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Biomedical subjects

T E Reilley

Publications and source records attributed to T E Reilley.

At least 19 recordsLinked to original sources
PubMed1995

Pulmonary extraction of dobutamine in critically ill surgical patients.

This study was conducted to assess the pulmonary extraction of dobutamine. Eleven patients admitted to the general surgical intensive care unit, with varying diagnoses requiring dobutamine as part of their therapeutic intervention, were included. A single simultaneous sample was drawn, at the clinically required rate of infusion, from the radial and pulmonary artery catheter sites. Total dobutamine clearance was determined using the pulmonary artery (pre-lung) sample. The mean +/- SD total dobutamine clearance was 82 +/- 67 mL.kg-1.min-1 a value which is larger than the average cardiac output of plasma of 56 +/- 20 mL.kg-1.min-1. The mean percent pulmonary extraction fraction of dobutamine was 3.6% +/- 22.5% (range -34-52), a value within the 9% coefficient of variability (CV) of the assay. However, five patients had pulmonary extraction greater than the CV of the assay. Of these five patients, three had "negative" extraction values, and two had "positive" extraction values. There was no relationship between the percent pulmonary extraction of dobutamine and the rate or duration of dobutamine infusion before sampling. The results show that the extraction of dobutamine by the lungs is minimal.

Adult↗
PubMed1994

Use of supplemental oxygen during bystander-initiated CPR.

STUDY OBJECTIVE: To evaluate the efficacy of three methods by which rescuers can breathe supplemental oxygen to increase their delivered oxygen concentration (FDO2) during single-rescuer, bystander-initiated CPR. DESIGN: Controlled, randomized, crossover study. SETTING: Simulation in laboratory setting using a CPR manikin. SUBJECTS: Thirteen-volunteer convenience sample group. INTERVENTIONS: Volunteers trained only in basic life support performed ventilation only and full CPR on a CPR manikin using room air and each of three supplemental oxygen delivery methods: nasal cannula, oxygen supply tube, and demand valve. The volunteers received minimal instruction on how to use the supplemental oxygen delivery methods. MAIN OUTCOME MEASURES: Peak FDO2 and peak carbon dioxide concentration; American Heart Association-defined ventilation and CPR compression performance indices. The data were analyzed using Duncan's method of analysis of variance. RESULTS: The mean peak FDO2 during ventilation-only/full CPR for the baseline (room air ventilation) and each supplemental oxygen delivery method (at specified flow rate) was: baseline (room air), -17.96% +/- 0.56%/16.77% +/- 0.56%; nasal cannula (at 10 L/min), -31.77% +/- 3.06%/27.01% +/- 3.68%; oxygen supply tubing (at 15 L/min), -36.82% +/- 9.93%/30.41% +/- 4.88%; and demand valve, -78.17% +/- 9.10%/68.22% +/- 7.10%. CPR performance was not hampered by the use of the supplemental oxygen methods. CONCLUSION: The use of supplemental oxygen increases the rescuer's FDO2 during ventilation-only and full CPR without interfering with CPR performance.

Adult↗
PubMed1994

Variability in dobutamine pharmacokinetics in unstable critically ill surgical patients.

OBJECTIVE: To delineate the variability in the pharmacokinetics of dobutamine over time in an unstable critically ill adult surgical patient population concurrently receiving therapeutic interventions to optimize oxygen delivery and consumption variables. DESIGN: Prospective study. SETTING: University hospital adult surgical intensive care unit. PATIENTS: Sixteen hemodynamically unstable adults (aged 18 to 84 yrs) requiring dobutamine for inotropic support. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Samples for dobutamine serum concentration determination were collected at selected times during therapy, following at least 30 mins of a constant infusion rate and measured using high-performance liquid chromatography. Clearance and changes in clearance were calculated. A first-order pharmacokinetic model was validated by lack of dependence of dose on clearance and an established graphical method. Mean +/- SD infusion rate of dobutamine was 8.2 +/- 5.7 micrograms/kg/min (range 1.7 to 22.3), which resulted in a mean serum concentration of 214 +/- 183 ng/mL (range 15 to 759). The correlation between infusion rate and steady-state dobutamine concentration was r2 = .67. Variability in steady-state dobutamine concentration at various infusion rates was large. Clearance at initial pharmacokinetic analysis averaged 58.4 +/- 33.3 mL/kg/min (range 19 to 120). The percent change in calculated clearance varies from a 72% decrease to an 88% increase, with the greatest variability in clearance occurring during the first 24 hrs of therapy. There was little correlation between initial dobutamine clearance and weight (r2 = .10), net cumulative fluid balance before initiation of dobutamine (r2 < .01), age (r2 = .20), and estimated creatinine clearance (r2 = .09). CONCLUSIONS: Dobutamine pharmacokinetics in adult critically ill patients is best described by a first-order model. Pathophysiologic factors may have an effect on the pharmacokinetics of dobutamine which appears to change over time. Both inter- and intrapatient variability in infusion rate administered and resultant serum concentrations were wide, suggesting that infusion rate should be guided by clinical end points rather than by predetermined values.

Adolescent↗
PubMed1993

Identifying high-risk patients before head and neck oncologic surgery.

Patients from the Comprehensive Cancer Center of the Arthur G. James Cancer Hospital and Research Institute, Ohio State University, Columbus, who were undergoing major head and neck oncologic surgery were prospectively studied to determine predictors of postoperative medical complications and wound infection. Of 119 patients studied, 28 (24%) had at least one postoperative medical complication. The strongest predictors of medical complication were poor functional capacity as assessed by the Specific Activity Scale questionnaire and alcohol abuse. Thirteen patients (11%) developed wound infections. The strongest predictors of wound infection were an elevated preoperative platelet count and prolonged surgery. Wound infection was the strongest correlate of prolonged hospital stay. These findings suggest that the Specific Activity Scale questionnaire identifies patients at risk for medical complication, that alcohol abuse should be managed aggressively, and that thrombocytosis identifies patients at risk for wound infection.

Adult↗
PubMed1993

Extracorporeal venovenous recirculation for the treatment of hypothermia during elective aortic surgery: a phase I study.

BACKGROUND: Hypothermia caused by massive transfusion or prolonged exposure during operation is difficult to reverse and is associated with adverse side effects. This prospective, randomized study evaluated a technique using extracorporeal venovenous recirculation (EVR) through a roller pump-driven device with a commercial countercurrent heat exchanger used for treatment of hypothermia (temperature < 35.5 degrees C) occurring during elective aortic operation. METHODS: Patients undergoing aortic operation had routine prophylaxis against hypothermia including ventilator cascades, warming blankets, and low-velocity fluid warmers. When core temperature was less than 35.5 degrees C, patients were randomized to continue existing therapy (control, n = 7) or EVR (n = 8), performed through two large-bore venous lines. RESULTS: There were no differences in age, sex, weight, body surface area, Acute Physiology and Chronic Health Evaluation II score, fluid replacement, length of operation, blood lost or given, induction temperature, red blood cell or platelet structure, hemolysis, length of intensive care unit or hospital stay, complications, or mortality rates. EVR was associated with increased final core temperature (35.5 degrees +/- 0.8 degrees [EVR] vs 33.8 degrees +/- 0.9 degrees [control]; p < 0.005) and body heat content (-13.9 +/- 62.3 kcal [EVR] vs -118.2 +/- 62.2 kcal [control]; p < 0.01), with heat gained being proportional to flow rate. CONCLUSIONS: These data show that EVR provides a safe and effective method for the treatment of hypothermia.

Aged↗
PubMed1992

Evaluation of collateral circulation of the hand.

In 1929, Edgar V. Allen described a noninvasive evaluation of the patency of the arterial supply to the hand of patients with thromboangitis obliterans (Am J Med Sci 1929; 178:237). In the early 1950s, Allen's test was modified (Wright I. Vascular diseases in clinical practice. Chicago: Year Book Medical Publishers, 1952) for use as a test of collateral circulation prior to arterial cannulation. This test involves the examiner occluding the patient's ulnar and radial arteries while the patient makes a fist, causing the hand to blanch. The patient is then asked to extend the fingers. After the hand is open, the examiner releases the ulnar artery while continuing to maintain pressure on the radial artery. Adequate collateral circulation is felt to be indicated by return of normal color to the hand. The patient is instructed not to hyperextend the fingers when opening the hand. Hyperextension may cause a decrease in perfusion to the arch, possibly resulting in a false interpretation of the Allen test (Anesthesiology 1972;37:356). The modified Allen's test can be performed quickly and easily, but it is susceptible to error. (With Allen's original test, both hands were tested simultaneously. The patient clenched both fists tightly for 1 minute while the examiner compressed one artery of each hand. This method helps diagnose complete occlusion, just as Allen intended. The test was later modified, however, to evaluate the adequacy of collateral circulation. To perform the modified Allen's test, the examiner compresses both arteries while the patient's fist are clenched.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Comparison of digital blood pressure, plethysmography, and the modified Allen's test as means of evaluating the collateral circulation to the hand.

The collateral circulation to the hand was evaluated on 70 hands of healthy volunteers. Comparisons were made between the results of the modified Allen's test alone and the Allen's test combined with either plethysmography or digital blood pressure. The modified Allen's test requires patient cooperation and the results can be subjective. Plethysmography does not require patient cooperation and produces a signal that varies directly with flow; however, this is not a quantifiable signal. Digital blood pressure (measured by the 2300 Finapres noninvasive blood pressure monitor, Ohmeda, Englewood, CO, USA) also requires no patient cooperation. The values produced are of clinical value and reproducible. Both the plethysmograph and digital blood pressure monitors were able to demonstrate the dominant arterial vessel of the hand. The digital blood pressure monitor produces an objective recordable numerical value, an accepted clinical parameter, and it does not require patient cooperation. The use of a digital blood pressure monitor may prove to be an acceptable alternative to the traditional Allen's test.

Blood Pressure↗
PubMed1992

Analysis of risk factors for postoperative pulmonary complications in head and neck surgery.

Preoperative pulmonary function tests (PFTs) are unproven in their predictive value for postoperative pulmonary complications. There is a lack of prospective outcome studies upon which to form an opinion, particularly regarding noncavitary surgery. Seventy-three head and neck surgery patients were prospectively evaluated with preoperative PFTs, arterial blood gas analysis (ABG), medical history, and physical examination. Age, anesthesia duration, forced expiratory volume in 1 second (FEV1), peak flow (PF), PaO2, Roizen class, and pack years of smoking were significantly correlated with postoperative pulmonary complications. As similar studies in head and neck surgery patients have not been previously taken, it is hoped that these results will serve as a basis for future endeavors.

Age Factors↗
PubMed1991

Postoperative course after sufentanil or fentanyl anesthesia for coronary artery surgery.

Postoperative hemodynamic effects were compared in 50 patients randomly selected to receive either sufentanil, 25 micrograms/kg, or fentanyl, 100 micrograms/kg, anesthesia for coronary artery bypass grafting. The two groups exhibited similar patient demographics; dose of premedicants and muscle relaxants; and use of inhalation agents. Values for 15 hemodynamic variables were recorded at baseline and at six postoperative times. The times to awakening, response to verbal commands, and extubation were also noted. Patients who received sufentanil had a more stable course, with higher cardiac outputs, lower systemic vascular resistances, and a lower incidence of hypertension. Postoperatively, the two groups had similar values for time to awakening, response to verbal commands, and extubation. Elimination half-lives differed significantly: 554 +/- 91 minutes (fentanyl) versus 277 +/- 60 minutes (sufentanil). Serum concentrations of both decreased linearly. The added advantages of postoperative hemodynamic stability could be important in the choice of anesthetic.

Anesthesia Recovery Period↗
PubMed1991

Experience with phenylephrine as a component of the pharmacologic support of septic shock.

OBJECTIVE: To evaluate the use of the selective alpha 1-adrenergic receptor agonist phenylephrine in the hemodynamic support of patients with septic shock. DESIGN: Retrospective analysis of clinical use of phenylephrine. SETTING: Surgical ICU in a university hospital. PATIENTS: Thirteen patients with septic shock (diagnosed by defined criteria) requiring pharmacologic support for the treatment of hypotension. INTERVENTIONS AND MAIN RESULTS: All patients underwent invasive hemodynamic monitoring followed by volume resuscitation and inotropic support to reverse flow-dependent oxygen consumption and lactic acidosis. Patients with persistent hypotension (mean arterial pressure [MAP] less than 65 mm Hg) and vasodilation (systemic vascular resistance index [SVRI] less than 1500 dyne.sec/cm5.m2 received phenylephrine at iv infusion rates of 0.5 to 9 micrograms/kg.min to maintain MAP greater than 70 mm Hg. MAP, SVRI, left ventricular stroke work index, and stroke volume index were significantly (p less than .05) increased after phenylephrine administration and at the time of highest oxygen consumption (VO2). Cardiac index was unchanged initially but increased at the time of highest VO2 (p less than .05). Pulmonary artery occlusion pressure and heart rate were unchanged. Average baseline VO2 increased from 145 to 200 mL/min.m2 and oxygen delivery (DO2) increased from 447 to 597 mL/min.m2 during phenylephrine treatment (p less than .05). Blood lactate concentrations decreased and urine output increased significantly (p less than .05), while serum creatinine concentrations remained unchanged during phenylephrine therapy. CONCLUSIONS: Treatment with phenylephrine was associated with beneficial hemodynamic effects when used to maintain perfusion, while increasing DO2 and VO2 in patients with septic shock.

Adult↗
PubMed1990

High-dose phenylephrine infusion in the hemodynamic support of septic shock.

A 75-year-old man with hyperdynamic septic shock and vasodilation was successfully supported hemodynamically for 88.5 hours through the use of a continuous infusion of phenylephrine at dosages up to 360 micrograms/min. The only other vasoactive compound administered was dopamine at a dosage of 3.4 micrograms/kg/min. Hemodynamic evaluation indicated improvements in mean arterial pressure, cardiac output, and oxygen transport parameters during the period of hemodynamic support, which did not indicate a detrimental effect on perfusion of vital organs and tissues despite the use of this vasoconstrictor. Phenylephrine's pharmacologic properties may represent an advantage for its use as a vasoconstrictor over catecholamines such as norepinephrine and dopamine, particularly in patients who develop tachyarrhythmias with these agents. The pharmacology, dosage, and appropriate monitoring of therapy with phenylephrine in patients with septic shock are discussed.

Acute Kidney Injury↗
PubMed1989

Intraoperative complications in patients receiving amiodarone: characteristics and risk factors.

This article reviews amiodarone's adverse cardiovascular properties, concentrating on those in surgical patients, and evaluates several potential risk factors. Amiodarone has negative inotropic and chronotropic properties as well as peripheral vasodilating properties that may manifest as bradycardia, reduced cardiac output, and hypotension. These reactions are clinically important during surgery, because of resistance to pharmacologic resuscitation and an increased mortality rate. Potential risk factors include ventricular dysfunction, rapid infusion rate, hypocalcemia, cardiopulmonary bypass, general anesthesia, concurrent negative inotropic or chronotropic drugs, and an elevated serum amiodarone or desethylamiodarone concentration. The following measures may decrease the risk of intraoperative adverse reactions in amiodarone-treated patients. The serum calcium concentration should be at the physiologic level and the serum amiodarone and digoxin concentrations should be in the therapeutic range. Negative inotropic and chronotropic agents should be discontinued when possible. A temporary cardiac pacemaker may prevent intraoperative hypotension due to bradycardia. Amiodarone may be discontinued before surgery to minimize the risk of intraoperative complications, but this decision should balance the potential for amiodarone-associated intraoperative complications against the risk of arrhythmia recurrence and the delay of surgery.

Amiodarone↗
PubMed1989

The effects of hyperoxia during fulminant sepsis.

Although adequate tissue oxygenation is essential to maintain cellular metabolism, the use of hyperoxia to improve oxygen delivery or to improve metabolic performance is controversial. For example, supplemental inspired oxygen is reportedly beneficial in the treatment of some experimental infections; however, oxygen therapy also has well-documented adverse side effects. To evaluate the effect of increased inspired oxygen concentration (FIO2) in animals with fulminant sepsis, 117 Sprague-Dawley rats underwent cecal ligation and puncture. Animals were then exposed to an FIO2 of either 0.21, 0.4, or 0.8. Twenty sham-operated controls had no mortality with any FIO2. Increasing the FIO2 increased mortality from 70% to 85% in animals receiving 40% O2, and to 100% in those receiving 80% O2. Autopsies revealed mild pulmonary oxygen toxicity with 80% O2 exposure in both control and septic animals, but normal lung histologic appearance in animals receiving lower levels of oxygen. Arterial blood gases documented maintenance of oxygenation and ventilation. Thus, pulmonary oxygen toxicity does not appear to be the mechanism for increased mortality. Supplemental oxygen may worsen, rather than improve, survival after fulminant infection.

Acute Disease↗
PubMed1988

Effect of positive end-expiratory pressure on extravascular lung water in porcine acute respiratory failure.

Recent studies of acute respiratory failure suggest that PEEP causes increased pulmonary interstitial fluid collection and therefore increased extravascular lung water (EVLW). We examined the effect of increasing levels of PEEP on EVLW in 20 to 25-kg pigs with acute respiratory failure induced by continuous infusion of live Pseudomonas aeruginosa (2 X 10(8) organisms/20 kg.min). Animals were intubated, paralyzed, and ventilated at 15 ml/kg tidal volume and an FIO2 of 0.4. Pigs in group 1 were given 4 ml/kg.h of iv fluid (lactated Ringer's solution) with no PEEP administered. Animals in groups 2 through 5 were given 0, 4, 17, and 44 ml/kg.h of lactated Ringer's solution, respectively, and PEEP was added at 5-cm H2O increments per half-hour, starting one hour after beginning P. aeruginosa infusion. EVLW in PEEP animals was less than or equal to that in controls despite variation in the administration of lactated Ringer's solution. This suggests that PEEP may slow EVLW accumulation over time and provide a protective effect that allows increased amounts of crystalloid fluids to be administered.

Animals↗
PubMed1988

Hemodialysis of amikacin in critically ill patients.

The clearance of amikacin during hemodialysis (HD) was determined in eight critically ill patients. The dialysis period averaged 3.4 h with a blood flow of 200 ml/min. The average amikacin clearance between dialysis was 7.30 +/- 4.78 (SD) ml/min which increased to 37.5 +/- 8.01 ml/min during dialysis. The average serum amikacin concentration before dialysis fell 27% after dialysis. The fraction of drug in the body removed only from dialysis averaged 21%. Although amikacin was cleared more effectively during HD compared to the interdialysis period, the small amount of drug removed suggests that routine supplemental dosing of amikacin after HD may not be necessary.

Adult↗
PubMed1987

Does compliance reflect oxygen delivery in porcine septic respiratory failure treated with positive end-expiratory pressure?

Oxygen delivery (DO2) in patients with acute respiratory failure has been correlated with total lung and chest wall compliance (CT), the optimal positive end-expiratory pressure (PEEP) level reportedly corresponds to maximal DO2. To test the validity of the relationship, we studied the correlation between CT and DO2 in 12 septic pigs with acute respiratory failure induced by continuous infusion of live Pseudomonas aeruginosa bacteria. Cardiac output, pulmonary and systemic arterial BP, blood gases, extravascular lung water, tidal volume, and airway pressure were measured serially in six control animals and six animals receiving increasing amounts of PEEP. There was no significant correlation between DO2 and CT in either group; however, animals receiving PEEP had less extravascular lung water.

Acute Disease↗