Search PubMed⌕ Search

Biomedical subjects

C Cottingham

Publications and source records attributed to C Cottingham.

13 recordsLinked to original sources
PubMed2000

Interhospital transport of the extremely ill patient: the mobile intensive care unit.

BACKGROUND: Critically ill patients may require specialized care that is offered only at tertiary referral centers. As regionalization and specialization of critical care become more common, transportation of critically ill patients must be refined. Transportation of critically ill patients within a hospital, much less outside the hospital, is often deemed unsafe because of medical instability. We report, here, our results from 2 yrs' experience of transporting extremely ill patients with respiratory failure via a ground critical care transport service. METHODS: A mobile intensive care unit was equipped and staffed to nearly recreate the intensive care environment. Staffing included a physician, nurse, respiratory therapist, and driver--all with extensive critical care experience. The mobile intensive care unit was equipped with a full pharmacy, advanced ventilatory equipment, and capability for full invasive hemodynamic monitoring. Data were analyzed by retrospective review. The predicted mortality rate, based on Pao2/Fio2 ratios, was compared with the actual mortality rate. RESULTS: During a 2-yr period, 39 critically ill patients were transported. Thirty-six of the 39 were candidates for extracorporeal lung assist, with a mean positive end-expiratory pressure requirement of 15.9, a mean Fio2 requirement of .93, and a mean Pao2/Fio2 ratio of 59.8. Pulmonary arterial catheters and peripheral arterial catheters were in place in 66.6% and 72% of patients, respectively. Vasoactive medications were being infused in 56%, and 74% were receiving medical paralytics. One patient died during movement from the bed to the transport gurney. Other than one episode of transient hypotension, there were no complications or untoward outcomes related to transport. Unique therapeutic interventions were performed at the receiving facility on 34 of 39 patients. The predicted mortality rate, based on indicators of lung dysfunction, was 68% to 100%; the actual subsequent hospital mortality rate was 43%. CONCLUSIONS: When a mobile intensive care unit is properly staffed and equipped and patient stabilization is performed before transfer, severely ill patients with respiratory failure can be transferred safely. For patients with respiratory failure, there may be a survival advantage in transfer to regional centers of expertise.

Adult↗
PubMed2000

Hyperlactatemia, increased osmolar gap, and renal dysfunction during continuous lorazepam infusion.

OBJECTIVE: To review effects of the vehicle of lorazepam, propylene glycol, in regard to lactate, osmolarity, and renal dysfunction. DESIGN: Case report. SETTING: Intensive care unit of a Level I trauma center. Patient A 36-yr-old Hispanic man who developed severe respiratory failure and required high-dose lorazepam for sedation. The patient was ventilated with low tidal volumes in a lung-protective fashion, with resultant "permissive hypercapnia." Lactates and osmolalities rose on initiation and fell, as expected, on discontinuation of the lorazepam infusion. However, there was no renal compensation for the hypercapnia except while the patient was not receiving lorazepam. MEASUREMENTS AND MAIN RESULT: Serial osmolalities, lactates, serum bicarbonate, PaCO2, and pH were measured during lorazepam infusion. Rise and fall of serum lactate and osmolality closely correlated with lorazepam. Serum bicarbonate rose significantly while the patient was not receiving lorazepam in response to hypercarbia and failed to rise while the patient was receiving lorazepam. CONCLUSION: The vehicle of lorazepam, propylene glycol, can cause hyperlactatemia and elevated osmolar gaps. However, propylene glycol may also interfere with renal tubular function and may blunt renal compensation for respiratory acidosis.

Adult↗
PubMed2000

Physician utilization of a portable computed tomography scanner in the intensive care unit.

OBJECTIVE: To determine the utilization of a portable computed tomography (CT) scanner for critically ill adult patients in an intensive care unit (ICU). DESIGN: Survey study and retrospective review. SUBJECTS: Critical care attending staff and fellows and neurosurgery residents. SETTING: A university hospital and Level I trauma center with a multitrauma ICU, a neurotrauma ICU, and a neurosurgical ICU. INTERVENTIONS: We surveyed all physicians who ordered portable CT scans from December 1996 through June 1998. Ordering physicians included critical care attending staff and fellows (anesthesiology, surgery, internal medicine) and neurosurgery residents. Physicians who no longer worked at the institution were contacted by mail or fax. Radiology records were reviewed to determine the actual number and type of scans performed. MEASUREMENTS AND MAIN RESULTS: The survey response was 100%. Most physicians reported ordering portable head CT scans (97%), followed by chest CT (88%), abdominal CT (78%), and pelvic CT (34%) scans. Analysis of the actual number of scans performed correlated with these reports (511 head, 115 chest, 88 abdomen, and 87 pelvis). The indication for portable CT scans (as opposed to a "fixed" or "stationary" scans) cited most often was patient severity of illness (77%). Patients on extracorporeal support (93%), those with cardiovascular instability (70%), followed by those with respiratory instability (57%) and neurologic instability (40%) were deemed too ill to transport. If the portable CT scanner was unavailable, however, most physicians (67%) ordered a fixed helical CT scan and the patient was transported to the radiology suite, regardless of medical condition. CONCLUSIONS: Access to a portable CT scanner impacts the physician ordering patterns for ICU patients. We found that 100% of surveyed physicians used the portable CT scanner for critically ill patients when the patient was unstable. If the diagnostic study was deemed medically necessary, and the portable scanner was unavailable, most surveyed physicians ordered a "fixed" helical scan and the patient was transported by an experienced transport team for the study. The portable CT offered an alternative and potentially safer means of obtaining diagnostic studies.

Attitude of Health Personnel↗
PubMed1998

Acute respiratory distress syndrome: estimated incidence and mortality rate in a 5 million-person population base.

BACKGROUND: Various estimates of the incidence and mortality rate of the acute (adult) respiratory distress syndrome (ARDS) have been published. The studies that led to those estimates were based on relatively small patient populations and employed variable diagnostic identifiers of ARDS. The purpose of this study was to estimate the incidence of ARDS and its mortality rate from a large database to which refined diagnostic criteria were applied. We conducted a retrospective review of all hospital discharges over a 4-year period, using screening criteria designed to select patients with ARDS. Discharges from all acute care hospitals in the state of Maryland were reviewed using a computer database from the Health Services Cost Review Commission (HSCRC). Patients >/= 12 years of age were included. Screening criteria consisted of ICD-9 codes 518.5 and 518.82 cross-referenced with procedural codes for ventilatory support (96.70, 96.71 and 96.72). Data were normalized to the number of cases per 100,000 people. RESULTS: During the 4-year study period there were 2,501,147 hospitalizations. Applying the ICD-9 ARDS criteria yielded lower and upper limits of 159-205, 439-568, 531-694 and 529-720 cases of ARDS for 1992, 1993, 1994 and 1995, respectively. Normalizing for a population of 5 million yields yearly lower and upper limit rates of 3.2-4.2, 8.8-11.4, 10.6-13.8 and 10.5-14.2 cases of ARDS per 100,000 people. Mortality upper and lower limit rates based upon the same duration, admissions and population were 38-49%, 39-52%, 36-47%, and 36-49%, respectively. CONCLUSIONS: The incidence of ARDS in Maryland is in the range of 10-14 cases per 100,000 people. The ARDS mortality rate is 36% to 52%, similar to that calculated in previous studies.

Journal Article↗
PubMed1993

Accuracy of the One Touch II whole blood glucose analyzer when used by analysts with diverse technical backgrounds.

BACKGROUND: The accuracy of hand-held analytical systems is dependent on the complexity of the instrument and the technical skills of the tester. We evaluated the analytical performance of the LifeScan One Touch II glucose analyzer when used by persons with various levels of technical skill and experience. METHODS: A medical technologist conducted tests on three One Touch II systems to ensure that the units were functioning properly. The technologist then trained six analysts (a physician, a registered nurse, a licensed practical nurse, a physician assistant, and two patients) in the proper use of the glucose analyzer. RESULTS: In the hands of a medical technologist, the precision of the three glucose analyzers tested was from 1.0% to 1.9% coefficient of variation (CV) and from 2.3% to 4.2% CV for the low- and high-quality control materials, respectively. The day-to-day precision (5-day period) was from 2.1% to 3.6% CV, and from 3.5% to 4.1% CV for the low- and high-quality control materials, respectively. Comparisons of the glucose values (n = 40 fresh patient serum samples) with a reference method yielded a correlation coefficient of 0.992 to 0.993, and an overall bias of -7%. Although the values obtained by the six operators were statistically different, the differences were not clinically relevant. CONCLUSIONS: Our data suggest that the One Touch II glucose analyzer is a reliable system, and that its function is not dependent on the technical skills of the operator.

Blood Glucose↗
PubMed1991

To what degree.

Explore the source record for details and available documents.

Curriculum↗
PubMedDate not supplied

Life-threatening acute systemic lupus erythematosus: survival after multiple extracorporeal modalities: a place for the multipotential extracorporeal service.

Diffuse alveolar hemorrhage secondary to systemic lupus erythematosus (SLE) may cause life-threatening respiratory failure and may be associated with multiple organ failure. Extensive support may be necessary to sustain life while systemic therapy becomes effective. We report here a patient with profound respiratory failure secondary to SLE associated with multiorgan failure, who was supported with veno-arterial extracorporeal lung assist (ECLA), veno-venous ECLA, and multiple continuous renal replacement therapies during plasmapheresis. The full spectrum of extracorporeal life support and treatment modalities was performed seamlessly by a single service within the critical care department.

Acute Disease↗