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Biomedical subjects

T J Gallagher

Publications and source records attributed to T J Gallagher.

At least 19 recordsLinked to original sources
PubMed1992

Descriptive analysis of critical care units in the United States.

OBJECTIVE: To gather data about available technology, staffing, administrative policies, and bed capacities of ICUs in the United States. DESIGN AND SETTING: On January 15, 1991, survey instruments were mailed to the administrators of 4,233 hospitals to gather information from the medical director of the institutions' respective ICUs for the purpose of developing a database on ICUs in the United States. The sampling frame for this study was based on all American Hospital Association (AHA) hospitals that stated they have ICUs. MEASUREMENTS: Census questionnaires solicited information on types of hospitals, types of ICUs, number of ICU beds open and closed, technology available to the unit, organizational structure and management of the ICU, as well as the staffing and certification of unit personnel. MAIN RESULTS: Data were obtained on 32,850 ICU beds with 25,871 patients from 2,876 separate ICUs in 1,706 hospitals in the United States. Census responses came from units in all sizes of hospitals within all ten census regions in the country, all states, and all types of hospital sponsorship (federal, state, and local government, private nonprofit and private for profit). The census response rate was 40% of the AHA hospitals that stated that they have ICUs, with specific ICU data on 38.7% of the nation's ICUs. The number of ICUs per hospital increases with overall hospital size. The smallest hospitals (less than 100 beds) usually had only one ICU. As hospital size increased, the single, all inclusive medical/surgical/coronary care units diminished, and in hospitals with greater than 300 beds, specialization of units became prevalent. In absolute terms, hospitals had the following number of ICUs: 1.04 +/- 0.20 (less than or equal to 100 beds); 1.30 +/- 0.65 (101 to 300 beds); 2.37 +/- 1.58 (301 to 500 beds); and 3.34 +/- 2.21 (greater than 500 beds). ICU beds averaged, nationally, 8.09% of hospital-licensed beds with a median of 6.98%. Generally, medical units, pediatric units, coronary care units (CCUs), and medical/surgical/CCUs reported an average of 10 beds per unit. Neonatal units averaged 21 beds, and surgical units averaged 12 beds. The average ICU size, nationally, was 11.7 +/- 7.8 beds per unit. Available technology within hospitals and individual units was increased as hospital size increased; surgical units tended to have more available technology than other unit types. A wide range of organizational arrangements within hospitals determines where the ICU appears in an organizational chart and to whom unit management is accountable. Thirty-six percent of the units were located organizationally within the hospital's department of medicine, while 23% were considered "free standing," having no departmental affiliation. Although units must have a medical director, the perception as to whether this director supervises the day-to-day operation was different in larger vs. smaller hospitals. In hospitals with less than or equal to 100 beds, 72% of the units were perceived to be supervised by the medical director, whereas in larger hospitals (greater than 500 beds), 81% of units were supervised. Study results indicated that medical directors in pediatric, neonatal, and burn units most often were perceived to supervise the unit. Presently, 63% of all ICUs responding are directed by an internist. The next largest group to direct ICUs were surgeons, followed by pediatricians. Pediatrician involvement tended to be exclusive in pediatric and neonatal units. Surgeons directed most surgical and neurologic units and were involved in 21% of mixed medical/surgical units. Internists predominated in medical units and in CCUs, as well as in combined medical/surgical/CCUs. Direction by anesthesiologists, although relatively infrequent, predominated in the surgical unit. Critical care medicine certification of the medical director and attending staff of the ICU increased as hospital size increased, although only 44% of all units stated that thei

Allied Health Personnel↗
PubMed1992

Endotracheal intubation.

Endotracheal intubation can be accomplished by several different methods, which are discussed herein. Special considerations such as the obstructed tube, air leakage around the tube, tube replacement, and drug therapy are also reviewed, as are the indications for tracheostomy, the use of double lumen tubes, and fiberoptic laryngoscopy or bronchoscopy.

Critical Care↗
PubMed1992

Initial evaluation of the diving accident victim.

Diving accidents include air embolism and decompression sickness. Both require early stabilization and initiation of therapy before transfer to a definitive medical center for recompression therapy. Initial treatment consists of hydration, oxygen therapy and often steroids and antithrombosis therapy. Symptoms must be separated from other related conditions including myocardial infarction.

Accidents↗
PubMed1990

Five percent human albumin in lactated Ringer's solution for resuscitation from hemorrhagic shock: efficacy and cardiopulmonary consequences.

Using an ovine model of acute hemorrhagic shock, we evaluated the utility of 5% albumin in lactated Ringer's (5% ALR) solution as a resuscitation solution. After instrumentation and obtaining baseline values for BP, mean arterial pressure (MAP), pulmonary capillary wedge pressure (WP), CVP, cardiac output, extravascular lung water (EVLW), and blood gases (mixed venous and arterial), animals were rapidly exsanguinated to an MAP of 50 mm Hg. After 30 min at this pressure, measurements were repeated and 5% ALR was administered until two of three variables (WP, MAP, cardiac output) were restored to baseline values. The administration of 5% ALR was continued as needed to maintain baseline values of these variables. Sixty minutes later, data were again recorded. For induction of shock, 15.7 +/- 5.2 ml of blood/kg body weight was removed. Pulmonary artery pressure, WP, MAP, and cardiac output all significantly decreased with shock. After resuscitation, all values except MAP returned to baseline. The resuscitation volume of 5% ALR was 25.2 +/- 18.4 ml/kg. There were no changes in EVLW or intrapulmonary shunt. Oxygen delivery was significantly compromised during shock but returned to baseline after resuscitation. We conclude that in a model such as ours, 5% ALR can reverse the hemodynamic effects of acute hemorrhagic shock.

Acute Disease↗
PubMed1989

High-frequency percussive ventilation compared with conventional mechanical ventilation.

In seven patients with severe respiratory distress, conventional mechanical ventilation and PEEP were used initially for respiratory support, which was changed to high-frequency percussive ventilation (HFPV) at the same level of airway pressure and FIO2. During both modes of ventilation, patients could breathe spontaneously via a low-threshold demand valve. With HFPV, PaO2 improved significantly (p less than .01) compared with PaO2 during conventional methods. Cardiac output was unaffected by the change to HFPV.

Carbon Dioxide↗
PubMed1988

Experiments on the effects of hyperbaric oxygen on flap survival in the pig.

The use of hyperbaric oxygen has been advocated as a method of improving survival of ischemic flaps. Experiments were done in the pig using modern flap designs and hyperbaric oxygen protocols that have been reported to be effective in rodents. The results of these experiments indicate that hyperbaric oxygen is not effective in improving flap survival in the pig.

Animals↗
PubMed1988

Hemodynamic effects of nifedipine in a canine model of acid aspiration.

A solution of ethyl alcohol, polyethylglycol, and distilled water that did (n = 5) or did not (n = 5) contain 250 micrograms/kg of the calcium channel blocker, nifedipine, was infused into the right atrium in 10 healthy mongrel dogs. Hydrochloric acid (pH = 1.8), 2 ml/kg, was then instilled into both lungs of all dogs via the tracheal tube. Hemodynamic data were collected before and 10 minutes after nifedipine was infused and 10, 45, 90 and 180 minutes after acid was instilled into the lungs. Gas exchange, including PaO2 and venous admixture, did not differ between the two groups. However, after aspiration, oxygen delivery significantly improved in the dogs given nifedipine compared to oxygen delivery in those not treated with nifedipine. We conclude that, despite significant decreases in PaO2 and venous admixture, nifedipine can restore oxygen delivery back to normal levels.

Animals↗
PubMed1987

Effects of hetastarch resuscitation on extravascular lung water and cardiopulmonary parameters in a sheep model of hemorrhagic shock.

Eight sheep, weighing 29-71 kg, were used to evaluate the cardiopulmonary response to Hespan infusion following shock. Before shock was induced, mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAP), cardiac output (CO), extravascular lung water (EVLW), colloid oncotic pressure (COP), and hemoglobin were measured and shunt, arteriovenous oxygen content difference (C[a - v]O2) and COP-PCWP gradient were calculated. The animals were bled to a MAP of 50 mmHg and that level was maintained for 30 min. At the end of that time, the data were collected again. The animals were resuscitated back to baseline values of PCWP, MAP, and CO with a 6% hydroxyethylstarch solution. With shock, PCWP, MAP, CO, and arterial pH decreased and C(a - v)O2 increased significantly (P less than 0.05). With resuscitation, PAP, PCWP and CO were significantly greater than baseline. Arterial pH was less than the baseline value but was within normal range. MAP did not return to preshock levels. EVLW and venous admixture did not change at any time. C(a - v)O2 returned to baseline with resuscitation. Volume of hetastarch infused was 29.1 +/- 10 cm3/kg. We conclude that hetastarch is an effective resuscitation solution in a model of hemorrhagic shock and appears to have no adverse cardiopulmonary effects.

Animals↗
PubMed1987

Influence of sterile protective sleeves on the sterility of pulmonary artery catheters.

Eighty-seven pulmonary artery catheters (PACs) with sterile protective sleeves were placed into 69 surgical ICU patients by one of the following two methods: through an introducer placed in a new, percutaneous site or by exchanging an indwelling catheter for an introducer. On removal, 5-cm catheter segments from the catheter tip and from within the introducer and sleeve, peripheral blood, and blood drawn from the PAC distal port were cultured quantitatively. Sleeve segment cultures were sterile if catheterization was less than 48 h and had been accomplished through a new percutaneous site. The risk of growing greater than 10(3) colonies on the tip and introducer segment increased to greater than 30% when PACs were left in over 96 h. The incidence of catheter-related bacteremia (CRB), defined as the simultaneous growth of identical organisms from the blood and the PAC tip, was 5.3% but may have been underestimated. CRB was associated with the use of corticosteroids (p = .009) and with cultures from any PAC segment growing more than 10(3) colonies (p less than .01). Although our data suggest that the use of the sterile protective sleeve is associated with a low risk of colonization, further study will be required to delineate the relationship between the use of protective sleeves and CRB.

Bacterial Infections↗
PubMed1987

Early bronchoscopy as a predictor of ventilatory support for burned patients.

Twenty-seven burned patients who had facial burns, hoarseness, or evidence of carbonaceous sputum or had been in a smoke-filled enclosed space underwent fiberoptic bronchoscopy at the time of admission. Airway severity was indexed (grades 1-5, grade 5 being the most severe). Fifteen nonsurvivors had a bronchoscopic index of 3.2 +/- 1.6 and 12 survivors an index of 3.4 +/- 1.2 (p greater than 0.05). No patient died of respiratory complications. Bronchoscopic index correlated poorly with the level of positive end expiratory pressure required to maintain oxygenation in any patient (r = 0.50). Likewise, bronchoscopic index did not correlate with duration of intubation in any survivor (r = 0.33). Immediate bronchoscopy after burn injury neither indicates the level of respiratory support that will be required nor predicts its duration.

Bronchoscopy↗
PubMed1987

Hypertonic saline as a resuscitation solution in hemorrhagic shock: effects on extravascular lung water and cardiopulmonary function.

To determine the effect of resuscitation with hypertonic saline on extravascular lung water, seven adult sheep were endotracheally intubated; mean arterial pressure (MAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PCWP), and central venous pressure (CVP) were monitored. A 5-French, thermistor-tipped catheter was used to measure extravascular lung water (EVLW). Colloid oncotic pressure (COP), serum electrolytes and osmolality, and arterial and mixed venous blood gas tensions were measured. The COP-PCWP gradient and the shunt fraction (Qsp/Qt) were calculated. After baseline measurements, the animals were bled to an MAP of 50 mm Hg (blood volume removed, 16.2 +/- 3.6 ml/kg), which was maintained for 30 min, measurements then being repeated. Three percent sodium chloride solution was infused at 500 ml/15 min until two of three parameters--cardiac output (CO), PCWP, or MAP--were restored to baseline values. Data were recorded again and then 60 min later. No shed blood was reinfused. The total volume of hypertonic saline infused was 39 +/- 19 ml/kg. Pulmonary artery pressure did not vary throughout the study. PCWP, MAP, and CO were significantly lower than baseline (P less than 0.05) 30 min after bleeding but all except MAP returned to baseline with resuscitation. Throughout the study, EVLW did not vary despite a COP-PCWP gradient less than 4 mm Hg. Serum sodium levels and serum osmolality were significantly above baseline values after resuscitation. In this animal model of hemorrhagic shock, infusion of hypertonic saline effected resuscitation without compromising cardiopulmonary function or increasing EVLW.

Animals↗
PubMed1986

Continuous positive airway pressure and expiratory positive airway pressure increase functional residual capacity equivalently.

The effect of continuous positive airway pressure (CPAP) and expiratory positive airway pressure (EPAP) on functional residual capacity (FRC) of ten healthy, spontaneously breathing, lightly anesthetized intubated mongrel dogs was studied. The CPAP and EPAP at 5, 10, 15, and 20 cm H2O were alternately applied to all animals. Total (lung and chest wall) compliance, esophageal pressure, airway pressure, transpulmonary pressure, control FRC, and the change in FRC (delta FRC) were measured before and after each application of CPAP and EPAP. Neither expiratory transpulmonary pressure nor delta FRC with CPAP differed significantly from that with EPAP at all levels (p greater than 0.05). These data suggest that CPAP and EPAP, when applied at the same expiratory pressure, result in an equivalent increase in FRC due to passive mechanical distention of the lungs.

Animals↗
PubMed1985

Frequency and percent inspiratory time for high-frequency jet ventilation.

A variety of frequencies and percent inspiratory times (%TI) may be used for high-frequency jet ventilation (HFJV). Five physiologic criteria were used to evaluate various combinations of frequency and %TI: mean airway pressure (Paw), cardiac output, PaCO2, PaO2, and intrapulmonary shunt (Qsp/Qt). At a constant drive pressure, the effects of frequencies of 100, 200, 300, 450, 600, 750, and 900 cycle/min at %TI values of 20%, 30%, and 40% of the respiratory cycle were evaluated and compared with the effects of controlled mechanical ventilation (CMV) at 8 to 12 breath/min. Only at 200 cycle/min and 20% TI, were Paw, cardiac output, PaCO2, PaO2, and Qsp/Qt all the same as the CMV values. At 100 cycle/min and 20% TI, CO2 elimination increased without significantly affecting Paw, cardiac output, PaO2, or Qsp/Qt. These data suggest that HFJV might compromise one or more physiologic variables at certain combinations of frequency and %TI. Therefore, at a fixed drive pressure, there appears to be a narrow range of HFJV ventilator settings that should be considered.

Animals↗