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Biomedical subjects

R P Dellinger

Publications and source records attributed to R P Dellinger.

At least 55 records · Page 3Linked to original sources
PubMed1992

Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine.

An American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference was held in Northbrook in August 1991 with the goal of agreeing on a set of definitions that could be applied to patients with sepsis and its sequelae. New definitions were offered for some terms, while others were discarded. Broad definitions of sepsis and the systemic inflammatory response syndrome were proposed, along with detailed physiologic parameters by which a patient may be categorized. Definitions for severe sepsis, septic shock, hypotension, and multiple organ dysfunction syndrome were also offered. The use of severity scoring methods when dealing with septic patients was recommended as an adjunctive tool to assess mortality. Appropriate methods and applications for the use and testing of new therapies were recommended. The use of these terms and techniques should assist clinicians and researchers who deal with sepsis and its sequelae.

Critical Care↗
PubMed1992

Fiberoptic bronchoscopy in the intensive care unit.

The primary uses of FFB in the intensive care unit are in the diagnosis of opportunistic infection and for airway management. In addition, use of PTC brush or BAL with quantitative cultures may allow identification of the specific cause of bacterial pneumonia. Determination of the location and cause of pulmonary hemorrhage is possible in the intubated patient without massive hemoptysis. Use of FFB in atelectasis is more controversial and less commonly encountered. Other uses include foreign body retrieval, tamponade of bleeding segments and diagnosis/treatment of BPF. In addition to development of technical skills and knowledge of the indications for FBB, critical care physicians should be aware of contraindications and potential complications, as well as steps to minimize the latter.

Bronchoscopes↗
PubMed1992

Undergraduate education in critical care medicine.

OBJECTIVE: To review the current status and future needs of medical students with respect to education in critical care medicine. DATA SOURCES: Literature review and questionnaire administered at the 1990 Educational and Scientific Symposium of the Society of Critical Care Medicine. MEASUREMENTS AND MAIN RESULTS: Medical students are presently not required to master even the basic aspects of critical care medicine before licensing. The results of the questionnaire demonstrated that critical care medicine professionals believe a critical care core curriculum should be established and its completion should be made a requirement for graduation from medical school. A reference set of critical care medicine learning objectives and a strategy for their implementation are presented. CONCLUSIONS: There is a gap between what student physicians are required to learn and what they need to know to effectively initiate critical care interventions and to appropriately refer patients to ICUs. This gap can and should be remedied with wide implementation of a critical care core curriculum.

Accreditation↗
PubMed1991

Acute life-threatening asthma.

Although adrenergic therapy may be lifesaving in patients with severe acute asthma, attention must also be directed toward reversing underlying inflammation with corticosteroids. Other therapy for acute severe bronchospasm is controversial, although inhalant anticholinergic therapy may have adjunctive benefit. Aminophylline or magnesium sulfate may be indicated in those patients with life-threatening asthma who do not respond to conventional therapy. Chest radiographs are needed in patients who (1) present in extreme distress, (2) need to be hospitalized, or (3) have clinical manifestations of pneumonia or pneumothorax. Antibiotics are not used for acute asthma in the absence of pneumonia.

Adrenal Cortex Hormones↗
PubMed1991

Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group.

BACKGROUND: HA-1A is a human monoclonal IgM antibody that binds specifically to the lipid A domain of endotoxin and prevents death in laboratory animals with gram-negative bacteremia and endotoxemia. METHODS: To evaluate the efficacy and safety of HA-1A, we conducted a randomized, double-blind trial in patients with sepsis and a presumed diagnosis of gram-negative infection. The patients received either a single 100-mg intravenous dose of HA-1A (in 3.5 g of albumin) or placebo (3.5 g of albumin). Other interventions, including the administration of antibiotics and fluids, were not affected by the study protocol. RESULTS: Of 543 patients with sepsis who were treated, 200 (37 percent) had gram-negative bacteremia as proved by blood culture. For the patients with gram-negative bacteremia followed to death or day 28, there were 45 deaths among the 92 recipients of placebo (49 percent) and 32 deaths among the 105 recipients of HA-1A (30 percent; P = 0.014). For the patients with gram-negative bacteremia and shock at entry, there were 27 deaths among the 47 recipients of placebo (57 percent) and 18 deaths among the 54 recipients of HA-1A (33 percent; P = 0.017). Analyses that stratified according to the severity of illness at entry showed improved survival with HA-1A treatment in both severely ill and less severely ill patients. Of the 196 patients with gram-negative bacteremia who were followed to hospital discharge or death, 45 of the 93 given placebo (48 percent) were discharged alive, as compared with 65 of the 103 treated with HA-1A (63 percent; P = 0.038). No benefit of treatment with HA-1A was demonstrated in the 343 patients with sepsis who did not prove to have gram-negative bacteremia. For all 543 patients with sepsis who were treated, the mortality rate was 43 percent among the recipients of placebo and 39 percent among those given HA-1A (P = 0.24). All patients tolerated HA-1A well, and no anti-HA-1A antibodies were detected. CONCLUSIONS: HA-1A is safe and effective for the treatment of patients with sepsis and gram-negative bacteremia.

Antibodies, Monoclonal↗
PubMed1991

Cocaine-associated chest pain.

STUDY OBJECTIVES: To describe the clinical and ECG features of cocaine abusers evaluated in the emergency department and admitted to the medical coronary care unit with chest pain consistent with myocardial ischemia. DESIGN: A four-month retrospective review of all cocaine abusers who presented to the ED with chest pain and a diagnosis of possible myocardial infarction. SETTING: Urban county hospital. TYPE OF PARTICIPANTS: Forty-eight adult cocaine abusers admitted with chest pain. MEASUREMENTS AND MAIN RESULTS: Patients included 34 men and 14 women with a mean age of 29 +/- 7.3 years. The average duration of cocaine abuse in 28 patients for whom it was reported was 5 +/- 4.8 years. Chest pain occurred within one hour of cocaine abuse in 13 admissions (27%), more than one hour after abuse in 13 admissions (27%), and it was not recorded in 23 admissions (47%). Initial ECGs were evaluated in all patients and revealed significant repolarization abnormalities consisting of abnormal ST segment elevations in 18 (37%) and T-wave inversions in 20 (41%) that often persisted on subsequent ECGs. Three patients sustained acute myocardial infarctions. CONCLUSIONS: Our findings confirm a small but significant incidence of myocardial infarction in cocaine abusers presenting to the ED with chest pain. The chronicity of cocaine abuse, the persistence of ECG abnormalities, and the variable temporal relationship of chest pain to cocaine abuse suggest possible chronic myocardial changes as etiologies of ischemia.

Adolescent↗
PubMed1990

Fiberoptic bronchoscopy in adult airway management.

The FFB may facilitate airway management and offers utilization in intubation, extubation, diagnosis of airway damage, ET tube changing, and simultaneous diagnosis and therapeutic intervention in UAO. The FFB may also be used to facilitate insertion of a double-lumen EB tube to initiate dual lung ventilation. In addition to development of technical skills, the ICU physician should know the indications and complications of FOB in the critically ill patient.

Adult↗
PubMed1990

Initial evaluation of human monoclonal anti-lipid A antibody (HA-1A) in patients with sepsis syndrome.

HA-1A, a human monoclonal immunoglobulin M antibody that binds specifically to the lipid A domain of endotoxin, was administered to septic patients to evaluate the safety, pharmacokinetics, and immunogenicity of the antibody. Thirty-four patients received a single infusion of either 25 mg, 100 mg, or 250 mg, and were followed clinically for 14 to 21 days after treatment. HA-1A serum levels were measured before infusion and frequently after infusion with a radiometric assay. A one-compartment pharmacokinetic model was fit to the measured serum levels, and accurately described the changes in HA-1A level over time in each dose group (r2 = .99). The mean +/- SEM apparent volume of distribution of HA-1A was 48.5 +/- 4.5 ml/kg, and the mean serum clearance was 2.8 +/- 0.4 ml/kg.h. The mean serum half-life of HA-1A was 15.9 +/- 1.5 h. The mean serum level one hour after a 100-mg dose was 33.2 +/- 2.4 micrograms/ml, and the mean concentration 24 h later was 9.1 +/- 1.6 micrograms/ml. The dose administered and presence of Gram-negative bacterial infection did not significantly influence the volume of distribution or serum clearance. No adverse reactions to HA-1A were observed, and no antibodies against HA-1A were detected in any patient. These data indicate that the pharmacokinetics of HA-1A are well described by a one-compartment pharmacokinetic model, and that HA-1A is safe and nonimmunogenic in patients with sepsis.

Adult↗
PubMed1990

Pathophysiology, monitoring, and management of the ventilator-dependent patient: considerations for drug therapy, emphasis on stress ulcer prophylaxis.

Adult respiratory distress syndrome (ARDS), or noncardiac pulmonary edema, is a form of acute hypoxemic respiratory failure. The goals of treatment for patients with ARDS are to provide supportive therapy, to reverse the underlying etiology or pathology, and to prevent subsequent complications. Supportive therapy consists of supplemental oxygen, positive end-expiratory pressure, and, often, mechanical ventilation. The reversal of the underlying pathology varies according to the etiologic origin of ARDS. Complications from ARDS include stress ulcers, which occur when gastric aggressive and defensive functions become unbalanced. Antacids and cytoprotective agents are used for stress ulcer prophylaxis, but histamine H2-receptor antagonists are now regarded as the standard of care. Because all the marketed H2-receptor antagonists are efficacious, choice of the agent is based on the adverse effect profile and drug interactions. No definitive data currently exist linking stress ulcer prophylaxis regimens that raise intragastric pH to a significant risk for nosocomial pneumonia.

Antacids↗
PubMed1988

Red/orange person syndrome.

We present a case of a patient whose skin turned orange overnight. The patient had tried to commit suicide by taking approximately forty 300 mg rifampicin capsules. Her case served as a stimulus for us to review the literature. Photographs taken during the initial work-up recorded the changes; her normal skin color returned within twenty-four hours, although her urine and tears remained orange for several days.

Adolescent↗
PubMed1987

Preexisting medical problems in the trauma patient: do they matter?

The answer to the question posed by the title of this chapter (preexisting medical problems in the trauma patient: do they matter?) has by now become obvious. The type and severity of the initial injury are the major determinants of outcome. Trauma prevention is therefore a compelling social goal. Skillful and timely resuscitation efforts favorably affect survival statistics. Even though detailed outcome data do not yet exist in all areas regarding pre-existing illness, it is clear that underlying disease may directly cause trauma, may necessitate modification in trauma management, and may even adversely effect the health-care providers themselves.

Humans↗
PubMed1984

Pelvic hematoma after intercourse while on chronic anticoagulation.

A 41-year-old anticoagulated woman presented with increasing pelvic pain that had begun two days prior during intercourse. An ultrasound and computerized tomographic (CT) scan confirmed the diagnosis of pelvic hematoma. The hematoma resolved spontaneously with normalization of clotting studies. The emergency physician should consider this rare cause of pelvic pain in selected anticoagulated patients. The need for a thorough history in emergency patients is emphasized, as well as the value of ultrasound and CT scan in the diagnosis of this disorder.

Adult↗
PubMed1984

Axillary vein thrombosis simulating superior vena cava syndrome.

We have described two cases of axillary vein thrombosis originally diagnosed as superior vena cava syndrome and the patient referred for immediate radiotherapy. In each case, additional history revealed vital information discounting the original diagnosis. The possibility of an abnormal chest x-ray film unrelated to symptoms and signs must be considered. Definitive diagnostic procedures are imperative and tissue diagnosis may be required before therapy.

Adult↗
PubMed1984

Sputum cytology in the management of patients with lung cancer.

Although more informative and precise diagnostic methods have become available, cytologic analysis of sputum is still considered the first step in evaluating bronchogenic carcinoma. We hypothesized that the cost of sputum examinations far outweighed their usefulness in actual patient management. To substantiate this, we retrospectively reviewed the charts of 190 patients with lung cancer who had sputum cytology done at Wilford Hall USAF Medical Center, Lackland Air Force Base, Texas, during the period January 1981 to June 1982. Twenty-three percent of our patients had at least one sputum sample positive for malignant disease, but in only four patients (2%) was bronchoscopy or another procedure avoided by sputum analysis. In most patients with bronchogenic carcinoma diagnosed by sputum cytology, additional invasive diagnostic procedures are not avoided because they are often necessary to stage the disease process. These additional procedures, done for staging, also provide the histologic diagnosis in the majority of patients. Fiberoptic bronchoscopy most frequently provided the diagnosis regardless of positive sputum cytology in our patients, and there was no associated mortality or serious morbidity.

Adenocarcinoma↗
PubMed1984

Pelger-Huet anomaly of granulocytes in a patient with tuberculosis.

The association of abnormal granulocyte nuclear formation and tuberculosis was first reported by Pelger in 1928. Huet, however, concluded this defect was hereditary, and the association of Pelger-Huet anomaly (PHA) of granulocytes and tuberculosis was obscured for many years. We report the second patient in the English literature with severe tuberculous infection and PHA, further substantiating the diagnostic and prognostic importance of PHA and tuberculosis.

Aged↗