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Biomedical subjects

C L Rice

Publications and source records attributed to C L Rice.

At least 91 records · Page 5Linked to original sources
PubMed1981

Does reduced colloid oncotic pressure increase pulmonary dysfunction in sepsis?

Starling's hypothesis of forces governing fluid movement across capillary membranes suggests that any unopposed decrease in intracapillary colloid oncotic pressure (COP) or increase in capillary permeability should result in increased interstitial fluid. Iso-oncotic increase in pulmonary artery wedge (PAW) causes pulmonary dysfunction. Isobaric reduction of COP with normal capillary permeability does not result in pulmonary interstitial edema. Because sepsis is a frequent antecedent of clinical pulmonary dysfunction, the question was asked: does reduction in the COP-PAW gradient in the presence of sepsis result in increased pulmonary dysfunction? Twenty baboons were studied: group 1--control, group 2--4-h constant infusion of E. coli, group 3--plasmapheresis alone, group 4--plasmapheresis followed by sepsis. Ringer's lactate was infused to keep PAW constant. Arterial and mixed venous blood gases were drawn and the intrapulmonary shunt (QS/QT) was calculated. The data were compared using Tukey's HSD test and one way analysis of variance. Plasmapheresis alone resulted in a 68% reduction in COP (15 +/- 2.9 (SD) torr to 4.6 +/- 0.6 in group 3 and 16.5 +/- 4.3 to 5.7 +/- 0.9 in group 4, p less than 0.05). Sepsis resulted in an increase in QS/QT in all septic animals. There was no increased QS/QT in those animals that had sepsis added to plasmapheresis, group 4 (p less than 0.05). These data indicate that sepsis leads to pulmonary dysfunction but that this dysfunction appears to be independent of colloid oncotic forces.

Animals↗
PubMed1979

Cardiac output response to extreme hemodilution with hemoglobin solutions of various P50 values.

Cardiovascular responses have been studied in baboons, after total exchange transfusion with hemoglobin solutions having various P50 values. At the end of the exchange transfusion, the hematocrit was 1.5%, the mean hemoglobin concentration was 4.4 g/dl, and the P50 varied between 12 and 26 mm Hg. Cardiac output did not change during the study, although heart rate increased, and stroke volume and MAP decreased. Hemoglobin concentration, per se, does not appear to be the critical stimulus for an increase in cardiac output with hemoglobin solution. In addition, the position of the hemoglobin-oxygen dissociation curve does not appear to influence these hemodynamic responses. The physiological response to anemia in the presence of hemoglobin solution appears different from that observed in the absence of plasma O2 carriers.

Anemia↗
PubMed1979

Splenorrhaphy for splenic trauma.

Thirty consecutive patients sustaining splenic injury from blunt abdominal trauma were evaluated as to the feasibility of performing splenorrhaphy rather than splenectomy. Twenty-four patients were over 14 years of age. The procedure to be performed was decided intraoperatively. Twelve patients required a splenectomy, and 18 patients had all or a portion of the injured spleen salvaged. The two groups were similar in age, mechanism of injury, and associated injuries. Nine of the 18 salvaged spleens required only debridement and the topical application of Avitene for hemostasis. The remaining nine patients required more extensive procedures including hemisplenectomy (three) and partial splenectomy (three); three patient patients required oversewing of bleeding splenic surfaces and the ligation of vessels without removal of splenic tissue. There were no differences in the number of blood transfusions required by the two groups. There were no postoperative complications resulting from the splenorrhaphy. Sixteen of the 18 who underwent splenorrhaphy were studied postoperatively by spleen scan. In all cases functioning splenic tissue was found consistent with the operative findings and procedure.

Abdominal Injuries↗
PubMed1979

Parenteral antibiotics in elective colon surgery? A prospective, controlled clinical study.

The addition of perioperative gentamicin and clindamycin to an oral antibiotic bowel preparation was studied in a prospective, randomized, double-blind series of patients undergoing elective colectomy. Fifty-nine patients completed the study, with all receiving mechanical preparation of the colon and oral neomycin and erythromycin base. Thirty-one of these patients also received a preoperative and postoperative intravenous dose of gentamicin and clindamycin, while 28 received placebos. The two groups of patients were similar in age, both habitus, pathologic diagnosis, concomitant disease, operative procedures, operative time, blood loss, and adequacy of mechanical preparation of the colon. The incidence of infectious complications related to colectomy was 1% (three of 28) in the placebo group and 7% (two of 31) in the group receiving intravenous gentamicin and clindamycin. There were no wound infections directly related to colectomy in either group. There was no statistically significant reduction of infectious complications with the addition of intravenous gentamicin and clindamycin to oral neomycin and erythromycin-base bowel preparation.

Aged↗
PubMed1979

Blood and blood substitutes: current practice.

We have seen that the vast majority of previously healthy patients can tolerate a significant reduction in red cell mass without adverse effect on oxygen consumption. For these patients, volume replenishment with electrolyte solutions will adequately restore blood volume and cardiac output. Colloid solutions offer no advantage over electrolyte solutions, certainly are more expensive and may even be harmful. For patients who need restoration of oxygen-carrying capacity, washed, packed red cell administration is the therapy of choice, and frozen, thawed red cells represent optimal utilization of a scarce commodity. Other components, such as fresh frozen plasma, factor VIII or IX concentrates and platelets, are not indicated unless a specific deficiency exists. Autologous blood, using one of the techniques described above, is a safe and effective means of replacing lost red cells in special circumstances. The use of these techniques, combined with realistic ordering of homologous blood for elective surgical procedures, should act in concert to relieve shortages of blood.

Albumins↗
PubMed1979

Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study.

The effects of hemodynamic resuscitation with protein-containing or balanced salt solution were studied prospectively in 29 patients undergoing abdominal aortic surgery. Blood loss was replaced with packed red cells and extracellular volume with either Ringer's Lactate (RL) or 5% albumin in Ringer's lactate (ALB). Fluids were given to maintain the pulmonary capillary wedge pressure (PCWP) equal to or within 5 torr above preoperative (PO) levels, the cardiac output (CO) equal to or greater than preoperative values, and the urine output at least 50 ml/hr. Serum colloid osmotic pressure (COP), CO, PCWP, the gradient between COP and PCWP (COP-PCWP), and intrapulmonary shunt (Qs/Qt) were measured PO, intraoperatively (IO), and daily for 3 days. The measured variables were similar PO in both groups. Operation time, estimated blood loss, and transfusions were similar. Total fluids received for resuscitation (day of operation) was 11.3 +/- 0.8 liters (RL) and 6.2 +/- 0.4 liters (ALB). Fluid balance at the end of resuscitation was 8.4 +/- 0.8 liters (RL) and 3.4 +/- 0.5 liters (ALB). Maximum decrease in COP was 40% (P less than 0.001) in the RL group and was insignificant in the ALB group. The COP-PCWP decreased from 11 +/- 1 to 2 +/- 1 in RL (P less than 0.001) and insignificantly in ALB. Qs/Qt increased slightly in both groups following operation but was not different between groups. Fluid balance, total fluid infused, sodium balance, total sodium infused, COP, or COP-PCWP did not significantly correlate with Qs/Qt. Two patients in the ALB group experienced pulmonary edema associated with normal COPs and elevated PCWPs. There were no cases of pulmonary edema associated with low COPs and normal PCWPs in the crystalloid group. These data seriously question the necessity to maintain COP by using protein-containing solutions during acute hemodynamic resuscitation. When titrated to physiological end points, even large volumes of balanced salt solutions are tolerated well.

Albumins↗
PubMed1978

Hemodynamic and respiratory response to varying gradients between end-expiratory pressure and end-inspiratory pressure in patients breathing on continuous positive airway pressure.

Nine patients on intermittent mandatory ventilation (IMV) and continuous positive airway pressure (CPAP) were allowed to breathe spontaneously at varying end expiratory pressure-end inspiratory pressure (EEP-EIP) gradients up to 10 cm H2O. There was no change in the mean cardiac output and oxygen delivery despite a lowered mean airway pressure (MAWP) when the gradient was increased. Three patients were uncomfortable at the higher gradients and another manifested evidence of fatigue of the muscles of respiration by raising her arterial PCO2 (PaCO2) and intrapulmonary shunt (Qs/Qt). In view of the difficulty experienced by some patients and lack of improvement in cardiac outputs (CO) during spontaneous inspiration when the EEP-EIP gradient is raised from zero to 5 and 10 cm H2O, it is recommended that the variation in airway pressure during spontaneous breaths while a patient is on CPAP be minimized.

Hemodynamics↗
PubMed1978

The significance of chest wall injury in the diagnosis of traumatic aneurysms of the thoracic aorta.

It has been suggested that patients sustaining blunt chest injury severe enough to result insignificant bony injury to the thorax may have traumatic aneurysms of the thoracic aorta in the absence of th widened mediastinum on plain film. To test the validity of this hypothesis, we performed aortograms on 14 patients with severe blunt chest injury but an otherwise normal chese X-ray. None of these patients was found to have an aortic injury. By contrast, of 21 patients with severe chest injury and a widened mediastinum who underwent thoracic aortography eight were found to have traumatic aneurysms of the thoracic aorta. These results suggest that in the absence of a widened mediastinum, severe chest wall injury is not an indication for aortography.

Adolescent↗
PubMed1978

Lymph and pulmonary response to isobaric reduction in plasma oncotic pressure in baboons.

Plasma colloid osmotic pressure was reduced by 76% (from 19.6 +/- 0.6 to 4.7 +/- 1.5 mm Hg) in five baboons while pulmonary capillary hydrostatic pressure was maintained at a normal level. This resulted in fluid retention, weight gain, peripheral edema and ascites, but no pulmonary edema. Thoracic duct lymph flow increased 6-fold and pulmonary lymph flow 7-fold. Thoracic duct lymph had a lower colloid osmotic pressure (2.0 +/- 0.7 mm Hg) than plasma (4.7 +/- 1.5 mm Hg), whereas the colloid osmotic pressure of pulmonary lymph (4.7 +/- 0.7 mm Hg) was the same as that of plasma. The lymph-plasma ratio for albumin fell in thoracic duct lymph but remained unchanged in pulmonary lymph. The difference between plasma colloid osmotic pressure and pulmonary artery wedge pressure decreased from 15.3 +/- 1.9 to -0.7 +/- 2.9 mm Hg. Despite this increase in filtration force, the lungs were protected from edema formation by a decrease of 11 mm Hg in pulmonary interstitial colloid osmotic pressure and a 7-fold increase in lymph flow.

Animals↗
PubMed1978

Central venous pressure or pulmonary capillary wedge pressure as the determinant of fluid replacement in aortic surgery.

Both central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) have been used as guides to fluid replacement in patients undergoing abdominal aortic surgery. To test the hypothesis that changes in PCWP (deltaPCWP) may be reliably estimated from changes in CVP (deltaCVP), 55 patients had simultaneous measurements (302 paired observations) of CVP and PCWP, as well as of cardiac output, before and during operation. The correlation between deltaCVP and deltaPCWP was high (r = 0.716, P less than 0.001). The estimated slope for the linear regression was 0.88. The standard error of the estimate was +/- 3.75 torr, making the prediction of deltaPCWP from deltaCVP accurate only to within 7.5 torr. There were five patients who each had a low and failing CVP accompanied by a stable cardiac output and a rising PCWP; for them, a decision to administer fluid based on the CVP might have resulted in pulmonary edema. Although deltaCVP accurately predicted direction and magnitude of deltaPCWP in the majority of patients (90%), there was a small group in whom there was no substitute for direct measurement of PCWP.

Adult↗