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Biomedical subjects

C W Broner

Publications and source records attributed to C W Broner.

11 recordsLinked to original sources
PubMed2001

Computerized clinical documentation system in the pediatric intensive care unit.

BACKGROUND: To determine whether a computerized clinical documentation system (CDS): 1) decreased time spent charting and increased time spent in patient care; 2) decreased medication errors; 3) improved clinical decision making; 4) improved quality of documentation; and/or 5) improved shift to shift nursing continuity. METHODS: Before and after implementation of CDS, a time study involving nursing care, medication delivery, and normalization of serum calcium and potassium values was performed. In addition, an evaluation of completeness of documentation and a clinician survey of shift to shift reporting were also completed. This was a modified one group, pretest-posttest design. RESULTS: With the CDS there was: improved legibility and completeness of documentation, data with better accessibility and accuracy, no change in time spent in direct patient care or charting by nursing staff. Incidental observations from the study included improved management functions of our nurse manager; improved JCAHO documentation compliance; timely access to clinical data (labs, vitals, etc); a decrease in time and resource use for audits; improved reimbursement because of the ability to reconstruct lost charts; limited human data entry by automatic data logging; eliminated costs of printing forms. CDS cost was reasonable. CONCLUSIONS: When compared to a paper chart, the CDS provided a more legible, compete, and accessible patient record without affecting time spent in direct patient care. The availability of the CDS improved shift to shift reporting. Other observations showed that the CDS improved management capabilities; helped physicians deliver care; improved reimbursement; limited data entry errors; and reduced costs.

Child↗
PubMed1995

Cyclic nucleotides and vasoactive intestinal peptide production in a rabbit model of Escherichia coli septicemia.

Nitric oxide and vasoactive intestinal peptide (VIP) are potent vasodilators and postulated as inducers of hypotension. These mediators activate guanylate cyclase and adenylate cyclase, respectively, with subsequent biosynthesis of cyclic guanosine monophosphate (cGMP) and cyclic adenosine monophosphate (cAMP) producing vascular smooth muscle relaxation and vasodilatation. Cyclic nucleotides and VIP were evaluated during Escherichia coli septicemia in two groups of rabbits; 1) sepsis alone and 2) sepsis and a competitive inhibitor of nitric oxide synthase, NG-monomethyl-L-arginine. Arterial blood was obtained for determination of bacteremia, lactic acidemia, nucleotides, nitrites, and VIP levels. Significant bacteremia, endotoxemia, tachycardia, lactic acidosis, and hypotension occurred in all animals (P < 0.005). Circulating blood levels of cGMP, nitrites, cAMP, and VIP (P < 0.005) increased with development of shock. The NG-monomethyl-L-arginine treated animals had less cGMP, nitrites, cAMP, and VIP produced (P < 0.01). Plasma cGMP levels remained stable, suggesting that stimulated phagocytes in whole blood were responsible for increased cGMP levels. Infusion of VIP produced profound hypotension and lactic acidemia. Results of these experiments provide definitive evidence that nitric oxide and VIP are mediators during septic shock and their messengers are cGMP and cAMP, respectively. In addition, phagocytic stimulation with increased production of cGMP may initiate shock, with these mediators acting synergistically to prolong hypotension.

Amino Acid Oxidoreductases↗
PubMed1994

Modulation of cyclic guanosine monophosphate production during Escherichia coli septic shock.

Endotoxin and other bacterial products induce the release of mediators which alter the circulation and cellular metabolism. Recent evidence suggests nitric oxide (NO) is one such mediator. The proposed mechanism by which NO produces hypotension is the activation of guanylate cyclase with subsequent biosynthesis of 3':5' cyclic guanosine monophosphate (cGMP). We studied the production of cGMP during Escherichia coli-induced septic shock in two experiments; the first with sepsis alone and the second using NG-monomethyl-L-arginine (L-NMMA), a competitive inhibitor of nitric oxide synthase. Animals in both experiments experienced significant bacteremia (P < 0.05), endotoxemia (P < 0.05), and lactic acidosis (P < 0.03). Mean arterial blood pressure decreased (P < 0.03) and heart rate increased (P < 0.05) within both groups but did not differ between groups. A significant increase in the production of circulating whole blood cGMP occurred at 3-5 h (P < 0.03). There was significantly less cGMP produced by the L-NMMA-treated animals (P < 0.01). These results demonstrate an elevation in cGMP during septic shock which is attenuated by the addition of L-NMMA. This suggests that NO may be present during gram-negative septic shock and its effects mediated through cGMP.

Animals↗
PubMed1993

Reversal of dopamine-refractory septic shock by diethyldithiocarbamate, an inhibitor of endothelium-derived relaxing factor.

Septic shock occurs when endotoxin and other bacterial substances induce the release of host products that act in concert to alter the circulation. Recently, investigators have speculated that endothelium-derived relaxing factor (EDRF), a potent endotoxin-inducible vasodilator, plays an important role in the pathogenesis of septic shock. Diethyldithiocarbamate (DTC), a copper chelator lacking intrinsic vasoactivity, inactivates EDRF. Intravenous DTC was compared with placebo and dopamine in 12 matched sets of 3 rabbits with induced Escherichia coli sepsis. Median levels of bacteremia and endotoxemia were similar in the 3 treatment groups. DTC-treated animals had higher mean arterial pressure and lower heart rates and blood lactate concentrations than either placebo- or dopamine-treated animals (P = .013, P < .001, and P = .001, respectively). These effects were independent of plasma catecholamine concentrations. DTC can reverse septic shock that is refractory to conventional therapy, and these results suggest that EDRF is an important mediator of septic shock.

Animals↗
PubMed1993

High-frequency ventilation for acute pediatric respiratory failure.

OBJECTIVE: To study the effectiveness of high-frequency ventilation (HFV) for the treatment of pediatric patients with acute severe respiratory failure. DESIGN: Post hoc analysis of retrospectively and prospectively acquired data. SETTING: Tertiary pediatric ICU. SUBJECTS: Twelve patients, ages 4 months to 15 years, who developed acute severe respiratory failure from diverse causes. INTERVENTIONS: Patients were treated with synchronized intermittent mandatory ventilation (SIMV) using moderate positive end-expiratory pressure (PEEP) and supplemental oxygen prior to HFV therapy. Ten of 12 patients required one or more medications to modulate preload, inotropy, and/or afterload. All patients were invasively monitored for arterial BP and arterial blood gases, and they were noninvasively monitored for oxygen saturation, end tidal or transcutaneous carbon dioxide, and electrocardiography. MEASUREMENTS AND MAIN RESULTS: Severity of respiratory failure was reflected by median values of pH of 7.34, lung compliance of 0.41 ml/cm H2O/kg, P(A-a)O2 of 553 mm Hg, oxygenation index (OI) of 28, and ventilation index of 102. Significant improvement in pH, PaCO2, PaO2, OI, and P(A-a)O2 was demonstrated early in the course of HFV (p < 0.05). Seven of the patients (58 percent) were survivors. CONCLUSIONS: These data suggest that HFV may offer significant benefit as a rescue modality for patients with severe respiratory failure refractory to SIMV strategies early in the course of the disease process.

Acute Disease↗
PubMed1993

Intravascular calcium deposits in a critically ill patient. Light- and electron-microscopic findings.

We describe a case of a 2-year-old girl with an unusual finding of amorphous hematoxyphilic substance in the pulmonary and myocardial vascular lumina. The patient had a prolonged history of intestinal obstruction necessitating extended periods of total parenteral nutrition. The patient terminally had hypercalcemia with levels reaching 4.63 mmol/L. The intravascular substance stains strongly positive for calcium, and weakly positive for fibrin. Electron microscopy shows that the substance has a distinctive configuration suggestive of calcium hydroxyapatite crystals.

Blood Vessels↗
PubMed1990

Hypermagnesemia and hypocalcemia as predictors of high mortality in critically ill pediatric patients.

Ca and Mg are biologically important minerals that are involved in maintaining the stability of membranes, muscle contractions, and enzyme activity in nearly all cells. Derangements of Ca and Mg homeostasis can precipitate serious and life-threatening problems in the critically ill patients. We examined serum ionized Ca and Mg levels in pediatric patients consecutively admitted to a pediatric ICU. Abnormal Mg and ionized Ca levels on admission were found in 43.3% and 17% of the patients, respectively. Hypocalcemia and hyper-magnesemia were both associated with poor outcome as measured by either survival or length of ICU stay. In addition, ionized Ca levels could not be predicted from total Ca measurement either alone or in combination with serum albumin and pH.

Adolescent↗
PubMed1990

Febrile infants less than eight weeks old. Predictors of infection.

Febrile infants less than eight weeks old frequently are admitted and receive parenteral antibiotics for treatment of possible sepsis. The authors assess 52 infants less than eight weeks old with a rectal temperature of 38.1 degrees C or higher as having either a readily identifiable focus of infection by physical examination, appearing "toxic" without a focus, or appearing well. The authors screened patients by using white blood cell (WBC) counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and chest radiographs in addition to blood, cerebrospinal fluid and urine cultures. The authors found a 9.6% incidence of bacteria in the 52 infants evaluated, with a 4.3% incidence in those febrile infants who appeared well. Five patients had positive blood cultures with Group B B Hemolytic streptococcus (four patients), and Viridans streptococcus (one patient). A clinical assessment of toxicity and a total band count greater than or equal to 0.5 x 10(3) cells/uL together were sensitive indicators of bacteremia, as were toxicity and a positive CRP. A "toxic" appearance, a WBC count greater than or equal to 15 x 10(3) cells/uL and an ESR greater than 30 were specific indicators of bacteria. Based on these data, identification of bacteremia in febrile infants may be possible with clinical assessment and screening laboratory tests. Because of the relatively small sampling size of this study, the authors feel that evaluation of a larger number of patients is warranted to evaluate these sensitivities in a more diffuse patient population.

Bacterial Infections↗
PubMed1989

Effect of antioxidants in experimental Escherichia coli septicemia.

Free radicals have been implicated in the pathogenesis of gram-negative bacterial sepsis. We assessed the effectiveness of antioxidants and chelators to alter oxidative injury in established severe experimental Escherichia coli septicemia. One hour after challenge by intraperitoneal injection of bacteria, 36 rabbits were treated with moxalactam and randomized in sets of three to receive either placebo, superoxide dismutase (SOD), or a combination of antioxidants and chelators consisting of SOD, sodium thiosulfate, alpha-tocopherol, deferoxamine, and diethyldithiocarbamate. Throughout the course of treatment, levels of bacteremia and endotoxemia were similar among the three experimental groups. Neither antioxidant-treated group was significantly different from the control group in mean arterial blood pressure, leukocyte count, platelet count, core temperature, blood lactate, oxygenation or survival. Arterial pH and [HCO3-] were significantly lower in the antioxidant combination group compared to the control and SOD groups (P less than .01). In this model, antioxidant and chelator therapy does not substantially ameliorate established septicemia.

Animals↗
PubMed1988

Effect of scavengers of oxygen-derived free radicals on mortality in endotoxin-challenged mice.

Oxygen-derived free radicals have been implicated as mediators of cellular injury in several model systems. Recently, a role for free radicals has been proposed in the mortality associated with Gram-negative bacterial sepsis. To determine if pretreatment with free radical scavengers can prevent endotoxin-induced mortality, mice rendered sensitive to endotoxin with actinomycin D were treated with either superoxide dismutase (SOD), N-acetylcysteine (NAC) or saline and were then challenged with a dose of endotoxin calculated to cause a mortality of greater than 80%. Mortality was assessed at 12-h intervals after challenge. Increased survival was seen in the SOD-treated group compared to the control group (p less than or equal to .05). In contrast, survival in mice treated with NAC, another potential scavenger, was not significantly different from the control group. These results support the hypothesis that superoxide and hydroxyl radicals contribute to mortality in Gram-negative bacterial sepsis.

Acetylcysteine↗