Biomedical subjects
Publications and source records attributed to N Wetmore.
Patients with acute respiratory failure who have high mortality risk can be analyzed according to the methods outlined above. Some (but not all) of the high mortality risk patients can be identified early in the course of respiratory failure. Temporary support with ECMO is indicated in these patients if there are no signs of irreversible damage.
ECMO support has been evaluated in 29 newborn infants with respiratory failure. Lung function improved in 16 and 13 surivived. Important technical factors include venoarterial bypass with full support capability, careful measurement and treatment of coagulation and platelet status, and a skilled and experienced team. Detecting high risk infants early in life is important. Intracranial bleeding is the most common cause of death.
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Oxygen consumption and caloric expenditure was 1 1/2 to 2 times normal in 15 major burn patients from the time of burn to the time of surface coverage. This hypermetabolic state was quite consistent hour-to-hour and day-to-day, and correlated best with the extent of full-thickness burn. Nutritional management and caloric intake can be intelligently planned using simple spirometry and indirect calorimetry to measure caloric requirements. Weight gain and prompt healing can be achieved by positive caloric balance. Based on daily metabolic studies, a positive caloric balance feeding protocol has been used in the treatment of 556 patients. This regimen, in combination with many other factors in physiologic and surface care, has resulted in high survival rates, short hospitalization, and rapid rehabilitation.
The results of treatment of acute respiratory insufficiency in the adult must be quantitated before indications for innovative treatment (such as extracorporeal oxygenation) can be defined. A method for retrospective and prospective data collection based on a graph of A-a gradient and time was evaluated in 45 patients. From this graph a pulmonary insufficiency index (PII) can be calculated which correlates well with mortality in this series. The mean PII of surviving patients was 0.84 and the highest value was 2.75. The mean PII of patients who died with pulmonary insufficiency was 15.9; the lowest value was 6.0. Using this method with a larger data base, it will be possible to predict mortality based on PII facilitating the study of ongoing management and innovative treatment methods.
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