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Biomedical subjects

A R Zucker

Publications and source records attributed to A R Zucker.

9 recordsLinked to original sources
PubMed1992

PEEP is necessary for exogenous surfactant to reduce pulmonary edema in canine aspiration pneumonitis.

Alveolar edema inactivates surfactant, and surfactant depletion causes edema by reducing lung interstitial pressure (Pis). We reasoned that surfactant repletion might reduce edema by raising Pis after acute lung injury and that positive end-expiratory pressure (PEEP) might facilitate this effect. One hour after tracheal administration of hydrochloric acid in 18 anesthetized dogs with transmural pulmonary capillary wedge pressure of 8 Torr, the animals were randomized into three groups: in the SURF + PEEP group, 50 mg/kg of calf lung surfactant extract (CLSE) was instilled into each main stem bronchus with 8 cmH2O of PEEP; in the SAL + PEEP group, PEEP was followed by an equal volume of saline (SAL); in the SURF group, CLSE was given without PEEP. After 5 h, edema in excised lungs (wet-to-dry weight ratios) was significantly less in the SURF + PEEP group (9.1 +/- 1.0) than in the other groups (11.3 +/- 1.8 and 11.3 +/- 1.8, respectively). In the SURF + PEEP group, pulmonary venous admixture fell by 6%; this change was different from the 7% increase in the SAL + PEEP group and 40% increase in the SURF group (P less than 0.05). Airway secretions obtained in the SURF + PEEP group had normal minimum surface tensions of 4 +/- 2 mN/m, a value much lower than in SAL + PEEP and SURF groups (32 +/- 4 and 22 +/- 7 mN/m, respectively). We conclude that surfactant normalizes surface tension and decreases transcapillary hydrostatic forces in this lung injury model, thereby reducing edema formation and improving gas exchange. These benefits occur only if surfactant is given with PEEP, allowing surfactant access to the alveoli and/or minimizing its inhibition by edema proteins.

Animals↗
PubMed1990

Transplantation of two patients with one liver. Analysis of a preliminary experience with 'split-liver' grafting.

Surgical reduction of donor livers to treat small children has been performed successfully in several centers. While this procedure improves the allocation of livers, it does not increase the organ supply. We have extended reduced-size orthotopic liver transplantation (OLT) to treat 18 patients with 9 livers, accounting for 26% of our transplants during a 10-month period and have evaluated the results. In 18 split liver OLTs, patient survival was 67% and graft survival was 50%. In comparison, for 34 patients treated with full-size OLT during the same period, patient survival was 84% (p = 0.298) and graft survival was 76% (p = 0.126). Biliary complications were significantly more frequent in split grafts, occurring in 27%, as compared to 4% in full-sized grafts (p = 0.017). Primary nonfunction (4% versus 5.5%) and arterial thrombosis (6% versus 9%) occurred with similar frequency in split and full-size OLT (p = not significant). These results demonstrated that split-liver OLT is feasible and could have a substantial impact in transplant practice. We believe that biliary complications can be prevented by technical improvements and that split-liver OLT will improve transplant therapy by making more livers available.

Adult↗
PubMed1990

Resource use, efficiency, and outcome prediction in pediatric intensive care of trauma patients.

To study the impact of trauma patients on Pediatric Intensive Care Units (PICUs), 164 trauma patients' data from 1,075 consecutive admissions to five PICUs were reviewed. Resource use (Therapeutic Intervention Scoring System [TISS] points) and mortality risks (Physiologic Stability Index [PSI] and Pediatric Risk of Mortality [PRISM] scores) were obtained daily for all patients. Trauma patients constituted 15.2% of all PICU patients, and used 14.9% of patient care days and 14.5% of TISS points. Efficiency of trauma patient care was 75% overall compared to 79% overall for nontrauma patients (p less than 0.001). Trauma patient mortality was 9.8%. Tests for goodness of fit showed the PSI and PRISM scores to be accurate outcome predictors for trauma patients (PSI: chi 2 (4) = 2.852, p greater than 0.50; PRISM: chi 2 (4) = 1.216, p greater than 0.50). Trauma patients are a minority of PICU patients and deaths. Their resource use is proportional to their numbers, although less efficient than for nontrauma patients. PSI and PRISM are accurate mortality risk predictors for trauma patients.

Child↗
PubMed1988

Liver transplantation, including the concept of reduced-size liver transplants in children.

Since the establishment of a clinical program in liver transplantation in 1984, 162 liver transplants have been performed in 131 patients (78 adults, 53 children). The patient mortality rate while waiting for a suitable organ has been 8% for adults and only 4% for children (25-46% reported in the literature). The low pediatric mortality is a result of the use of reduced-size liver transplants. A total of 14 procedures have been performed in recipients whose clinical condition was deteriorating and for whom no full-size graft could be located. Of 14 children, 13 were less than 3 years of age. Patient survival is 50%, comparable to survival of high-risk recipients of full-size livers. Using reduced-size liver grafting in a transplant program can lower mortality for children awaiting a transplant by overcoming size disparity. Reduced-size liver grafting will allow more effective use of donor resources and provide a potential avenue of research for organ splitting and living related donation.

Adolescent↗
PubMed1988

Therapeutic strategies for acute hypoxemic respiratory failure.

Acute hypoxemic respiratory failure is a pulmonary capillary leak state that occurs in many different clinical settings. The resultant edema causes refractory hypoxemia due to intrapulmonary shunting and loss of lung compliance. Mechanical ventilation with PEEP and high concentrations of supplemental oxygen are frequently necessary for patient survival, but these therapies may themselves contribute to further lung damage. Studies have shown that manipulations of the pulmonary circulation aimed at reducing the forces promoting edemagenesis have salutary effects on gas exchange and lung mechanics and can be performed safely. The use of these combined modalities for pediatric patient care has been discussed. Finally, other approaches to treatment currently being investigated in animal models of AHRF have been presented. As these and other new treatment methods are explored, hopefully it will be possible to decrease the unacceptably high mortality rate still encountered in AHRF.

Acute Disease↗
PubMed1987

Efficiency of intensive care. A comparative analysis of eight pediatric intensive care units.

To calculate overall pediatric intensive care unit (PICU) efficiency rates, 1668 patients representing 6962 patient-days were studied in eight PICUs. The contributions to inefficiency by two patient groups--low-risk monitored patients and potential early-discharge patients--were quantified using measures of daily mortality risk and therapeutic assessments. Low-risk monitored patients never received a unique PICU therapy and had daily mortality risks less than 1%. Potential early-discharge patients were similar to the low-risk monitored patients except that their unnecessary PICU use came only on their last consecutive day(s) of PICU stay. Efficiency ratings ranged from 0.894 to 0.547 in the eight PICUs. Low-risk monitored patients constituted from 16% to 58% of the PICU patient populations and used from 5.4% to 34.5% of the total days of care. Potential early-discharge patients constituted from 12% to 29% of the populations and the potential early-discharge days of care ranged from 5.1% to 17.2% of the total days of care. These results indicate that large disparity exists in efficiency among PICUs. Efficiency rates of greater than 0.80 seem to be a reasonable goal.

Child↗
PubMed1986

The effects of plasmapheresis and hemofiltration on canine acid aspiration pulmonary edema.

Aspiration of hydrochloric acid causes pulmonary capillary endothelial damage and edema. One approach to treatment is reduction of circulating volume and pulmonary wedge pressure (Ppw) to low values compatible with adequate cardiac output (QT) and oxygen delivery (QO2) to the tissues. We investigated this approach in 18 dogs after intratracheal instillation of HCl. One hour after injury, animals were randomized into 3 equal groups and studied for another 4 h. Control dogs (Group C) were maintained at a Ppw of 12 mmHg throughout the experiment. In a second group (Group H), Ppw was reduced over 30 min to 5 mmHg by hemofiltration and maintained at this amount throughout the experiment. In a third group (Group P) Ppw was reduced and maintained at 5 mmHg by plasmapheresis. In Group C, extravascular thermal volume (ETV), measured in vivo, increased to 520 ml by 5 h, and venous admixture (QVA/QT) increased to 30%. In contrast, plasmapheresis stopped ETV accumulation at the 1-h value of 250 ml, whereas QVA/QT decreased to 8% at 5 h. Hemofiltration did not significantly reduce either ETV or QVA/QT, which were 420 ml and 30%, respectively, at 5 h. The wet weights of lungs excised at 5 h and normalized to body weight (WW/BW) confirmed that plasmapheresis reduced edema (WW/BW, 19 ml/kg) compared (p less than 0.05 ANOVA) with that in the control group (WW/BW, 27), and that hemofiltration did not significantly reduce edema (WW/BW, 24).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗