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Biomedical subjects

V Rudick

Publications and source records attributed to V Rudick.

At least 37 records · Page 2Linked to original sources
PubMed1997

Midazolam versus propofol for long-term sedation in the ICU: a randomized prospective comparison.

OBJECTIVE: To compare the efficacy, safety, and cost of midazolam and propofol in prolonged sedation of critically ill patients. DESIGN: Randomized, prospective study. SETTING: General intensive care unit (ICU) in a 1100-bed teaching hospital. PATIENTS: 67 critically ill, mechanically ventilated patients. INTERVENTIONS: Patients were invasively monitored and mechanically ventilated. A loading dose [midazolam 0.11 +/- 0.02 (SEM) mg.kg-1, propofol 1.3 +/- 0.2 mg.kg-1] was administered, followed by continuous infusion, titrated to achieve a predetermined sedation score. Sedation was continued as long as clinically indicated. MEASUREMENTS AND RESULTS: Mean duration of sedation was 141 and 99 h (NS) for midazolam and propofol, respectively, at mean hourly doses of 0.070 +/- 0.003 mg.kg-1 midazolam and 1.80 +/- 0.08 mg.kg-1 propofol. Overall, 68% of propofol patients versus 31% of midazolam (p < 0.001) patients had a > 20% decrease in systolic blood pressure after the loading dose, and 26 versus 45% (p < 0.01) showed a 25% decrease in spontaneous minute volume. Propofol required more daily dose adjustments (2.1 +/- 0.1 vs 1.4 +/- 0.1, p < 0.001). Nurse-rated quality of sedation with midazolam was higher (8.2 +/- 0.1 vs 7.3 +/- 0.1 on a 10-cm visual analog scale, p < 0.001). Resumption of spontaneous respiration was equally rapid. Recovery was faster after propofol (p < 0.02), albeit with a higher degree of agitation. Amnesia was evident in all midazolam patients but in only a third of propofol patients. The cost of propofol was 4-5 times higher. CONCLUSIONS: Both drugs afforded reliable, safe, and controllable long-term sedation in ICU patients and rapid weaning from mechanical ventilation. Midazolam depressed respiration, allowed better maintenance of sedation, and yielded complete amnesia at a lower cost, while propofol caused more cardiovascular depression during induction.

Adult↗
PubMed1997

The isolated post ischaemic rat heart is more vulnerable to protamine sulphate than the non-ischaemic heart.

Protamine sulphate is currently used for the reversal of heparin anticoagulation but is known to cause direct myocardial depression. The purpose of this study was to compare the effects of protamine sulphate on the isolated heart with and without cardioplegic ischaemia. Isolated rat hearts (Langendorff preparation) were electrically paced at 300 beats/min and perfused with Krebs-Henseleit solution. Five groups were tested: (1) control: no ischaemia, no protamine; (2) no ischaemia, protamine; (3) no ischaemia, protamine (time-matched control to groups 4 and 5); (4) control: ischaemia, no protamine; and (5) ischaemia, protamine. Protamine sulphate was infused for 15 min at 10 microg/ml. In groups 4 and 5, cardioplegic ischemia was maintained for 30 min at 30 degrees C before protamine exposure. Protamine decreased myocardial performance in a time- and dose-dependent manner. Protamine depressed mean (s.d.) myocardial left ventricular pressure in both non-ischaemic hearts (groups 2 and 3, to 49(4)% and 50(4)% from baseline, respectively) and post ischaemic hearts (group 5, to 28(8%). Mean (s.d.) left ventricular-developed pressure only partially recovered after protamine in post-ischaemic hearts (to 55(13)% of baseline) compared with full recovery of the non-ischaemic group. Protamine depressed coronary flow to 70(5)% and 74(8)% in non-ischaemic hearts (groups 2 and 3, respectively) and to 58(7)% in group 5. Coronary flow recovered completely at the end of the experiments in all protamine-treated groups. In conclusion, isolated rat hearts subjected to cardioplegic ischaemia are more vulnerable to protamine than are non-ischaemic hearts.

Animals↗
PubMed1997

Direct induction of acute lung and myocardial dysfunction by liver ischemia and reperfusion.

OBJECTIVES: To investigate whether liver ischemia and reperfusion (IR) directly affect functions of remote organs. BACKGROUND: Cardiovascular and respiratory dysfunction follows hemorrhage, spinal shock, or trauma as a result of no-flow-reflow phenomena. Hepatic IR induces remote organ damage probably by xanthine oxidase and oxygen species. MATERIALS AND METHODS: Isolated rat livers, lungs, and hearts were perfused with Krebs-Henseleit solutions. After stabilization, livers were either perfused or made ischemic. Then, livers and hearts or livers and lungs were reperfused in series, and the liver was disconnected and the second organ continued to perfuse with the accumulated effluents. MEASUREMENTS AND MAIN RESULTS: Ischemic and reperfused liver effluent contained high lactate dehydrogenase and uric acid concentrations compared with controls; xanthine oxidase increased 60 to 100 times. Ischemic and reperfused lung peak inspiratory pressure almost doubled; airway static compliance halved; myocardial contractility decreased to 70% of baseline; wet weight-to-dry weight ratios of lungs and livers increased. CONCLUSION: Ischemic and reperfused liver can directly induce myocardial and pulmonary dysfunction, presumably by oxidant-induced injury.

Acute Disease↗
PubMed1997

Gut decontamination reduces bowel ischemia-induced lung injury in rats.

OBJECTIVE: To evaluate the effects of gut decontamination on endotoxin, tumor necrosis factor (TNF) levels, and the associated lung injury in a rat model of bowel ischemia. SUMMARY BACKGROUND DATA: Gut ischemia induces disruption of the intestinal mucosal barrier, allowing translocation of bacteria and endotoxin into the blood, which may trigger a systemic inflammatory response and lung injury. METHODS: Thirty anesthetized rats were randomized into three groups: (1) ischemia-reperfusion (I/R) alone (a 60-min superior mesenteric artery occlusion and 4 h of reperfusion, n=10); (2) rats that underwent gut decontamination prior to ischemia (I/R+GD, n=10); and (3) control rats (sham operated, n=10). Serum levels of lipopolysaccharide (LPS) and TNF were measured at the end of the experiment. Lung permeability was measured using bovine serum albumin labeled with 125I, and organ injury was assessed histologically. RESULTS: One hour of bowel ischemia and 4 h of reperfusion (I/R) led to elevations of blood LPS and TNF levels of 0.33+/-0.005 EU/mL and 173+/-56 pg/mL, which were higher than the sham group (p<0.01). Gut decontamination (I/R+GD) significantly attenuated the LPS and TNF generation, 0.09+/-0.005 and 56.2+/-6 pg/mL (p<0.01). Lung injury as assessed by pulmonary permeability index was also reduced by gut decontamination, 2.1+/-0.42 vs 5.3+/-0.82 in the control group (p<0.03). Surprisingly no difference was detected in the number of pulmonary neutrophils in sequestration between the groups. CONCLUSIONS: Our data suggest that gut decontamination can reduce the generation of LPS, TNF, and the severity of lung damage that often follows ischemia and reperfusion of the intestine in rats.

Animals↗
PubMed1997

A risk-benefit assessment of flumazenil in the management of benzodiazepine overdose.

The worldwide expansion in the use of benzodiazepines has led to their frequent, and often inappropriate, use and to increase in their involvement in self-induced poisoning and iatrogenic overdosing. Flumazenil is a specific and competitive antagonist at the central benzodiazepine receptor, reversing all effects of benzodiazepine agonists without tranquillising or anticonvulsant actions. Incremental intravenous bolus injections of flumazenil 0.1 to 0.3 mg are the most effective and well tolerated in the diagnosis and treatment of pure benzodiazepine overdose; additional boluses or an infusion (0.3 to 0.5 mg/h) can be given to prevent patients from relapsing into coma. Intravenous flumazenil 10 to 20 micrograms/kg is effective in neonates and small children. Intramuscular, oral (20 to 25 mg 3 times daily or as required) and rectal administration may be used as alternatives in long term regimens. Patients with mixed-drug overdose require higher doses (up to 2 mg bolus, approximately equal to 1 mg/h infusion) to regain consciousness. Children and the elderly, chronically ill patients, and pregnant women and their fetuses all respond satisfactorily to flumazenil, but the usefulness of the drug in patients with hepatic encephalopathy and alcohol overdose is debatable. The use of flumazenil results in complete awakening with restoration of upper airway protective reflexes, thus enabling gastric lavage to be performed and transfer of the patient from the emergency room to another hospital department. Resumption of effective spontaneous respiration allows for expeditious extubation, weaning off mechanical ventilation or the avoidance of endotracheal intubation. While flumazenil is not associated with haemodynamic adverse effects, caution should be exercised when using this agent in patients who have co-ingested chloral hydrate to carbamazepine or whose ECG shows abnormalities typical to those seen after overdose with tricyclic antidepressants (TCAs); the use of flumazenil in the presence of these drugs can sometimes induce treatable cardiac dysrrhythmia. Flumazenil per se does not induce adverse effects. Coma reversal by flumazenil may cause mild, short-lived reactions caused by sudden awakening. Withdrawal symptoms in long term benzodiazepine users and seizures in patients who have taken an overdose of TCA or carbamazepine and a benzodiazepine can occur with flumazenil; these symptoms are avoidable by utilising slow flumazenil dose titration.

Anti-Anxiety Agents↗
PubMed1997

Investigation of plasma membrane-associated apolipoprotein E in primary macrophages.

Our previous studies identified the lysosome as the compartment for degradation of newly synthesized apoE in primary macrophages. Lysosomal degradation of newly synthesized apoE is extensive and rapid (> 50% in 60 min). In the present study we tested the hypothesis that the macrophage cell surface is part of the itinerary of apoE in its path to the lysosomes. We therefore examined the existence and size of the apoE pool associated with the macrophage cell surface. Such a pool may not only provide a mechanism of targeting apoE for lysosomal degradation, by endocytosis, but also have important implications for the metabolism of lipoproteins by macrophages. Treatment of macrophages with heparin (10 micrograms/ml and 5 mg/ml) and heparinase I (1 U/ml), which releases substantial amounts of apoE from HepG2 cells, results in no additional release of apoE from macrophages. Treatment of macrophages with xyloside (1 mM) or GRGDTP (500 micrograms/ml) does not decrease the extent of cell-associated apoE. Both immunogold labeling, followed by electron microscopy, and immunofluorescent labeling and light microscopy further confirm the lack of significant amounts of cell surface-associated apoE in macrophages. In contrast, immunolabeled apoE is readily observed in permeabilized cells. Taken together, these data indicate the absence of significant apoE-glycosaminoglycan interaction at the macrophage cell surface. The lack of such an interaction is likely due to paucity of heparan sulfate proteoglycans on the macrophage cell surface, when compared to hepatocytes. Along with our previous observations. (Deng. J., V. Rudick, and L. Dory, 1995. J. Lipid Res. 36:2129-2140), these results suggest direct targeting of a portion of newly synthesized apoE from trans-Golgi network to lysosomes for degradation, without involving the plasma membrane and endocytosis.

Animals↗
PubMed1996

Use of flumazenil in the treatment of drug overdose: a double-blind and open clinical study in 110 patients.

OBJECTIVES: To assess the efficacy, usefulness, safety, and dosages of flumazenil required when flumazenil is used in the diagnosis of benzodiazepine-induced coma (vs. other drug-induced coma), and to reverse or prevent the recurrence of unconsciousness. DESIGN: A two-phase study: a controlled, randomized, double-blind study followed by a prospective, open study. SETTING: An 800-bed, teaching, university-affiliated hospital. PATIENTS: Unconscious patients (n = 110) suspected of benzodiazepine overdose, graded 2 to 4 on the Matthew and Lawson coma scale, were treated with flumazenil, the specific benzodiazepine receptor antagonist. The first 31 patients were studied in a double-blind fashion, while the rest of the patients were given flumazenil according to an open protocol. INTERVENTIONS; All patients received supplemental oxygen; endotracheal intubation was performed, and synchronized intermittent mandatory ventilation was initiated whenever it was deemed necessary. A peripheral intravenous cannula was inserted, as were indwelling arterial and urinary bladder catheters. Blood pressure, electrocardiogram, respiratory rate, end-tidal CO2, and core temperature were continuously monitored. The first 31 double-blind patients received either intravenous flumazenil (to a maximum of 1 mg) or saline, while the rest of the patients were given flumazenil until either regaining consciousness or a maximum of 2.5 mg was injected. Patients remaining unconscious among double-blind patients or those patients relapsing into coma after the first dose were later treated in the open phase of the study. Treatment continued by boluses or infusion as long as efficacious. MEASUREMENTS AND MAIN RESULTS: Fourteen of 17 double-blind, flumazenil-treated patients woke after a mean of 0.8 +/- 0.3 (SD) mg vs. one of 14 placebo patients (p < .001). Seventy-five percent of the aggregated controlled and uncontrolled patients awoke from coma scores of 3.1 +/- 0.6 to 0.4 +/- 0.5 (p < .01) after the injection of 0.7 +/- 0.3 mg of flumazenil. These patients had high benzodiazepine serum blood concentrations. Twenty-five percent of the patients did not regain consciousness. These patients had very high serum concentrations of nonbenzodiazepine drugs. Sixty percent of the responders who had primarily ingested benzodiazepines remained awake for 72 +/- 37 mins after flumazenil administration; 40% relapsed into coma after 18 +/- 7 mins and various central nervous system depressant drugs were detected in their blood in addition to benzodiazepines. Seventy-one percent of the patients had ingested tricyclic antidepressants. Seventy-eight percent of the responders were continually and efficaciously treated for < or = 8 days. Fourteen (25%) of the intubated patients were extubated safely while 12 patients, who had shown increased respiratory insufficiency, resumed satisfactory respiration after flumazenil injection. Five cases of transient increase in blood pressure and heart rate were encountered. There were 27 mildly unpleasant "waking" episodes, such as anxiety, restlessness, and aggression, but no patient had benzodiazepine withdrawal signs, convulsions, or dysrhythmia, most noticeably absent in tricyclic antidepressant-intoxicated patients. CONCLUSIONS: Flumazenil is a valid diagnostic tool for distinguishing pure benzodiazepine from mixed-drug intoxication or nondrug-induced coma. Flumazenil is effective in preventing recurrence of benzodiazepine-induced coma. Respiratory insufficiency is reversed after its administration. Flumazenil is safe when administered cautiously, even in patients with coma caused by a mixed overdose of benzodiazepine plus tricyclic antidepressants.

Adult↗
PubMed1996

Administration of amphotericin B in lipid emulsion decreases nephrotoxicity: results of a prospective, randomized, controlled study in critically ill patients.

OBJECTIVES: To evaluate the differences in efficacy and in clinical and biochemical tolerance to amphotericin B administered in a lipid emulsion compared with amphotericin B administered in 5% dextrose in water in the treatment of Candida albicans infection in intensive care unit (ICU) patients. DESIGN: Prospective, controlled, randomized study, conducted during a 2.5-yr period, comparing the two treatment protocols. SETTING: General ICU of a university-affiliated municipal hospital. PATIENTS: Sixty consecutive critically ill patients with confirmed or suspected Candida infection. INTERVENTIONS: Patients received amphotericin B (1 mg/kg/24 hrs), administered randomly in 5% dextrose in water (group A), or in lipid emulsion (20% intralipid) (group B). MEASUREMENTS AND MAIN RESULTS: Clinical tolerance (fever, chills, hemodynamics), hepatorenal tolerance, and biological tolerance (serum electrolytes and coagulation profile) were evaluated. Patients receiving amphotericin B in lipid emulsion experienced a lower frequency rate of drug-associated fever (61.4% vs. 5.8%, p < .003) rigors (54% vs. 8.5%, p < .004), hypotension (17% vs. 0%), and nephrotoxicity (increase of serum creatinine concentration 66.7% vs. 20%, p < .0002). Significant (264,500 +/- 71,460 to 163,570 +/- 34,450 mm3, p < .01) thrombocytopenia, not associated with active bleeding, occurred in patients receiving amphotericin B lipid in emulsion but not in patients receiving the drug in dextrose. CONCLUSIONS: Treatment with amphotericin B in a lipid emulsion when given to critically ill patients with Candida sepsis seems to be safer and as effective as the conventional mode of administration.

Adult↗
PubMed1996

[Isolated limb perfusion with tumor necrosis factor for malignancies of the limbs].

Tumor necrosis factor (TNF) induces rapid necrosis in a variety of experimental neoplasms. However, its clinical application is limited by life-threatening systemic toxicity. Isolated limb perfusion (ILP) enables administration of large doses of TNF and cytotoxic drugs directly to the affected limb, avoiding systemic toxicity. We describe our experience in 20 consecutive patients (10 with melanoma and 10 with soft tissue sarcoma) treated with high-dose TNF and melphalan via ILP. ILP was performed via the external iliac (10 cases), femoral (2), popliteal (5) or brachial (3) vessels. Patients received 3-4 mg TNF to an upper, and 1-1.5 mg/kg to a lower extremity. Isolation efficiency was determined by injection of radiolabelled albumin. The procedure was successful in all 20 patients. Local complications included wound infection in 6 cases and hematoma in 2. 1 patient developed sepsis secondary to extensive necrosis of a large, secondarily infected tumor. The first 6 patients who underwent high-flow perfusion experienced systemic side-effects, mainly hypotension. These side-effects were eliminated when low-flow perfusion was introduced. The response rate was 100%. In the sarcoma group, 5/10 had complete response, and 5 partial response. Amputation or mutilating surgery was avoided in 9/10. Of the 10 with melanoma, 7 had complete, and 3 partial response. We conclude that administration of TNF via ILP is a safe and effective modality for treating advanced neoplasms of the limbs.

Adolescent↗
PubMed1995

Antinociception induced by simultaneous intrathecal and intraperitoneal administration of low doses of morphine.

The application of morphine simultaneously into the spinal cord and brain ventricles produces a supraadditive antinociceptive effect. In this study, we attempted to determine whether combined intrathecal (IT) and intraperitoneal (IP) administration of small doses of morphine also produces such a synergistic antinociceptive effect. The experiments were performed on male Wistar rats. Nociception was measured using the tail immersion test. For IT administration morphine was injected through a catheter implanted in the subarachnoid space. Combined administration of small doses of IT (1 microgram) and IP (1 mg/kg) morphine resulted in a strong, highly significant antinociceptive effect. This effect was not only much higher than that produced by separate administration of the same doses of morphine, but also much higher than the expected effect of the combination. These results demonstrate that low doses of IT and IP morphine interact in a supraadditive fashion to produce potent analgesia.

Analgesia↗
PubMed1995

Soluble tumor necrosis factor receptors reduce bowel ischemia-induced lung permeability and neutrophil sequestration.

OBJECTIVES: To evaluate the possible role of tumor necrosis factor (TNF) in the development of lung injury after bowel ischemia, and the ability of TNF-soluble receptors to negate TNF toxicity, using a rat small bowel ischemia and reperfusion model. DESIGN: Prospective, randomized, controlled laboratory study. SETTING: Research laboratory. SUBJECTS: Forty adult male Sprague-Dawley rats weighing approximately 300 g. INTERVENTIONS: The rats were divided equally into four groups: a) ischemia and reperfusion alone; b) those animals receiving TNF antibodies (1 mL) before reperfusion; and c) those animals receiving 200 micrograms of human recombinant TNF soluble receptors. These 30 anesthetized rats underwent 60 mins of superior mesenteric artery occlusion per 4 hrs of reperfusion. The remaining ten animals were sham operated (laparotomy), serving as controls. Lung permeability was measured using bovine serum albumin labeled with 125I, and organ injury was assessed histologically. MEASUREMENTS AND MAIN RESULTS: Thirty and 60 mins after declamping and reperfusion, plasma TNF concentrations increased to 830 +/- 66 and 173 +/- 56 pg/mL, respectively, compared with 10 pg/mL before ischemia (p < .001). In sham-operated control rats, TNF concentrations did not increase from baseline concentrations. Four hours after reperfusion, sequestration of neutrophils in the pulmonary microcirculation was noted (319 +/- 60 vs. 84 +/- 13 neutrophils/10 high-power fields in sham-operated rats [p < .04]). Pulmonary microvascular leak also occurred, as measured by translocation of radiolabeled albumin into the bronchoalveolar space and expressed as the ratio of bronchoalveolar lavage to blood concentrations. This ratio was 5.3 +/- 0.8 in ischemic control animals compared with 1.1 +/- 0.3 in sham animals (p < .03). Treatment with antibodies to TNF before reperfusion attenuated the pulmonary injury (75 +/- 6 neutrophils/10 high-power fields, permeability index 1.6 +/- 0.1) less than in ischemic controls (p < .005). A similar protection was achieved with soluble TNF receptors, which prevented bowel ischemia-induced lung neutrophil sequestration (117 +/- 35 neutrophils/10 high-power fields, pulmonary vascular leak ratio of 2.3 +/- 0.1, p < .05). CONCLUSIONS: The results of this study show that ischemia and subsequent reperfusion of the intestine in rats produce lung injury. This injury is mediated, at least in part, by TNF. Soluble TNF receptors are an effective tool in preventing lung TNF injury after intestinal ischemia.

Animals↗
PubMed1995

Lysosomal degradation and sorting of apolipoprotein E in macrophages.

We previously reported that a substantial amount of newly synthesized apoE in mouse macrophages is degraded prior to secretion; a portion of this pool of apoE can be rescued by the addition of HDL3 to the incubation medium. In the present studies, the location and nature of the intracellular degradation of apoE were more closely examined. Inhibitors of protein trafficking (brefeldin A) as well as a number of protease inhibitors were used. The experiments using brefeldin A (5 micrograms/ml) clearly established that neither the endoplasmic reticulum nor the Golgi complex are the sites of apoE degradation. Using a pulse-chase design, [35S]apoE cannot be chased out in the presence of brefeldin A and remains undegraded within the cell. The accumulated apoE lacks the sialic acid residues, indicating that this final stage of processing must occur in the trans-Golgi network or later. Lysosomotropic agents, ammonium chloride and chloroquine, on the other hand, inhibit apoE degradation by over 70 and 80%, respectively, while total cell protein degradation remains unaffected. Similarly, a cocktail consisting of four lysosomal protease inhibitors (pepstatin, E-64, chymostatin, and antipain), inhibits specifically apoE degradation by over 60%. In contrast, ALLN, an inhibitor of Ca(2+)-dependent cysteine proteases, has a moderate effect on apoE degradation (30% inhibition) and a more pronounced effect on total protein degradation. These data suggest that the site of intracellular apoE degradation in the macrophage is the lysosome. These conclusions are supported by light and electron microscopy of macrophages, clearly showing the presence of immunoreactive apoE (along with cathepsin D) in the endosomal/lysosomal compartment of control and lysosomotropic agent-treated cells. In contrast, little or no labeling is seen in this compartment in brefeldin A-treated cells. At lower concentrations of the lysosomotropic agents, the extent of inhibition of apoE degradation is compensated for by its increased secretion, in a manner analogous to the effect of these agents on lysosomal enzymes. Higher concentrations of these agents, which lead to a profound inhibition of apoE degradation, also specifically block apoE secretion. The block in apoE secretion in the presence of high concentrations of chloroquine leads to undiminished or higher concentrations of immunoreactive apoE in the endosomal/lysosomal compartment, suggesting that apoE is targeted for lysosomal degradation directly, without prior secretion or surface association. These data strongly suggest pH-dependent sorting of apoE in macrophages to the degradative and secretory pathways and imply a protein-protein interaction in the process.

Animals↗
PubMed1994

Epidural morphine pretreatment for postepisiotomy pain.

OBJECTIVE/DESIGN: A randomized double-blind controlled study was conducted on two groups of 45 parturients to evaluate the importance of the timing of epidural morphine administration for the relief of postepisiotomy pain. Both groups had preemptive analgesia by continuous lumbar epidural bupivacaine blockade. Upon completion of the episiotomy repair and before the onset of pain, the patients received epidural injections of 3 ml saline with or without 2 mg morphine in groups A and B respectively. When pain appeared, group A patients received an epidural injection of 3 ml saline while group B patients received 2 mg morphine in 3 ml saline. Postepisiotomy pain level was evaluated by a visual analogue scale. RESULTS: The incidence of pain in group B women following epidural morphine administration was 68.6%. This was significantly higher than that of group A at 15.6% (p < 0.01). Furthermore, group B showed that the rate of effective pain relief after 2 mg epidural morphine significantly decreases as the level of pain intensity rises (p < 0.01). CONCLUSION: Epidural morphine for postepisiotomy pain is much more effective if administered before the onset of pain.

Analgesia, Epidural↗
PubMed1994

Metabolic effects of continuous veno-venous haemofiltration in critically ill patients.

OBJECTIVE: To evaluate the short-term metabolic and haemodynamic effects of continuous veno-venous haemofiltration (CVVH) in critically ill patients with acute renal failure (ARF). DESIGN: Prospective study of nine consecutive critically ill patients with established acute oliguric renal failure. SETTING: A general ICU in an 800-bed university hospital. PATIENTS: Critically ill patients, mean age 56 +/- 6 years. Four had multi-organ failure, one had acute haemolytic uraemic syndrome, one had idiopathic lactic acidosis, two had haemorrhagic pancreatitis and one had urinary sepsis. INTERVENTIONS: All patients were mechanically ventilated with arterial and pulmonary artery catheters in situ. MEASUREMENTS AND MAIN RESULTS: Oxygen consumption (VO2), CO2 production (VCO2) resting energy expenditure (REE), continuous blood pressure, heart rate, central venous pressure (CVP), pulmonary artery pressure (PAP), and cardiac output (CO), as well as tidal and minute volumes, end-tidal CO2 and arterial blood gases, were continuously measured for one hour prior to and one hour following the institution of CVVH. Body temperature, arterial blood pressure, heart rate, CVP and pulmonary artery catheter data remained stable throughout the study period. Prior to CVVH, VO2 was 326 +/- 33 ml/min, VCO2 was 245 +/- 27 ml/min and REE was 2241 +/- 231 kcal/24 hours. Following institution of CVVH, VO2 was 324 +/- 33 ml/min, VCO2 was 244 +/- 27 ml/min and REE was 2227 +/- 230 kcal/24 hours. CONCLUSIONS: CVVH does not affect metabolic rate and haemodynamic stability in critically ill patients. The lack of any effect on the metabolic rate and haemodynamic parameters in such patients may have significant clinical importance and it further attests to the suitability of CVVH for the treatment of critically ill patients.

Acute Kidney Injury↗
PubMed1994

Sternal wound infection: our experience with 200 cases.

More than 200 patients with sternal wound infections have been treated in the Plastic Surgery Department of our Medical Center over the years 1984-1993. Most of these were referrals from other hospitals. In recent years, the cases have become more severe, partially due to the fact that cardiac surgeons tend to operate older and sicker patients more readily than they previously did. 80% of these were post coronary bypass surgery, and the others heart and heart-lung transplants, repair of congenital heart anomalies, valve replacements etc. Several of the cases were cardiac surgery re-do's. Risk factors for developing this complication, such as diabetes, obesity, technical errors of sternal incision, prolonged intubation, the use of aortic balloon, etc. will be discussed. Many of our earlier patients had chronic fistulae following conservative therapy with old treatment modalities. In recent years, patients are usually referred at the acute stage. Most patients undergo removal of sternum and ribs. Previously, reconstruction included mainly transfer of the rectus ahdominis muscle, whereas lately the pectoralis muscles is utilized. Omentum was used in only one case. The importance of pre-operative imaging procedures has been thoroughly studied in our series. Especially important is the definition of the extent of the infection, and localization of foreign bodies causing chronic infections, such as suture material, epicardial electrodes etc. A change in infectants has also been noticed. In the first half of the study period, Pseudomonas aeruginosa comprised at least 40%.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Acute poisoning treated in the intensive care unit: a case series.

A retrospective study on patients with acute poisoning admitted to the Intensive Care Unit (ICU) of the Ichilov Hospital over a 3-year period (1982-84) is presented. Of 419 patients seen in the Emergency Room for intoxication during these years, 71 (17%) required intensive care upon admission. Suicide attempts accounted for 90% of the ICU admissions, with drugs of the benzodiazepine (BDZ) group being the most commonly used (51%). Mixed-drug overdose was seen in 55% of the patients. There was a poor correlation between the drugs suspected on admission and those actually detected in the blood. Although the total number of admissions due to poisoning increased in 1984 (21 in 1982 vs. 37 in 1984), mechanical ventilation was required by fewer patients (92% in 1982 vs. 51% in 1984) and for a shorter period of time (3.1 days in 1982 vs. 2.1 days in 1984), which resulted in a shorter ICU stay (4.8 days in 1982 vs. 3.1 days in 1984). The introduction of the new BDZ antagonist flumazenil may have partially accounted for this positive trend.

Acute Disease↗