Biomedical subjects

J C Cobo

Publications and source records attributed to J C Cobo.

7 recordsLinked to original sources

PubMed1985

Hemodynamic and oxygen transport patterns in surviving and nonsurviving postoperative patients.

Invasive hemodynamic monitoring was performed on 220 critically ill surgical patients judged by clinical evaluation to have a high likelihood of surgical complications or death. Patients with markedly abnormal preoperative hemodynamic values were excluded from analysis. Data were separated into preoperative, intraoperative and postoperative time intervals and the mean value of each variable for each patient at each time period was computed. In comparison to survivors, the nonsurvivors generally had: (a) reduced myocardial performance as judged by lower cardiac index and left ventricular stroke work in the presence of high right and left ventricular filling pressures, (b) reduced pulmonary function (increased alveolar-arterial oxygen content difference and pulmonary shunt fraction), (c) pulmonary vasoconstriction (increased pulmonary artery pressure and pulmonary vascular resistance), and (d) decreased oxygen delivery despite maintenance of normal arterial blood gases and comparable hemoglobin values. Both survivors and nonsurvivors had vital signs usually within the normal range (until the terminal state of nonsurvivors).

Adult↗

PubMed1985

Massive symptomatic cystic hygroma confined to the thorax in early childhood.

A case of massive symptomatic cystic hygroma confined to the left hemithorax and mediastinum in a 21-month-old boy is reported. The symptoms were of increasing respiratory distress and cough with fever. The mass surrounded all of the major vascular and nervous structures of the mediastinum and left hemithorax and was attached to the pericardium. It was excised, and the postoperative course was complicated by prolonged chylothorax and malfunction of the left hemidiaphragm. Seven other reported symptomatic cases of cystic hygroma confined to the thorax in early childhood are reviewed. The hygromas tend to be large and their care typically is complex and complicated. Hemorrhage into the cysts is a frequent finding and likely contributes to the acute and progressive symptoms.

Child, Preschool↗

PubMed1985

The eyes as a portal of entry for hepatitis and other infectious diseases.

Surgeons who are exposed to cardiac, vascular and dialysis access, as well as the operating room staff, are at high risk for becoming infected with hepatitis. The virulence of this disease warrants maximum protection for these individuals. The eye is an exposed and documented portal of entry for blood and other potentially infectious debris. We strongly recommend the use of optically clear glasses or goggles in the operating room in order to minimize the danger of contacting a disabling and potentially lethal illness.

Eye↗

PubMed1984

Cardiorespiratory effects of pneumatic trousers in critically ill patients.

Although pneumatic antishock trousers (PT) are widely used in prehospital and emergency care, little is known about their cardiorespiratory effects in critically ill patients. To examine this issue, we measured hemodynamic and oxygen metabolism variables in ten critically ill patients. All patients were studied with PTs uninflated, after five minutes of PT inflation to 40 mm Hg, and five minutes after PT deflation. Significant increase in mean arterial pressure, systemic vascular resistance, and pulmonary artery pressures were present after PT inflation. No significant changes in cardiac index, stroke index, arterial or mixed venous blood gas values, or oxygen delivery were found. There was a downward trend in VO2 that was on the border of statistical significance. Regression analysis of cardiorespiratory variables on blood volume demonstrated no physiologic effects of external counterpressure in hypovolemic, hypervolemic, or normovolemic patients. We concluded that PT inflation increases BP through its effects on peripheral resistance. No significant autotransfusion effect was present, and there was a suggestive impairment in oxygen metabolism.

Adult↗

PubMed1984

Sequential cardiorespiratory patterns associated with outcome in septic shock.

Sequential hemodynamic and oxygen transport monitoring was performed in 33 patients with septic shock to define physiologic patterns associated with outcome. Measurements taken over a 24-hour period prior to the hypotensive crisis, defined as the lowest initial mean arterial pressure (MAP) after a decrease of at least 30 mm Hg from initial normal values, were compared to those taken during the 24 hours thereafter. In the 24-hour period prior to the hypotensive crisis, the 19 survivors demonstrated significantly greater cardiac index (CI), left cardiac work index (LCWI), oxygen delivery (DO2), and oxygen consumption (VO2) than the 14 patients who died. No other significant differences were found between the two patient groups. When sequential cardiorespiratory patterns were examined, significant increases in CI, LCWI, left ventricular stroke work index (LVSWI), DO2, and VO2 were present in survivors as early as eight hours before the hypotensive crisis. The results presented in this study suggest that patterns of survival may be determined in critically-ill septic patients before shock, as defined by the initial hypotensive episode, develops.

Aged↗

PubMed1984

Sequential hemodynamic and oxygen transport abnormalities in patients with acute pancreatitis.

Physiologic abnormalities were evaluated by sequential hemodynamic and oxygen transport measurements in 33 patients with acute pancreatitis. The hypotensive crisis, which was defined as the lowest mean arterial pressure (MAP), was used as the common temporal reference point to align the data in a coherent fashion. The data of the 48-hour periods before and after the hypotensive crisis then were evaluated. The patients were divided into normotensive and hypotensive groups and the latter were divided into survivors and nonsurvivors to evaluate the severity of the disorder and to identify the patterns representative of survival and death. The physiologic abnormalities of the hypotensive patients include decreased systemic vascular resistance index (SVRI) and compromised cardiac function. The latter was demonstrated during the hypotensive episode by significantly reduced left ventricular stroke work index (LSWI), despite increases in heart rate (HR), central venous pressure (CVP), pulmonary capillary wedge pressure (WP), and cardiac index (CI). The normotensive group had increased oxygen consumption (Vo2), oxygen delivery (Do2), pulmonary shunt (Qsp/Qt), LSWI, normal SVRI, and high CI. The hypotensive nonsurvivors had lower MAP, LSWI, SVRI, Do, and hematocrit as well as higher pulmonary vascular resistance index (PVRI) and Qsp/Qt than did the survivors. These findings do not support myocardial depression as the primary cardiovascular abnormality in acute pancreatitis, but rather suggest the decreased vascular tone from flow maldistribution in the peripheral microcirculation limits tissue oxygenation in the face of increased metabolic requirements of the hypercatabolic state.

Acute Disease↗

PubMed1983

Sequential cardiorespiratory patterns in septic shock.

Sequential hemodynamic and oxygen transport monitoring was performed in 33 patients with septic shock to define the temporal pattern of physiologic events. Measurements taken over a 24-h period before the hypotensive crisis, defined as the lowest initial mean arterial pressure (MAP), were compared to those taken during the 48 h thereafter. In the 24-h period before the hypotensive crisis, there were increases in cardiac index (CI), central venous pressure (CVP), pulmonary capillary wedge pressure (WP), pulmonary vascular resistance index (PVRI), and pulmonary shunt (Qsp/Qt), but decreases in MAP, systemic vascular resistance index (SVRI) and oxygen delivery (Do2). When sequential cardiorespiratory patterns were examined, oxygen consumption (VO2) fell transiently to significantly low values 12 h before as well as at the time of the hypotensive crisis. SVRI fell and CI rose to values significantly different from normal in the 4 h before the low MAP. During the subsequent 48 h after the hypotensive crisis, CI, CVP, WP, PVRI and Qsp/Qt remained elevated. Values for MAP, SVRI, DO2, and VO2 were significantly reduced. These results demonstrate the existence of antecedent cardiorespiratory alterations that precede the hypotensive episode in septic shock and suggest that flow maldistribution in the systemic circulation is an early event with possible pathogenic significance.

Adult↗