PubMed Health⌕ Search

Biomedical subjects

S G Peters

Publications and source records attributed to S G Peters.

14 recordsLinked to original sources
PubMed1992

Intubation of critically ill patients.

Respiratory failure is one of the most common causes for admission to an intensive-care unit. Any patient with loss of central nervous system control of breathing, neuromuscular respiratory failure, or impairment of gas exchange may require tracheal intubation and mechanical ventilation. Tracheal intubation provides a conduit for ventilatory support, maintains the patency of an airway that has potential for obstruction, protects the airway from the contents of the stomach, and allows access to the trachea for pulmonary hygiene. Although the mechanics of intubation are easily learned, many factors must be considered in critically ill patients. Herein we summarize the principles of tracheal intubation in acutely ill patients.

Critical Care↗
PubMed1992

Outcome of recipients of bone marrow transplants who require intensive-care unit support.

To determine the outcome and prognostic factors associated with bone marrow transplantation (BMT), we reviewed the clinical course of 35 adult recipients of such a transplant who were admitted to our intensive-care unit (ICU). This constituted 24% of patients who underwent BMT for treatment of hematologic disorders during the study period. The reasons for admission to the ICU were postsurgical care in 5, respiratory failure in 25, shock in 4, and renal failure in 1. The in-hospital mortality was 20% for the postsurgical patients and 87% for the others. None of the postsurgical patients required mechanical ventilation, whereas 90% of the others did, and the associated mortality was 93%. Infection was the cause of the respiratory failure in all but 3 of the 25 patients and was associated with 95% mortality. Complications that involved multiple organs increased the mortality to 100%. No significant differences were found in age, sex, type of BMT, serologic tests for cytomegalovirus, history of graft-versus-host disease, conditioning regimen for BMT, and duration of stay in the ICU and the hospital between survivors and nonsurvivors. The APACHE II (acute physiology and chronic health evaluation) prognostic scoring system underestimated mortality and had no correlation with the duration of stay in the ICU or the hospital. Vasopressors, total parenteral nutrition, and transfusion of blood components in the ICU had no influence on the outcome. Open-lung biopsy was helpful in making specific diagnoses, and pulmonary artery catheters were used in most patients to guide therapy but did not improve survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Academic Medical Centers↗
PubMed1992

Portal and peripheral blood short chain fatty acid concentrations after caecal lactulose instillation at surgery.

The major end products of fermentation, short chain fatty acids (acetate, propionate, butyrate) were measured in portal and peripheral venous blood after the caecal instillation of lactulose at surgery in patients undergoing elective cholecystectomy. Blood samples for short chain fatty acid measurement were taken before and at 15 minute intervals up to 60 minutes after caecal instillation of either 20 ml sterile saline or 6.7 g or 10 g lactulose. Fasting concentrations (n = 28) were (mumol/l, mean (SD)); portal acetate 128.0 (70.8), propionate 34.4 (23.3), butyrate 17.6 (18.4); peripheral acetate 67.0 (23.0), propionate 3.7 (1.2), butyrate traces only. After lactulose there was a rapid rise in portal short chain fatty acids with peak concentrations being reached in 15 to 45 minutes. Mean peak concentrations (mumol/l (SD)) after 10 g lactulose were acetate 240.9 (142.2), propionate 39.0 (17.8) and butyrate 26.9 (17.6). The changes in acetate concentrations seen in portal blood were reflected in peripheral blood acetate measurements. In contrast with portal blood, only small amounts of propionate and traces of butyrate were found in peripheral blood.

Adult↗
PubMed1991

Radiology in the intensive-care unit.

Portable chest radiography is an essential component of clinical patient management in the intensive-care unit. With routine use of this procedure, unexpected cardiopulmonary abnormalities are frequently detected, and malposition or complications of intravascular devices and endotracheal, thoracostomy, or nasogastric tubes are also commonly found. The pulmonary parenchyma may be assessed for changes of acute lung injury, cardiogenic edema, areas of pneumonitis, atelectasis, or other abnormal collections of fluid or air. In mechanically ventilated patients, barotrauma occurs frequently and may be manifested by subtle intrathoracic collections of air. Technical factors may limit the resolution of the anteroposterior chest radiograph obtained at the bedside, but crucial clinical information is often gained. Portable chest radiographic findings, the role of computed tomography and ultrasonography, and interventional radiologic procedures pertinent to patients in the intensive-care unit are reviewed.

Critical Care↗
PubMed1990

Infections related to central venous catheters.

Infection is a potentially life-threatening complication of central venous catheterization. Although line-related bacteremias and sepsis are relatively uncommon, the frequent use of central lines in the intensive-care unit makes these infections a common consideration. Semiquantitative culture techniques for analysis of the catheter tip provide evidence for the diagnosis of catheter-related infections. Bacterial growth of more than 15 colony-forming units/plate is typically considered significant. Preventive measures include using sterile insertion techniques, providing meticulous care for the local site, and minimizing the duration of catheter use. The practice of changing lines over a guidewire is controversial. For treatment of most catheter-related infections, the catheter should be removed and antibiotics should be administered if associated systemic infection occurs.

Catheterization, Central Venous↗
PubMed1990

Unilateral bronchospasm during pleurodesis in an asthmatic patient.

A case of unilateral bronchospasm during pleurodesis in a patient with a history of recurrent pneumothorax and asthma is presented. The etiology of this event is not clear; however, it likely includes reflex parasympathetic bronchoconstriction due to physical stimulation of the pleural surface during pleurodesis. Treatment involved independent lung ventilation, corticosteroids, and aminophylline.

Adult↗
PubMed1989

Intensive-care unit experience in the Mayo liver transplantation program: the first 100 cases.

The first 100 liver transplantations at the Mayo Clinic were performed in 83 patients, who required a total of 917 patient days in the intensive-care unit (ICU). The mean duration of stay in the ICU was 5.91 days after liver transplantation and 6.15 days for patients who subsequently required readmission to the ICU. During the immediate postoperative period, hypothermia and hyperglycemia invariably occurred. Later during the initial admission or on readmission to the ICU, there arose the possibility of infections and renal insufficiency. Prompt diagnosis and treatment are necessary for hypertension, hypokalemia, severe metabolic alkalosis, fever, altered mental status, oliguria, and signs of graft failure in liver transplant patients. In our patient series, selective bowel decontamination minimized the occurrence of gram-negative and fungal sepsis, and use of antihypertensive agents and correction of coagulopathies may have decreased the risk of intracranial bleeding in patients with hypertension and clotting defects. Anticipation of potential conditions postoperatively and early implementation of treatment are key factors in the successful ICU management of patients who have undergone liver transplantation.

Adolescent↗
PubMed1988

Home mechanical ventilation.

Recently, interest in the use of mechanical ventilation outside the hospital setting has been increasing. Patients with various types of chronic respiratory failure may benefit from this approach. Evaluation for long-term mechanical ventilation necessitates assessment of the underlying disease process, the goals of the medical team, and the needs of the patient and family. Externally applied negative-pressure devices can provide adequate ventilation for many patients, particularly those with neuromuscular diseases. Positive-pressure ventilation by means of a tracheostomy provides greater control of the airway, allows adjustment of tidal volume and minute ventilation, and may be delivered by portable equipment. Ongoing care and support services in the home must be provided. A variety of mechanical devices and new techniques of ventilator support have made home mechanical ventilation a realistic option for long-term care.

Adult↗
PubMed1988

Outcome of respiratory failure in hematologic malignancy.

We reviewed records of patients with hematologic malignancy requiring mechanical ventilation (MV) from 1976 to 1985 (excluding postoperative MV less than 48 hours). There were 119 episodes in 116 patients. In-hospital mortality was 82 percent. Of 21 (18 percent) episodes survived, median duration of survival was 12 months. Survivors did not differ from nonsurvivors in age, leukocyte count, or duration of MV. Survival for chronic lymphocytic leukemia was 42 percent, for other leukemias 16 percent, Hodgkin's disease 29 percent, and non-Hodgkin's lymphomas, 6 percent. Bronchoscopy was performed in 28 patients, resulting in a diagnosis of infection, hemorrhage, or malignancy in 19 cases. Open lung biopsy (OLB) was obtained in 23 patients, yielding a diagnosis of interstitial inflammation or fibrosis (13 cases), drug effect (three), malignancy (two), hemorrhage (one), Pneumocystis (seven), aspergillosis (two), and Legionella (one). Only two patients survived following OLB. Despite intensive management and adequate diagnosis, respiratory failure in patients with hematologic malignancy carries a high mortality. Although these data may help identify groups with a limited prognosis for long-term recovery, patient care must be individualized.

Female↗
PubMed1987

Pneumocystis carinii pneumonia. Review of 53 cases.

Between 1976 and 1983, 53 cases of Pneumocystis carinii pneumonia were documented at the Mayo Clinic. Underlying diseases included leukemia in 15 patients, lymphoma in nine, nonhematologic malignancies in five, acquired immune deficiency syndrome in two, an various inflammatory diseases treated by corticosteroids in 16 patients. Cytotoxic drugs with corticosteroids were used in 68 percent of patients, whereas 23 percent received corticosteroids alone. Clinical features consisted of progressive dyspnea (74 percent), cough (55 percent), and fever (62 percent), with normal findings on examination (43 percent), or crackles (53 percent). Arterial oxygen tension and oxygen saturation were 48.6 +/- 12.8 mm Hg and 81.2 +/- 6.5 percent, respectively. Chest roentgenographs exhibited diffuse alveolar and interstitial infiltrates with predominantly perihilar distribution. The diagnostic rates for open lung biopsy and bronchoscopy were 97 percent and 62 percent, respectively. Clinical improvement and survival following appropriate therapy were noted in 22 patients (41.5 percent), whereas the remaining 31 patients died within four weeks of hospitalization. When survivors were compared with nonsurvivors, there was no difference in mean age, leukocyte counts, arterial oxygen tension, or duration of symptoms before treatment. A coexisting pulmonary infection was identified more frequently in nonsurvivors (51.6 percent) than in survivors (22.7 percent, p = 0.01). The mortality from P. carinii pneumonia alone was 47 percent, whereas 76 percent of those with coexisting infection died. Despite antibiotic therapy and potentially effective chemoprophylaxis, P. carinii pneumonia remains a significant and life-threatening complication of diseases or treatments associated with immune suppression.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Effects of the fibre components pectin, cellulose, and lignin on bile salt metabolism and biliary lipid composition in man.

Randomised crossover studies in three separate groups of 10 healthy volunteers were undertaken to determine the effects of biliary lipid composition and bile salt metabolism of daily dietary supplementation for four weeks with the purified fibre components pectin (12 g/day), cellulose (15 g/day) and lignin (12 g/day). The subjects' biles were initially unsaturated with cholesterol and no significant changes in the lithogenic indices or mean percentages of cholesterol, phospholipid, or total bile acids after any of the supplements were observed. After pectin, the mean (+/- SD) percentage of cholic acid decreased significantly from 42.8 (+/- 10.8) to 39.0 (+/- 11.2), the mean (+/- SD) percentage of deoxycholic acid increased significantly from 18.2 (+/- 13.7) to 25.4 (+/- 13.5) and C14-deoxycholate metabolites were raised significantly by 65%. After cellulose, the mean (+/- SD) percentage of chenodeoxycholic acid was increased significantly from 33.6 (+/- 6.3) to 35.4 (+/- 7.0), the mean (+/- SD) percentage of deoxycholic acid decreased significantly from 18.6 (+/- 9.6) to 14.2 (+/- 8.3) and C14-deoxycholate metabolites halved. Lignin did not exert any significant effects. Though these results show that individual fibre components are associated with quite different effects on bile acid metabolism, in the short term no significant effect on biliary cholesterol saturation was observed in bile initially unsaturated with cholesterol. The bile acid changes most likely result from the different effects on colonic metabolism induced by the individual fibre components.

Adult↗
PubMed1986

A canine model of bronchial injury induced by nitric acid. Lung mechanics and morphologic features.

We created a model of airway obstruction that avoids long-term toxic exposure. Bronchial injury was induced in 7 dogs by exposure to nebulized 1% nitric acid (HNO3) on alternate days for 4 wk. Lung mechanics were measured prior to exposure and after 2 and 4 wk. Both TLC and VC decreased and the FRC/TLC ratio increased. Expiratory flows decreased while breathing air and an 80% helium-20% oxygen mixture; the volume of isoflow increased. Pulmonary resistance increased and dynamic compliance decreased. On single-breath nitrogen washout, there were increases in the slope of phase III and in closing capacity. Histologically, there was widespread chronic airway inflammation, slight epithelial changes, slight peribronchiolar fibrosis, and an increase in smooth muscle. Pathologic scores were significantly higher in the HNO3-exposed group than in the control group. Scores for peripheral and central airway pathology were correlated with results of tests of airway obstruction.

Airway Resistance↗
PubMed1985

The effects of the fiber components pectin, cellulose and lignin on serum cholesterol levels.

Eight-week randomized cross-over studies in three separate groups of 10 healthy volunteers were undertaken to determine the effects of daily dietary supplementation with pectin (12 g/day), cellulose (15 g/day) and lignin (12 g/day) on serum lipid levels. Detailed dietary records were kept throughout the study and there was no significant change in dietary intakes except for the fiber supplement. Neither pectin, cellulose, nor lignin significantly altered serum total cholesterol, triglycerides, high-density lipoprotein cholesterol, or the ratio of high-density lipoprotein to total cholesterol in healthy normolipidemic subjects over four weeks.

Adult↗