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Biomedical subjects

S Bursztein

Publications and source records attributed to S Bursztein.

At least 19 recordsLinked to original sources
PubMed1998

Comparison of sodium bicarbonate, Carbicarb, and THAM during cardiopulmonary resuscitation in dogs.

OBJECTIVES: During cardiopulmonary resuscitation (CPR), elimination of CO2 was shown to be limited by low tissue perfusion, especially when very low perfusion pressures were generated. It has therefore been suggested that sodium bicarbonate (NaHCO3), by producing CO2, might aggravate the hypercarbic component of the existing acidosis and thereby worsen CPR outcome. The objectives of this study were to evaluate the effects of CO2 producing and non-CO2 producing buffers in a canine model of prolonged ventricular fibrillation followed by effective CPR. DESIGN: Prospective, randomized, controlled, blinded trial. SETTING: Experimental animal research laboratory in a university research center. SUBJECTS: Thirty-eight adult dogs, weighing 20 to 35 kg. INTERVENTIONS: Animals were prepared for study with thiopental followed by halothane, diazepam, and pancuronium. Ventricular fibrillation was electrically induced, and after 10 mins, CPR was initiated, including ventilation with an FIO2 of 1.0, manual chest compressions, administration of epinephrine (0.1 mg/kg every 5 mins), and defibrillation. A dose of buffer, equivalent to 1 mmol/kg of NaHCO3, was administered every 10 mins from start of CPR. Animals were randomized to receive either NaHCO3, Carbicarb, THAM, or 0.9% sodium chloride (NaCl). CPR was continued for up to 40 mins or until return of spontaneous circulation. MEASUREMENTS AND MAIN RESULTS: Buffer-treated animals had a higher resuscitability rate compared with NaCl controls. Spontaneous circulation returned earlier and at a significantly higher rate after NaHCO3 (in seven of nine dogs), and after Carbicarb (six of ten dogs) compared with NaCl controls (two of ten dogs). Spontaneous circulation was achieved twice as fast after NaHCO3 compared with NaCl (14.6 vs. 28 mins, respectively). Hydrogen ion (H+) concentration and base excess, obtained 2 mins after the first buffer dose, were the best predictors of resuscitability. Arterial and mixed venous Pco2 did not increase after NaHCO3 or Carbicarb compared with NaCl. CONCLUSIONS: Buffer therapy promotes successful resuscitation after prolonged cardiac arrest, regardless of coronary perfusion pressure. NaHCO3, and to a lesser degree, Carbicarb, are beneficial in promoting early return of spontaneous circulation. When epinephrine is used to promote tissue perfusion, there is no evidence for hypercarbic venous acidosis associated with the use of these CO2 generating buffers.

Animals↗
PubMed1995

Necrotizing fasciitis: an indication for hyperbaric oxygenation therapy?

BACKGROUND: The accepted treatment protocol for necrotizing fasciitis (NF) consists of extensive surgery and wide spectrum antibiotics. Hyperbaric oxygenation (HBO) has been recommended as adjuvant therapy for NF, improving patient mortality and outcome. However, the beneficial effect of HBO for NF remains controversial. METHODS: A retrospective evaluation of treatment outcome in 37 patients treated for NF between 1984 and 1993 was carried out. The mortality rate, morbidity criteria, and risk factors for grave prognosis were compared between a group of 25 patients who received HBO as part of their treatment protocol and a group of the remaining 12 patients treated by surgical excision and antibiotics alone. RESULTS: The two groups were found to be similar with regard to age, gender, the incidence of individual risk factors for ominous prognosis, and the Acute Physiology and Chronic Health Evaluation (APACHE) II score for disease's severity on presentation. The mortality rate among the HBO-treated patients was 36%, as opposed to 25% in the non-HBO group. The mean number of surgical débridements required per patient was significantly higher in the HBO group: 3.3 compared with 1.5 in the non-HBO-treated patients. Although the average length of hospitalization for survivors was shorter for the HBO group, the difference between the groups did not reach statistical significance. CONCLUSIONS: The results of this study cast doubt on the suggested advantage of HBO in reducing patient mortality and morbidity when used as adjuvant therapy for NF.

Adolescent↗
PubMed1995

Intraosseous regional anesthesia as an alternative to intravenous regional anesthesia.

A series of 109 orthopedic operations was performed under intraosseous regional anesthesia on the upper and lower limbs. Anesthesia was satisfactory in 106 of the cases; in the other three, inadequate anesthesia was caused by faulty technique. The spread of lidocaine into the bone and venous network was demonstrated by radiography, and the blood levels after tourniquet release were below the toxic level. Intraosseous regional anesthesia proved to be a valuable technique to be used whenever intravenous anesthesia fails or is not feasible. Injection into cancellous bone (osteoclysis) is easily and quickly performed under aseptic conditions, and there were no systemic complications.

Adult↗
PubMed1994

Influence of continuous haemofiltration-related hypothermia on haemodynamic variables and gas exchange in septic patients.

OBJECTIVE: To investigate the influence of continuous haemofiltration (CHF) on haemodynamics, gas exchange and core temperature in critically ill septic patients with acute renal failure. PATIENTS AND METHODS: In 20 patients (17 male, 3 female) ultrafiltration rate, core temperature, gas exchange and haemodynamic variables were measured at regular intervals during the first 48 h of haemofiltration. Baseline data were compared to those obtained 30 min after initiating CHF and also to those during hypothermia (if observed). MAIN RESULTS: Haemodynamic variables remained remarkably constant throughout the study period. In patients with a relatively low ultrafiltration rate (855 +/- 278 ml/h) temperature did not change, while in patients with a high ultrafiltration rate (1468 +/- 293 ml/h) core temperature significantly decreased from 37.6 +/- 0.9 degrees C to 34.8 +/- 0.8 degrees C (p < 0.001). There was a statistically significant correlation between temperature decrease and ultrafiltration rate (r = -0.68, Y = 1.8-0.003 X, p < 0.01). Hypothermic patients also showed a mean decrease in VO2 from 141 +/- 22 ml/min/m2 to 112 +/- 22 ml/min/m2 (p < 0.01) with a concomitant increase in PaO2 from 103 +/- 37 mmHg to 140 +/- 42 mmHg (p < 0.001) and in PvO2 from 35 +/- 4 mmHg to 41 +/- 5 mmHg (p < 0.001). CONCLUSIONS: 1) Continuous haemofiltration does not cause significant alternations in haemodynamic variables. 2) Hypothermia frequently occurs in patients undergoing continuous haemofiltration with high ultrafiltration rates. These hypothermic patients show a reduction in VO2 leading to an increase in PvO2 and PaO2. This mild hypothermia in these circumstances has no evident deleterious effects.

Acute Kidney Injury↗
PubMed1993

Left ventricular function in patients with acute myocardial infarction, acute pulmonary edema, and mechanical ventilation: relationship to prognosis.

OBJECTIVES: To evaluate the relationship between left ventricular function and prognosis in patients treated with mechanical ventilation for severe, persistent pulmonary edema as a consequence of acute myocardial infarction. DESIGN: A prospective study. SETTING: A nine-bed coronary care unit in a 900-bed teaching hospital. PATIENTS: Sixty-nine successive patients. INTERVENTIONS: All patients had acute pulmonary edema not responding to classical treatment and were treated with mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: The inhospital mortality rate was 67%. Thirteen of 23 patients surviving hospitalization died during follow-up, a mean of 5.8 +/- 7.7 months after infarction. Six of ten long-term survivors are in functional capacity class 1 or 2 (New York Heart Association) and four survivors are in class 3. Echocardiographic examination indicated that severe left ventricular dysfunction was present in most patients during the time of mechanical ventilation. Repeat echocardiographic examination performed 14.2 +/- 8.1 months after infarction showed a remarkable improvement in left ventricular function among the survivors. Multivariate analysis indicated that the small group of patients with a good long-term prognosis could not be separated prospectively from the larger group dying during or after hospitalization using variables obtained at the time of mechanical ventilation. CONCLUSIONS: The mortality rate is high in this group of patients. Left ventricular function of survivors is severely diminished at the time of infarction but improves markedly during follow-up. The small subgroup of patients with a good long-term prognosis cannot be identified prospectively when evaluated during the acute stage of infarction and the provision of mechanical ventilation.

Acute Disease↗
PubMed1992

Hypercaloric glycerol in injured patients.

BACKGROUND: This study investigates the effects of glycerol as a fuel source in the hypermetabolic patient (after injury). METHODS: Twenty-two patients were studied after multiple trauma and randomly assigned to either glucose or glycerol as the carbohydrate source (220 gm glycerol or 320 gm dextrose) during a lipid-based system of parenteral nutrition. In the immediate postoperative period, measurements were made of nitrogen balance, substrates, energy expenditure, insulin, glucagon, and liver function tests. RESULTS: In the glycerol group glucose concentrations in plasma were significantly lower, whereas glycerol levels increased nearly twentyfold. Insulin and glucagon levels increased in both groups; however, the rise in insulin level was greater in the glucose group, whereas glucagon increased in both groups to a similar degree. Nitrogen balance was restored to equilibrium in the glycerol group while remaining negative in the glucose group. No abnormalities in liver function test results or differences in serum albumin levels were noted in either group. A 12% thermic effect was noted in the glucose group but not in the glycerol group. CONCLUSIONS: Glycerol seems to be a viable fuel source in the traumatized patient, being associated with nitrogen retention and minimal thermal effect. A marked rise in plasma levels of glycerol does occur, but this does not appear to have any associated toxicity.

Adolescent↗
PubMed1990

Reassessing intensive care for patients with the acquired immunodeficiency syndrome.

The number of patients with the acquired immunodeficiency syndrome (AIDS) admitted to hospitals is increasing dramatically. Treatments such as zidovudine, aerosolized pentamidine, and nutritional support are being administered to subacutely ill patients with increasing effectiveness. The number of patients with AIDS treated in intensive care units, on the other hand, has been decreasing progressively, perhaps as a result of a mortality rate close to 90%. However, because recent data demonstrate (1) a lower mortality rate in patients with AIDS who receive mechanical ventilation and (2) the ability to reverse the wasting syndrome in selected groups, we propose a reassessment of the criteria for intensive care unit admission of patients with AIDS.

AIDS-Related Complex↗
PubMed1989

A mathematical analysis of indirect calorimetry measurements in acutely ill patients.

Beside indirect calorimetry is generally accepted as reliable for evaluating energy expenditure (EE) and oxidation of carbohydrate (dCH) and fat (dF) in critically ill patients. Daily measurement of nitrogen excretion is usually included in the calculation of EE, dCH, and dF but it is difficult to perform in the clinical setting and is not necessary for accurate determination of EE. In this paper new equations, which are suitable for use with critically ill patients, are given for calculating EE, dCH, and dF without N-excretion measurements. With these equations the maximum errors for EE, dCH, and dF were 56, 179, and 306 kcal/d, respectively. The mean errors in 38 measurements of 26 critically ill patients were 27, 86, and 143 kcal/d, respectively. Measurement of EE by these equations is very accurate and suitable for both research and clinical use. Although the calculation of dCH and dF is much less precise, it can still given an indication of fuel utilization.

Acute Disease↗
PubMed1986

Central vein catheterization. Failure and complication rates by three percutaneous approaches.

We prospectively studied the results of 714 attempts at central venous catheterization during an eight-month period in our intensive care department. We compared the rates of failure of catheterization and early complications among three percutaneous approaches: subclavian, anterior jugular, and posterior jugular veins. The procedures were performed by experienced staff or resident physicians and inexperienced interns and residents under teaching supervision. Overall rates of failure and complication were similar for each percutaneous approach within each group of physicians. Overall failure rate was 10.1% for the experienced group and 19.4% for the inexperienced. The complication was 5.4% for experienced and 11% for inexperienced. Among inexperienced physicians, the success rate was 86.7% and the complication rate 7.6% in unconscious patients, whereas in conscious patients these rates were 70.5% and 13.8%, respectively. The inexperienced physicians caused fewer complications in mechanically ventilated than in spontaneously breathing patients. We suggest that inexperienced physicians should first attempt central vein catheterizations in unconscious and mechanically ventilated patients.

Adolescent↗
PubMed1986

Early use of naloxone in shock--a clinical trial.

Naloxone hydrochloride (N) 0.4-1.2 mg i.v. was administered during 10 episodes of shock (8 septic and 2 cardiogenic) in 9 adult patients. Shock was defined as systolic blood pressure (SBP) less than or equal to 90 mmHg and urine output less than 0.5 ml/h and signs and symptoms of hypoperfusion lasting for greater than or equal to 30 min, despite fluid loading to a CVP 5 cmH2O above baseline. N was given as early as 30 min after onset of shock and resulted in an increase of SBP from a mean of 75 +/- 10 to a mean of 130 +/- 25 mmHg maximum (P less than 0.01). Within 10-60 min urine output increased from 16 +/- 12 to 122 +/- 56 ml/h, heart rate, CVP and arterial blood gas tensions remained unchanged. No side effects were observed. Naloxone, even in small doses, may improve hemodynamic parameters in human shock, provided it is administered very early.

Adult↗
PubMed1986

Sodium poisoning: a lethal case of a burned child.

An unusual case of lethal salt poisoning of a burned child is presented. Excessive hypernatraemia and hyperosmolality resulted in an irreversible cascade of events which lead to death despite vigorous attempts to rescue the victim.

Administration, Topical↗
PubMed1985

Effect of metoclopramide--a dopaminergic blocker and endogenous cortisol on TSH secretion in critically ill men.

In 17 critically ill men, low levels of FT4, TT4, TT3 and elevated levels of rT3 and cortisol were found. In spite of the low levels of circulating thyroid hormones, TSH levels of the critically ill men were significantly lower than those of the control group, with no correlations to the high cortisol levels. After iv injection of metoclopramide (MCP), a dopamine (DA) receptor blocker, the TSH and prolactin (Prl) increments in the critically ill patients were significantly lower than in the controls. No correlation was observed between basal cortisol levels and integrated TSH response to MCP. It is suggested that increased DA tone or high cortisol levels are not responsible for the lower basal TSH levels and for the blunted TSH or Prl responses to MCP in the critically ill. High levels of cortisol may be responsible for the altered TT4 peripheral metabolism to TT3 and rT3 in these patients.

Adult↗