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Biomedical subjects

R Prielipp

Publications and source records attributed to R Prielipp.

11 recordsLinked to original sources
PubMed2000

Female gender associates with increased duration of intubation and length of stay after coronary artery surgery. CABG Clinical Benchmarking Database Participants.

BACKGROUND: Females have worse outcome than do males after coronary artery bypass grafting; however, gender effects on length of stay (LOS) outcomes, such as duration of intubation or intensive care unit (ICU) LOS, have not been evaluated previously. The authors hypothesized that adjustment for pertinent preoperative covariates would eliminate any significant effect of gender on duration of intubation, LOS in the ICU after extubation, total ICU LOS, postoperative (exclusive of ICU) LOS, or total postoperative LOS. METHODS: Patients undergoing elective or urgent primary coronary artery bypass grafting surgery at 51 academic health centers in 1995 and 1997 were studied. Unique multivariable statistical models were developed for duration of intubation, ICU LOS after extubation, total ICU LOS, and postoperative (exclusive of ICU and total) LOS to test for independent associations with gender. Preoperative but not intraoperative or postoperative variables were included in the model. P> or =0.01 was considered significant. RESULTS: All LOSs were of significantly longer duration in females than in males in both the 1995 (n = 1,064) and 1997 (n = 910) data collections. After covariate adjustment, female sex remained associated with significantly longer duration ICU LOS and total postoperative LOS in both the 1995 (female:male ratios 1.30:1 and 1.13:1, respectively) and the 1997 (female:male ratios 1.19:1 and 1.12:1, respectively) data sets. After covariate adjustment, duration of intubation and ICU LOS after extubation were of significantly longer duration in women than men in 1995 (female:male ratios 1.22:1 and 1.39:1, respectively), but the differences were not significant in 1997. CONCLUSIONS: Even in the context of accelerated recovery programs, these analyses show that female sex has powerful associations with increased LOS intervals for coronary artery bypass grafting surgery, even after adjustment for preoperative covariates. These effects could result from differences in the ways in which men and women respond to coronary artery disease, anesthesia, and coronary artery bypass grafting surgery, or to bias on the part of healthcare workers.

Aged↗
PubMed1999

Fenoldopam: a new parenteral antihypertensive: consensus roundtable on the management of perioperative hypertension and hypertensive crises.

A panel of clinicians from anesthesiology, surgery, nephrology, hypertension, cardiology, and pharmacology was convened to discuss pharmacologic therapeutics in the management of hypertensive crisis and perioperative hypertension. The panel discussed the advantages and limitations of currently available parenteral drugs, and assessed the potential use of fenoldopam mesylate, a drug in clinical development since 1981, and recently approved by the U.S. Food and Drug Administration (FDA). Fenoldopam is a dopamine receptor (DA1 selective) agonist that is a systemic and renal vasodilator. It was concluded that fenoldopam offers significant advantages as a parenterally administered agent for the management of blood pressure in both hypertensive emergencies and in the perioperative setting.

Acute Disease↗
PubMed1997

Con: calcium is not routinely indicated during separation from cardiopulmonary bypass.

Severe hypocalcemia is uncommon in adult cardiac surgery patients; the nearly ubiquitous mild hypocalcemia does not impair myocardial performance. Clinicians should recognize that in certain circumstances, calcium may interact negatively with catecholamines such as epinephrine or dobutamine. Lastly, evidence suggests that calcium influx during ischemia-reperfusion contributes to myocardial dysfunction after CPB. Therefore, there appears to be no justification for the practice of routinely administering large doses of calcium salts to adult cardiac surgery patients after CPB.

Calcium↗
PubMed1993

Near-patient blood gas and electrolyte analyses are accurate when performed by non-laboratory-trained individuals.

OBJECTIVE: The objective of this study was to determine the accuracy of a near-patient blood gas and electrolyte analyzer when used by non-laboratory-trained clinicians in the critical care setting. METHODS: One hundred eighty-five blood samples (split samples) from 50 intensive care unit patients were analyzed by clinicians in the critical care environment using a near-patient blood gas and electrolyte analyzer (GEM Premier, Mallinckrodt Sensor Systems, Ann Arbor, MI). Near-patient measurements were compared with those obtained by laboratory technologists in an established intensive care unit laboratory. RESULTS: There was good agreement between the near-patient analyzer and the laboratory for pH, PCO2, sodium, potassium, ionized calcium, and hematocrit. Bias and precision were 0.006 and 0.03 for pH, 0.03 and 0.34 kPa for PCO2, 0.78 and 2.61 mmol/L for sodium, -0.11 and 0.12 mmol/L for potassium, -0.007 and 0.05 mmol/L for ionized calcium, and -0.99 and 1.33% for hematocrit. Bias between the laboratory instrument and the bedside analyzer was small for PO2 (-0.56 kPa). However, precision between instruments was significantly higher (2.39 kPa for all PO2 values and 1.61 kPa for PO2 < or = 13 kPa). CONCLUSIONS: The test instrument is accurate and reproducible when used in the clinical setting by non-laboratory-trained individuals. Non-laboratory-trained individuals can obtain laboratory results in the near-patient setting comparable to those obtained by trained laboratory technologists.

Blood Gas Analysis↗
PubMed1993

Human sepsis increases lymphocyte intracellular calcium.

OBJECTIVE: To determine whether free intracellular calcium is increased during human bacterial sepsis. DESIGN: Prospective controlled study of lymphocyte free intracellular calcium concentrations from patients with sepsis compared with critically ill nonseptic patients and healthy subjects. SETTING: A large multidisciplinary ICU of a university hospital. PATIENTS: Eleven patients with sepsis, six patients after cardiac surgery, six patients with head injury, and 22 healthy control subjects. INTERVENTIONS: Blood samples obtained for lymphocyte isolation and measurement of free intracellular calcium concentrations. MEASUREMENTS: Lymphocytes were isolated using Ficoll-paque centrifugation and free intracellular calcium concentrations were measured using the fluorescent dye fura-2. We also evaluated the effect of septic serum, endotoxin, tumor necrosis factor (TNF), and lysophosphatidylcholine on lymphocyte free intracellular calcium concentrations. MAIN RESULTS: Mean (+/- SEM) lymphocyte free intracellular calcium concentrations were significantly (p < .05) higher in the septic patients (176 +/- 12 nM) compared with cardiac surgical (112 +/- 9 nM), head-injured (110 +/- 11 nM), or healthy control patients (112 +/- 5 nM). Endotoxin (0.1 and 1.0 mg/mL) and TNF (10 and 100 ng/mL) did not alter lymphocyte free intracellular calcium values. Lysophosphatidylcholine (100 and 200 microM) significantly increased lymphocyte free intracellular calcium in a dose-dependent manner. Septic serum had no effect on resting lymphocyte free intracellular calcium concentrations but potentiated the free intracellular calcium response to lysophosphatidylcholine. CONCLUSIONS: Lymphocyte intracellular calcium homeostasis is altered during human sepsis. In addition, circulating factors present in septic serum are capable of altering cellular calcium handling.

Adolescent↗
PubMed1993

Gut bacterial translocation/dissemination explains the increased mortality produced by parenteral nutrition following methotrexate.

Mortality is reported to be higher in methotrexate (MTX)-treated animals receiving total parenteral nutrition (TPN), compared to animals receiving enteral nutrition. The increased mortality is felt to be related to gut atrophy and bacterial translocation. In this study, we examined the effect of MTX (30 mg/kg) on survival, body weight loss, gut mass, and gut bacterial translocation in rats randomized to TPN or enteral nutrition. Twenty-four male Sprague-Dawley rats (n = 8 per group) were randomized to TPN, a peptide-based enteral diet (PEP), or CHOW. Animals were weighed daily and followed for survival (6 days). A separate group of rats (n = 6 per group) were similarly randomized and sacrificed at 3 days. Mesenteric lymph node complex, liver, spleen, lung, and blood were cultured for translocating bacteria. Body weight loss was similar in all groups (12.0-16.9 g/day). Mortality was significantly (P < 0.05) higher in the TPN animals (100%), compared to PEP (50%) and CHOW (25%) fed animals. All tissues in the TPN animals contained large quantities of bacteria, while most tissues in the CHOW group were free of bacteria. Bacterial counts in the PEP tissues were intermediate between TPN and CHOW. There were no significant differences between groups for gut weights or mucosal protein content. This study supports a direct relationship between bacterial translocation and mortality in rats following MTX.

Animals↗
PubMed1992

Immediate postoperative enteral feeding decreases weight loss and improves wound healing after abdominal surgery in rats.

OBJECTIVE: To determine the effect of immediate vs. delayed (72 hrs) postoperative enteral feeding on weight loss and wound healing after experimental abdominal surgery. DESIGN: Prospective, randomized, controlled study. SETTING: Laboratory of a large university-affiliated medical school. SUBJECTS: Seventeen male Sprague-Dawley rats, each weighing 350 to 400 g. INTERVENTIONS: Four-centimeter longitudinal midabdominal incisions were made and gastroduodenal feeding tubes were inserted in the animals. The abdominal wound was closed in two layers. Immediately after closure, animals were randomized to receive immediate enteral feeding (early-fed group) with a peptide-based enteral formula or 5% dextrose in water at 4 mL/hr. Seventy-two hours after surgery, the 5% dextrose in water group was switched to the peptide formula (late-fed group). Animals were weighed daily. On postoperative day 5, the strength of the abdominal wound was determined using a balloon-bursting pressure technique. Blood was also obtained for measurement of insulin growth factor 1 concentrations. Mucosal protein content of the small bowel was measured. RESULTS: Total body weight loss was less in the early-fed group (26 +/- 4 vs. 46 +/- 5 g/5 days) and wound strength was increased in the early-fed group compared with the late-fed group (6 +/- 0.4 vs. 2.9 +/- 0.8 kPa; 45 +/- 3 vs. 22 +/- 6 mm Hg). There were no differences between groups for circulating insulin growth factor 1 concentrations or small intestinal mucosal protein concentrations. CONCLUSIONS: Immediate postoperative enteral feeding results in decreased weight loss and improved wound healing after abdominal surgery in rats.

Animals↗
PubMed1992

Low dose calcium administration increases mortality during septic peritonitis in rats.

Calcium is essential for normal cellular function. However, increases in cell calcium are also involved in cellular dysfunction and death by activating destructive enzymatic processes such as proteases, nucleases, and lipases. Since ionized hypocalcemia is common during sepsis, calcium is often administered in an attempt to normalize circulating levels. Previous studies using endotoxin and large amounts of calcium demonstrated increased mortality in calcium-treated animals. This study extends these preliminary data to endogenous sepsis (cecal ligation) and low dose calcium therapy. Sprague Dawley rats (n = 9 per group) had jugular catheters placed and their cecums ligated. They were randomized to an infusion of D5W at 1 ml/hr, calcium chloride at 4 mg/ml/hr (Low Ca), or calcium chloride at 6 mg/ml/hr (High Ca) for 24 hr. An additional group of animals received calcium chloride at 6 mg/ml/hr but had no surgery. Animals were followed for 24 hr survival. A separate group of animals (n = 6 per group) was prepared in a similar manner. Blood was obtained 6 hr following cecal ligation for circulating endotoxin concentrations, and animals were sacrificed. Calcium infusion increased ionized calcium levels slightly (low Ca, 1.12 +/- .06 to 1.21 +/- .09; high Ca, 1.06 +/- .04 to 1.16 +/- .05; P less than 0.05). Survival (24 hr) was 100% in the nonseptic controls and D5W septic animals, 67% in the low Ca septic group, and 44% (P less than 0.05) in the high Ca septic group.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1991

Total parenteral nutrition increases mortality after hemorrhage.

OBJECTIVES: To determine the effect of total parenteral nutrition (TPN) and different enteral feeding formulas on survival and liver function following hemorrhage in rats. DESIGN: Prospective randomized controlled study. SETTING: Laboratory of a large university-affiliated medical school. SUBJECTS: Sixty-seven male Sprague-Dawley rats weighing 350 to 450 g. INTERVENTIONS: Jugular and gastroduodenal feeding catheters were inserted in animals 1 day before hemorrhage, and animals were started on one of six different fluid or nutritional regimens: TPN, iv saline, an enteral amino acid-based formula (AA) (Vivonex-TEN), an enteral peptide-based formula (PEP) (Reabilan-HN), an enteral intact-protein based formula (PRO) (Osmolite-HN), or enteral saline. A catheter was inserted in the tail artery and animals were hemorrhaged 5 mL/kg at baseline and 1 hr later. Animals were returned to their cages and observed for survival. Liver function was determined by measuring circulating bile acid levels at baseline and 24 hr after hemorrhage. MEASUREMENTS AND MAIN RESULTS: Mortality was significantly increased in animals receiving TPN (63%) and AA (24%). Mortality was 13% in animals receiving PRO and 0% in animals receiving PEP and saline. Liver function deteriorated in all animals after hemorrhage except the PEP group. CONCLUSIONS: TPN and AA increased mortality in animals after hemorrhage. PEP was associated with zero mortality and protection of liver function after hemorrhage.

Amino Acids↗
PubMedDate not supplied

Effect of rate of enteral nutrient supply on gut mass.

Early enteral feeding after injury is important for maintenance of gut integrity. However, enteral nutrients are frequently administered at low rates because of decreased gastrointestinal motility. These low rates are said to "maintain the gut." This study was performed to evaluate the effect of rate of enteral nutrient delivery on gut mass. Six male Sprague-Dawley rats had no surgery and served as controls (ad libitum rat chow diet). Twenty-four male Sprague-Dawley rats underwent abdominal surgery for placement of gastroduodenal feeding tubes (tip located 2 cm into intestine from pylorus) and were randomized (n = 6 per group) to ad libitum rat chow, 1/2 strength peptide diet (Reabilan HN, RHN) at 1 mL/h (1/2RHN-1 mL), full-strength peptide diet at 2 mL/h (RHN-2 mL), or full-strength peptide diet at 4 mL/h (RHN-4 mL). These diets supplied approximately 30%, 13%, 50%, and 100% of rat recommended daily allowances. The control animals gained weight (38 +/- 3 g over 5 days) whereas all postsurgery animals lost weight. Weight loss was greatest in the 1/2 RHN-1 mL (-55 +/- 3 g over 5 days) and RHN-2 mL (-52 +/- 6 g over 5 days) groups compared with the RHN-4 mL animals (-41 +/- 5 g over 5 days). All animals fed liquid enteral diets had reduced gut weights compared with chow-fed animals. Gut weights did not differ between control and postsurgery ad libitum chow animals.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗