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Biomedical subjects

S K Pingleton

Publications and source records attributed to S K Pingleton.

At least 55 records · Page 3Linked to original sources
PubMed1983

Complications of acute respiratory failure.

Acute respiratory failure is frequently fatal. Attempts to decrease mortality must include attention to pulmonary and extrapulmonary complications. Pulmonary complications include pulmonary emboli, barotrauma, fibrosis, and pneumonia. Swan-Ganz catheters, tracheal intubation, and mechanical ventilation can also result in pulmonary complications. Extra-pulmonary complications such as gastrointestinal hemorrhage, renal failure, infection, and thrombocytopenia may increase mortality. Early diagnosis, aggressive treatment, and prophylaxis of complications should increase survival.

Acute Disease↗
PubMed1983

Bronchoscopic photography of a bronchial carcinoid tumor associated with unilateral hypoperfusion of the lung.

A patient with a bronchial carcinoid-producing unilateral hypoperfusion of the lung is described. Bronchoscopic photographs show the adenoma to assume different intrabronchial positions during inspiration and expiration. Although patent during inspiration, the lumen was effectively occluded during expiration. The adenoma exhibited a ball-valve movement which is speculated to be the initial mechanism of hypoperfusion in this setting.

Bronchial Neoplasms↗
PubMed1983

Enteral alimentation and gastrointestinal bleeding in mechanically ventilated patients.

The incidence of upper gastrointestinal (GI) bleeding in mechanically ventilated ICU patients receiving enteral alimentation was reviewed and compared to bleeding occurring in ventilated patients receiving prophylactic antacids or cimetidine. Of 250 patients admitted to our ICU during a 1-yr time period, 43 ventilated patients were studied. Patients in each group were comparable with respect to age, respiratory diagnosis, number of GI hemorrhage risk factors, and number of ventilator, ICU, and hospital days. Twenty-one patients had evidence of GI bleeding. Fourteen of 20 patients receiving antacids and 7 of 9 patients receiving cimetidine had evidence of GI bleeding. No bleeding occurred in 14 patients receiving enteral alimentation. Complications of enteral alimentation were few and none required discontinuation of enteral alimentation. Our preliminary data suggest the role of enteral alimentation in critically ill patients may include not only protection against malnutrition but also protection against GI bleeding.

Adult↗
PubMed1983

The effect of erythromycin on theophylline pharmacokinetics in chronic bronchitis.

We examined theophylline pharmacokinetics for changes caused by the addition of erythromycin in patients with chronic bronchitis and obstructive pulmonary disease. Twelve hospitalized patients were randomized in a crossover fashion to receive aminophylline and either erythromycin or placebo. After the eighth dose, plasma was analyzed for theophylline, using the enzyme-mediated immunoassay technique. A 6-h urine collection was analyzed for theophylline metabolites, using high-pressure liquid chromatography. Erythromycin significantly decreased mean theophylline clearance by 22% from 4.9 L/min to 3.87 L/min (p less than 0.05). Mean peak theophylline levels increased 28% from 11.9 micrograms/ml to 15.3 micrograms/ml (p = 0.05). No change in urine theophylline metabolites was found. Patients with chronic bronchitis and obstructive pulmonary disease who begin erythromycin while receiving a preexisting therapeutic theophylline regimen experience a significant elevation of theophylline concentration, which predisposes to theophylline toxicity. For those patients with theophylline levels at the higher end of the therapeutic range (15 to 20 micrograms/ml), we recommend an initial 25% reduction in theophylline dosage when erythromycin is added. Serum theophylline levels should be monitored for further refinement of dosage.

Adult↗
PubMed1983

Effect of location, pH, and temperature of instillate in bronchoalveolar lavage in normal volunteers.

Bronchoalveolar lavage has not been subjected to careful standardization. We examined the variables of lung lavage location and lavage fluid composition (pH and temperature) upon the percent of fluid recovered, cell count and differential, protein and pH in normal subjects. In the first part of the study, random order lavages of the right middle lobe (RML), right lower lobe (RLL), left lingula, and left lower lobe (LLL) were performed with 100-ml aliquots of normal saline (pH, 5.5) at room temperature (25 degrees C). Percent fluid recovery was greater in the RML and lingula than in the RLL (p less than 0.05). Cell count, cell differential, and protein were similar between lobes. In the second part of the study, each lobe was lavaged with 50-ml aliquots: the RML with normal saline at 37 degrees C, the RLL with normal saline buffered to a pH of 7.0 at 37 degrees C, the left lingula with normal saline at 25 degrees C, and the LLL with normal saline buffered to a pH of 7.0 at 25 degrees C. Percent fluid recovery was greater in the RML than in the lingula and greater in both the RML and lingula than in the lower lobes (p less than 0.05). Total cell count was significantly higher in the RML than in the LLL (p less than 0.05). Cell count per milliliter and protein recovered were not different between any lobe lavaged. The pH of recovered fluid was greater with buffered saline. Complications of fever and chills occurred in almost 50% of subjects in both parts of the study. Lavage location can affect fluid recovery. Alteration of lavage fluid composition did not affect cell or protein recovery. We suggest lavage of the RML to ensure larger fluid recovery and the highest total cell count.

Adult↗
PubMed1983

Necrotizing fasciitis as a complication of tube thoracostomy.

Necrotizing fasciitis is a serious, rapidly progressive infection of subcutaneous tissue and fascia, most often related to trauma or surgery. We report a case of necrotizing fasciitis which occurred as a complication of tube thoracostomy. Physicians performing tube thoracostomy should be aware of this potential complication, since definitive treatment requires not only antibiotic therapy, but also surgical debridement.

Adult↗
PubMed1983

Treating the patient with upper gastrointestinal hemorrhage.

The basic approach to a patient with upper GI hemorrhage is primarily stabilization of any hemodynamic insufficiency. A patient history that includes alcohol abuse, ulcer disease, or esophageal varices may call for immediate endoscopy. Approximately 20% of all patients fail to respond to any therapy except surgery; however, a majority of patients who receive appropriate support and resuscitation will stop bleeding.

Cautery↗
PubMed1982

Complications associated with the adult respiratory distress syndrome.

The adult respiratory distress syndrome is frequently fatal. Attempts to decrease mortality must include attention to pulmonary and extrapulmonary complications of this syndrome. Pulmonary complications include pulmonary emboli, barotrauma, fibrosis, and pneumonia. Mechanical ventilation, Swan-Ganz catheters, and tracheal intubation also result in pulmonary complications. Extrapulmonary complications such as gastrointestinal hemorrhage, renal failure, infection, and thrombocytopenia may increase mortality. The incidence of gastrointestinal hemorrhage can be reduced with prophylactic antacids. Likewise, the incidence of pulmonary emboli can be reduced with low dose heparin. Careful attention to patients' urine output, fluid, and electrolyte status as well as vigorous cardiovascular support are also essential to decrease renal complications. Early diagnosis, aggressive treatment, and prophylaxis of complications should increase survival.

Adult↗
PubMed1982

Steady state urinary excretion of theophylline and its metabolites in the presence of erythromycin.

The effect of erythromycin on the quantitative pattern of urinary excretion of theophylline and its known metabolites at steady state in eight human subjects was examined. The percent of dose excreted of the various compounds in the absence and presence of the antibiotic were as follows: theophylline, 9.3% vs. 16.3%; 1, 3-dimethyluric acid, 51.9% vs. 59.6%; 3-methylxanthine, 11.9% vs. 13.0%; and 1-methyluric acid, 27.3% vs. 31.6%. These results show that erythromycin did not influence the metabolism of theophylline under the experimental protocol employed.

Adult↗
PubMed1981

Prevention of pulmonary emboli in a respiratory intensive care unit: efficacy of low-dose heparin.

Ninety-eight patients admitted to our respiratory intensive care unit during a one-year period were compared retrospectively with 99 well-matched patients admitted during a second one-year period. The use of prophylactic low-dose heparin in the second year was associated with a significant decrease in pulmonary emboli documented by ventilation-perfusion scan, pulmonary angiography, and autopsy. No specific bleeding complications could be directly attributed to the use of low-dose heparin. The frequency and severity of gastrointestinal hemorrhage as determined by hemoglobin fall and transfusion requirements were not significantly affected by the prophylactic use of low-dose heparin. Low-dose heparin appears to be effective and safe in respiratory intensive care unit patients in the prevention of pulmonary emboli.

Asthma↗
PubMed1980

Helium-oxygen mixtures during bronchoscopy.

Fiberoptic bronchoscopy in mechanically ventilated patients has been limited to endotracheal tubes of 8.0--8.5 mm diameter. When performed through smaller tubes, pressures exceeding ventilator limits may occur, alveolar ventilation may become impaired, or progressive hyperinflation from airway obstruction during expiration may result. In this study, the efficacy of a 70% helium-30% oxygen ventilating gas mixture was compared to 30% oxygen in air in a laboratory mechanical lung analog and during 15 bronchoscopies in 7 intubated patients. One patient with a 7.5 mm tube was studied. With the helium-oxygen mixture, ventilator pressures were not exceeded, alveolar ventilation was uncompromised, and hyperinflation did not occur. Bronchoscopy may be safely performed through endotracheal tubes smaller than 8.0 mm using a helium-oxygen mixture.

Air↗
PubMedDate not supplied

Continuous positive airway pressure: patients' and caregivers' learning needs and barriers to use.

OBJECTIVE: To identify learning needs and factors related to postdischarge use of continuous positive airway pressure (CPAP) ventilation. DESIGN: Exploratory descriptive correlational. SETTING: Metropolitan and rural clinics. SUBJECTS: Adult patients (N = 21) and family caregivers, one half 60 years or older. INSTRUMENTS: Family interviews, life satisfaction and quality, family function and relationship, depression and learning preparedness. RESULTS: There were numerous learning needs related to CPAP machine management, monitoring illness severity, and recognizing depressive symptomology, oxygen deficits, and cardiovascular sequelae. Family members are involved in overcoming barriers interfering with nightly CPAP use. Interview and questionnaire data clearly indicate life satisfaction improves after CPAP treatment. CONCLUSION: Predischarge and teaching programs coordinated by expert nurses are needed to address families' learning needs and support habitual long-term CPAP use. Family problem solving and depression interventions, instruction on recognizing symptoms of cardiovascular complications, and long-term follow-up programs are currently being studied.

Adaptation, Psychological↗