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Biomedical subjects

N Smith-Erichsen

Publications and source records attributed to N Smith-Erichsen.

At least 37 records · Page 2Linked to original sources
PubMed1987

Intensive care: cost and benefit.

This study presents a review of 961 patients treated in the general intensive care unit (ICU) of Akershus Central Hospital (ACH) from 1978 to 1981, including also a follow-up study of the 419 patients treated in 1978 and 1979 who were observed for an average period of 20 months after admittance to the ICU. The ICU patients represented 1.7% of all the patients admitted to the referring departments. Approximately 2/3 (67.3%) of the patients were surgical patients, representing 2.9% of the patients treated in that department, 19.6% were medical patients, and 8.6% came from the department of pediatrics. Surgery was the main reason for ICU admittance in 48.1% of the patients; in 70% of these, surgery by itself made postoperative intensive care necessary. Acute or chronic cardiovascular or respiratory disorders caused or contributed to ICU admittance in 78% of the patients; disorders of the nervous system (29.0%), gastrointestinal system (25%), and severe infections (28%) came next. The average stay in the ICU was 6.2 days. The patient's need for observation, nursing and therapy was assessed daily according to a care grade scale from 1 to 5, with 5 as maximum effort. The average care grade during the stay, multiplied by the duration of stay in days, gave the care product, which was used as an expression of the patient's need for ICU resources. The sum of care products for all the patients through 1 year thus expressed the total work load on the ICU. The ICU budget for 1 year, divided by the total care product for the same year, and thereafter multiplied by the care product for single patients or patient groups, was used as the basis for calculation of ICU costs. Patients receiving mechanical ventilation required 95% of the total work load in the ICU, and 66.3% of these efforts were directly associated with the ventilator treatment period as judged by the care product. Complications to treatment were recorded in 7.3% of the patients, and four of these patients dies of such complications. Improvement by intensive care was achieved in 81.4% of the patients, 5.2% were unchanged, and 13.4% died while in the ICU. Mortality was 9.5% below and 19.3% above the age of 60 years. Of the 419 patients who were followed for an average period of 20 months after admittance to the ICU, 56 died in the ICU, 28 died later during the same stay in ACH, and another 47 died after discharge from ACH, whereas 288 (68.7%) were still alive.(ABSTRACT TRUNCATED AT 400 WORDS)

Cost-Benefit Analysis↗
PubMed1986

Uncontrolled plasma proteolysis: a major threat to the septicemic patient.

In order to further elucidate the pathophysiological significance of plasma proteolysis during septicemia, surgical patients with septicemia were studied by means of chromogenic peptide substrate assays. In fatal cases continuous low values for prekallikrein, plasminogen and antithrombin III were found until death. At autopsy a persistent septic focus was found in all but one of the fatal cases. Very low levels of prekallikrein during sepsis and reduced functional inhibition of plasma kallikrein in septic shock indicated a poor prognosis. In the survivors the parameters returned towards the normal range upon successful therapy. Furthermore the paper demonstrates the application of a new parameter, the proenzyme functional inhibition index (PFI-index) in patients with septicemia. The data reveal that by means of this parameter patients at high risk can be identified at an early stage of the disease.

Antithrombin III↗
PubMed1986

Abdominal aortic reconstruction. Prognostic importance of coexistent diseases.

In 109 patients who underwent abdominal aortic reconstruction, the importance of preoperative complicating factors was retrospectively studied. High age at operation, presence of coronary heart disease, heart failure, hypertension, chronic pulmonary disease and renal failure, heavy smoking and alcoholism were among the investigated factors. A simple preoperative risk score was defined, based on the number of such complicating factors present in each case. Although the operation was technically uncomplicated in all 109 patients, 15 required intensive care for more than 4 days and seven died. Morbidity and mortality were heightened in cases with more than three risk factors. Coronary heart disease and renal failure were the most important risk factors.

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PubMed1985

Studies on pathological plasma proteolysis in patients with septicemia.

Plasma proteolysis was studied in surgical patients with septicemia by means of chromogenic peptide substrate assays. Using these methods both levels of proenzyme, functional inhibition capacity and enzyme activities indicating alpha 2-macroglobulin protease complexes were determined. In fatal cases continuous low values for prekallikrein, plasminogen and antithrombin III were found until death. At autopsy a persistent septic focus was found in all but one of the fatal cases. Very low levels of prekallikrein during sepsis and reduced functional inhibition of plasma kallikrein in septic shock indicated a poor prognosis. In the survivors the parameters returned towards the normal range upon successful therapy. Furthermore, the paper demonstrates the application of a new parameter, the Proenzymes functional inhibition index (PFI-index) in patients with septicemia. The data reveal that by means of this parameter, patients at high risks can be identified at an earlier stage of the disease than previously done.

Blood Coagulation Factors↗
PubMed1985

Serial determinations of platelets, leucocytes and coagulation parameters in surgical septicemia.

The prognostic and therapeutic information obtained by serial determinations of platelets, leucocytes, Normotest (NT), Thrombotest (TT), fibrinogen concentrations and the ethanol gelation test (EGT) was evaluated in 18 surgical patients with septicemia. Nine of these patients died and autopsy revealed a persistent septic focus in all but one. In this last patient only microscopic changes after an intra-abdominal abscess evacuated 14 days prior to death was found. Consecutive platelet counts provided valuable prognostic and therapeutic information during the course of septicemia. Within two weeks after start of therapy, this parameter had returned towards the normal range in the survivors whereas continuous low platelet counts were observed until death in the patients with a persistent septic focus. The initial degrees of thrombocytopenia did not discriminate between survivors and non-survivors. Serial leucocyte counts did not give information of prognostic or therapeutic value in either group during the observation period. NT- and TT-values were significantly lower in the fatal cases than in the survivors during the first week of septicemia. Moreover, TT seemed to be a better early discriminator between survivors and non-survivors than NT. Neither fibrinogen concentrations nor the EGT provided information of prognostic or therapeutic value in this study.

Blood Coagulation Tests↗
PubMed1984

Evaluation of severity and prognosis in early stages of septicemia by means of chromogenic peptide substrate assays.

Components of the plasma protease systems were determined by means of chromogenic peptide substrate assays during the early stage of septicemia in 21 patients of whom 11 died. The proenzyme functional inhibition index, calculated from the measured values for plasma prekallikrein, functional kallikrein inhibition, plasminogen and functional antiplasmin and antithrombin III activities, were markedly reduced in both groups, but significantly lower in the fatal cases than in the survivors from the first day of septicemia and throughout the observation period. Fatal septicemia thus appear to be associated with a more extensive proteolytic activity in plasma than nonfatal septicemia and can be readily disclosed by calculation of the proenzyme functional inhibition index.

Antithrombin III↗
PubMed1983

Plasma kallikrein-kinin system in septicemia.

Plasma prekallikrein and functional kallikrein inhibition were studied in 18 surgical patients with complicating septicemia using chromogenic peptide substrate assays. Nine patients died and nine survived. In all 18 patients plasma prekallikrein values were reduced markedly when septicemia was diagnosed. During treatment gradually increasing values were found in the survivors, whereas values remained low in the fatal cases. Significantly reduced functional plasma kallikrein inhibition was associated with the development of fatal septic shock. The findings show that determination of these components of the plasma kallikrein-kinin system gives valuable information of prognostic value in patients with septicemia. Furthermore, the chromogenic peptide substrate assays used are fast and easy to perform and therefore suitable for intensive care medicine.

Adult↗
PubMed1983

The functional inhibition of plasma kallikrein. A critical factor in septic shock.

Functional kallikrein inhibition and prekallikrein levels have been studied during septic shock and septicemia in 13 patients using chromogenic peptide substrate assays. Eleven septic shock episodes were studied of which 5 were fatal. Marked reductions in functional kallikrein inhibition and prekallikrein values occurred during fatal septic shock. In patients who could be resuscitated from septic shock, functional kallikrein inhibition was in the normal range, but significantly lower than in patients with septicemia only. Also in these two groups of patients decreased prekallikrein values were found. During treatment a gradual increase in prekallikrein was observed in the survivors and functional kallikrein inhibition values remained in the normal range during the whole course. Our results indicate that the functional inhibition of plasma kallikrein plays a major role in determining the outcome of septic shock.

Humans↗
PubMed1982

Treatment of sepsis in the surgical patient evaluated by means of chromogenic peptide substrate assays.

In the present study treatment of sepsis in 18 surgical patients, 9 survivors and 9 fatal cases, were evaluated by determining components of the plasma proteolytic enzyme systems using chromogenic peptide substrate assays. During persistent sepsis, continuous low values for prekallikrein, plasminogen and antithrombin III were found until death. At autopsy a septic focus was found in all but one of the fatal cases. Very low levels of prekallikrein during sepsis and reduced functional inhibition of plasma kallikrein in septic shock indicated a poor prognosis. In the survivors all parameters returned towards normal range upon successful therapy. Plasminogen and antithrombin III were most rapidly normalized. It is concluded that determination of components of the plasma protease systems using chromogenic peptide substrate assays, gives valuable information about course and prognosis in surgical sepsis, and that they are suitable for practical clinical use.

Adult↗
PubMed1982

Studies of components of the coagulation systems in normal individuals and septic shock patients.

Components of the coagulation system were determined in plasma samples from normal individuals and septic shock patients. The parameters measured included Hageman factor (HF), prekallikrein (PKK), high molecular weight kininogen (HMwK), antithrombin III (AT III), fibrinogen (Fg) and fibrin(ogen) degradation products (FDP's). The combined effects of factors II, VII & X were estimated using Normotest (NT). Plasma levels of HF, PKK, and HMwK and both immunochemical levels and functional activities of AT III were significantly lower in the septic shock patients. NT values were also significantly reduced. Fibrinogen levels varied from very low to very high indicating both Fg consumption and acute-phase synthesis. Elevated FDP levels were seen during septic shock, but no difference between survivors and fatal cases was found. Prekallikrein levels and functional AT III activities were significantly higher in the samples from patients who recovered following septic shock than in the samples from subjects who died. During treatment all the parameters gradually returned toward normal in the survivors, whereas continuous low values for HF, AT III, PKK, and NT were observed in the fatal cases.

Antithrombin III↗
PubMed1979

Airway closure and fluid filtration in the lung.

We have investigated the effect of airway closure on fluid balance in the isolated, perfused rabbit lung in which the alveolar, pleural and vascular pressures could be regulated independently. The rate of filtration into the interstitial space was monitored by continuous weighing. A reduction in pleural pressure of 0.5 kPa with open airways increased fluid filtration by 0.11 g min-1. Reduction in pleural pressure of 0.5 kPa with the main airways closed reduced the alveolar pressure by 0.4 kPa and increased fluid filtration by 0.86 g minp1. We concluded that the pleural pressure is transmitted poorly to the alveolar interstitial space in the normal lung with open airways. However, airway closure allows the pleural pressure to be transmitted almost completely to this interstitium, with interstitial oedema as a possible consequence.

Airway Obstruction↗
PubMed1978

Pulmonary complications after bleomycin, irradiation and surgery for esophageal cancer.

Eight patients with epidermoid carcinoma of the esophagus were given radiotherapy of 3000 rads and 120 mg of bleomycin. Esophageal resection was performed five to six weeks later. Four of these patients died within six weeks, three from respiratory failure, and one from complications secondary to an anastomotic fistula. Of the remaining four patients, three showed varying degrees of pulmonary infiltration for several weeks. Interstitial pneumonitis was demonstrated in all the fatal cases. Four patients given the same irradiation and bleomycin doses were only subjected to exploratory surgery. They had no postoperative pulmonary complications. Ten patients given the same irradiation and bleomycin treatment without surgery also showed no pulmonary complications. Sixteen patients received higher doses of radiotherapy and bleomycin. Seven of these developed lung infiltrations terminating fatally in four. The likely mechanism of the observed postoperative pulmonary complications is that the preoperative treatment sensitized the lungs, while the subsequent surgical trauma triggered a reaction in the lungs leading to respiratory failure.

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