Biomedical subjects

H A Bruining

Publications and source records attributed to H A Bruining.

219 records · Page 13Linked to original sources

PubMedDate not supplied

Assessment of energy expenditure by indirect calorimetry in healthy subjects and patients with liver cirrhosis.

The reliability of resting energy expenditure (REE) measurements by indirect calorimetry with a ventilated hood was investigated in 50 healthy controls and 10 patients with liver cirrhosis. In each subject basal energy expenditure (BEE) was determined once and REE three times (morning REE1, noon REE2, afternoon REE3). In controls and patients the first 5-minute BEE and first 5-minute REE (controls also second 5-minute REE) were higher than in the remainder of the 30-minute recording. Only the last 20 minutes of recordings were used to calculate BEE (1645 +/- 315, mean +/- SD, in kilocalories per day), REE1 (1880 +/- 365), REE2 (1782 +/- 384), and REE3 (1775 +/- 316) in controls, and in cirrhotics: BEE (1530 +/- 235), REE1 (1714 +/- 267), REE2 (1715 +/- 238), and REE3 (1779 +/- 275). REE was higher than BEE in controls and cirrhotics (p less than 0.05). The REE variation coefficient was 5 +/- 3% in controls and 5 +/- 2% in cirrhotics. No systematic difference between REE1, REE2, and REE3 was found. Energy expenditure predicted by the Harris-Benedict equation differed up to 21% from measured BEE in individual controls; group mean BEE, however, was correctly predicted. In cirrhotics differences between measured and predicted BEE up to 26% occurred, while measured BEE was higher than predicted BEE (p = 0.06). It is concluded that REE can be reliably assessed by indirect calorimetry with a ventilated hood system in controls and patients at any time of the day, when values obtained in the first 10 minutes are deleted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMedDate not supplied

Respiratory distress syndrome and its treatment with high positive end-expiratory pressure ventilation.

In a 25-month period, nine patients developed a severe, rapidly progressive respiratory distress syndrome (RDS) and did not respond adequately to conventional respiratory therapy despite the application of positive end-expiratory pressure ventilation (PEEP) up to an upper limit of 15 cm H2O. Treatment with high PEEP was instituted up to 35 cm H2O, in order to achieve a PaO2 higher than 70 mmHg. Massive infusion of electrolyte solutions, colloids and red blood cells were necessary to maintain an adequate circulation that could be monitored by simple parameters such as arterial blood pressure, peripheral skin temperature and urine production. Seven patients (78%) survived. Sepsis was the cause of death in two patients. There were no pulmonary functional or radiological abnormalities, one to 14 months after discharge from the hospital. The upper limit for PEEP should be abandoned and PEEP should be administered according to the needs of each individual patient. As an adequate oxygenation can always be achieved with high-PEEP ventilation, in surgical patients there is hardly, if ever, an indication for ECMO.

Adolescent↗

PubMedDate not supplied

The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee.

OBJECTIVE: To determine the prevalence of intensive care unit (ICU)-acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality. DESIGN: A 1-day point-prevalence study. SETTING: Intensive care units in 17 countries in Western Europe, excluding coronary care units and pediatric and special care infant units. PATIENTS: All patients (> 10 years of age) occupying an ICU bed over a 24-hour period. A total of 1417 ICUs provided 10 038 patient case reports. MAIN OUTCOME MEASURES: Rates of ICU-acquired infection, prescription of antimicrobials, resistance patterns of microbiological isolates, and potential risk factors for ICU-acquired infection and death. RESULTS: A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower respiratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infection reported. Most frequently reported micro-organisms were Enterobacteriaceae (34.4%), Staphylococcus aureus (30.1%;[60% resistant to methicillin], Pseudomonas aeruginosa (28.7%), coagulase-negative staphylococci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (> 48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. ICU-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval[Cl], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% Cl, 1.71 to 7.18), and bloodstream infection (OR, 1.73; 95% Cl, 1.25 to 2.41) increased the risk of ICU death. CONCLUSIONS: ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients.

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