990

The range of pulmonary artery catheter balloon inflation pressures.

Pulmonary artery catheters are frequently used and may be the cause of pulmonary artery rupture. The "feel" of balloon inflation, a clinical sign of a "wedged" catheter, was noted to vary among different manufacturers' catheters. The inflation pressures of five catheters from four manufacturers were examined in the laboratory. Peak pressures ranged from 475 +/- 10 mm Hg to 1,037 +/- 36.8 mm Hg. Plateau pressures ranged from 220 +/- 4 mm Hg to 495 +/- 2.9 mm Hg. Catheters with high inflation pressures may make detection of a wedged catheter by feel impossible and, thus, may increase the risk of a pulmonary artery rupture.

Analysis of Variance↗
PubMed1989

Pulmonary artery catheter deterioration during hydrochloric acid infusion for the treatment of metabolic alkalosis.

Hydrochloric acid (HCl) infusions for the correction of metabolic alkalosis have been used for 20 yr. In the critical care setting, HCl is usually infused through a central venous or pulmonary artery (PA) catheter. In two patients receiving HCl infusions through a PA catheter, we observed and examined solid yellow particulate material in the aspirating syringe while testing the proximal lumen for patiency. We carried out in vitro investigation infusing PA catheters with 0.1, 0.2, 0.3, and 0.4 normal HCl at 20 degrees, 38 degrees, and 42 degrees C for 24 and 48 h. Although frank catheter deterioration could not be documented, the surface and interior of those catheters infused with greater than 0.1 normal HCl changed texture, indicating a change in catheter composition. Exceeding a concentration of 0.1 normal is not recommended when HCl is infused through PA catheters.

Alkalosis↗
PubMed1986

Effects of dantrolene and verapamil on atrioventricular conduction and cardiovascular performance in dogs.

The effects of intravenous dantrolene sodium, alone and in combination with verapamil, upon atrioventricular conduction, cardiovascular function, and neuromuscular function were studied in chloralose-urethane anesthetized dogs. Hemodynamic variables (systemic arterial, central venous, and pulmonary arterial pressures and cardiac output) and His-bundle electrograms were monitored, and measurements were made during atrial pacing at 175 beats/min, as well as at the spontaneous heart rate. In one part of the study animals received dantrolene sodium incrementally at 30-min intervals to cumulative doses of 1, 2.5, 5, and 10 mg/kg. Subsequently, verapamil was administered incrementally at 30-min intervals to cumulative doses of 0.1, 0.2, 0.4, and 0.6 mg/kg. In the second part of the study, dogs received identical dosage sequences, but verapamil preceded dantrolene administration. Dantrolene caused no significant depression of atrioventricular conduction or cardiac performance but did increase systemic vascular resistance at doses above 2.5 mg/kg. Verapamil alone (greater than or equal to 0.2 mg/kg) or with dantrolene (greater than or equal to 0.1 mg/kg) increased the atrial-His-bundle conduction interval. In the presence of verapamil, dantrolene (greater than or equal to 2.5 mg/kg) decreased cardiac index and increased pulmonary artery occlusion pressure. Although 0.6 mg/kg verapamil depressed cardiac index and increased pulmonary artery occlusion pressure, this effect was observed at 0.4 mg/kg after prior treatment with dantrolene. Verapamil did not augment the dose-dependent twitch depression observed with dantrolene. Dantrolene alone had no apparent effect on atrioventricular conduction and caused little enhancement of the effects of verapamil. However, each drug appeared to enhance the myocardial depressant effects of the other.

Animals↗
PubMed1979

A laboratory animal model for malignant hyperpyrexia.

Strandard laboratory rabbits which are not genetically susceptible to malignant hyperpyrexia were anesthetized with either halothane or pentobarbital. Administration of caffeine in 125 mg increments produced a syndrome strongly resembling malignant hyperpyrexia in rabbits anesthetized with halothane. All these animals became rigid, hyperpyrexic, acidotic and hyperkalemic, whereas caffeine-treated, pentobarbital-anesthetized animals developed only mild acidosis. Pentobarbital alone and halothane alone caused no changes in measured variables. This model for malignant hyperpyrexia resembles the naturally occurring disease more closely than several preceding pharmacologic models.

Anesthesia↗