Biomedical subjects
Publications and source records attributed to P E Engler.
Estimation of intrapulmonary blood shunt fraction requires accurate evaluation of pulmonary capillary, arterial, and mixed venous oxygen contents. The presence of carboxyhemoglobin, as well as methemoglobin and sulfhemoglobin, may lead to large errors in the calculated intrapulmonary blood shunt fraction. The errors are most pronounced at low values of carboxyhemoglobin and low values of true intrapulmonary shunt fraction.
Indocyanine green dye dilution curves with abnormal contours have been recorded in four patients with acute and critical illnesses using standardized recording methods. The abnormal curves are characterized by a high and prolonged concentration of dye occurring after the peak concentration. This altered contour can be detected by use of routine mathematical processing since the derived hemodynamic parameters are affected by the altered contour. A physiologic basis for the altered curve contour is proposed.
An automated system has been developed for measuring hemodynamic, oxygen transport and tissue utilization functions. Rapid measurement and data analysis of physiologic profiles by paramedical personnel allow prompt evaluation of altered cardiovascular function. Evaluation of physiologic function allows therapeutic interventions to be instituted on a timely basis, appropriately directed toward improvement of the measured cardiovascular abnormalities. Physiologic profile studies were performed on 1016 occasions in 580 patients during a three-year period and form the basis of this report. Although utilized on hospitalized patients, there are implications for use in evaluating and treating all critically ill patients.
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The automated physiologic profile provides the critical care physician with hemodynamic, oxygen consumption and tissue utilization data at reasonable cost. A paramedical assistant performs all data acquisition, recordings and blood sampling procedures. Data reduction is performed through use of off-the-shelf desk-top calculator equipment and accessories and a standardized graphic display is provided for the physician in charge. The physiologic profile has been utilized in high-risk patients requiring medical and surgical interventions. It is routinely employed in postoperative monitoring of cardiac patients and patients undergoing major surgical procedures with associated cardiovascular decompensation. Diagnosis of cardiac and pulmonary deterioration and promptness of advanced support interventions represent additional areas of effective clinical application.
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A relatively simple and inexpensive data management system is described with which comprehensive physiologic and cardiovascular profiles are produced. The system is comprised of a desk-top programmable calculator interfaced with an acoustic digitizer input, and an X-Y plotter, with alphanumeric printing output capability. Numerical clinical data such as intracardiac pressures and blood gas values are entered into the calculator via the keyboard, and graphical data such as dye-dilution curves or ventricular contours are digitized with a pen stylus on the acoustic tablet. The data are processed in the calculator and the results charted in familiar and readily interpreted bar-graph format on preprinted charts on the X-Y plotter. The entire system is inexpensive and compact enough to be applicable to small- and medium-size community hospitals.
Measurements of hemodynamic, oxygen transport, and tissue utilization functions were incorporated into a physiologic profile assessment system in order to evaluate patients who are candidates for mechanical support of the failing heart. Circulatory function was assessed in patients with acute myocardial infarction associated with diminished peripheral perfusion and compared to an age-matched, normal patient group. Serial studies performed prior to and during intra-aortic balloon counterpulsation provide a means to assess circulatory status accurately and document the efficacy of therapeutic interventions.