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Biomedical subjects

D J Cullen

Publications and source records attributed to D J Cullen.

At least 73 records · Page 4Linked to original sources
PubMed1983

Benefit of elective intensive care admission after certain operations.

To determine if patients who have undergone uneventful vascular surgery (VS), nonvascular intracranial surgery (ICS), or anterior cervical laminectomies (ACL) have enough serious postoperative problems to justify routine overnight observation in an intensive care unit (ICU), we recorded every problem and associated therapy administered to 263 such patients within 36 h of ICU admission. The severity of each treated problem was graded from 1 (safe to delay treatment for at least 2 h) to 4 (life-threatening, immediate treatment required). Defining patient benefit from the ICU as treatment for one grade 4 problem or more than one grade 3 problem, 44% of VS patients (N = 177), 14% of ICS patients (N = 73), and none of the ACL patients (N = 13) benefited. We conclude that these percentages justify an overnight ICU stay for all VS patients, especially as the occurrence of serious problems was unpredictable and most serious problems were still being treated 4 h postoperatively. Furthermore, routine ICU admission of all patients in the groups studied would reduce patient costs if only 13 of the 88 patients who benefited were prevented from becoming critically ill.

Craniotomy↗
PubMed1982

Evaluating outcome from intensive care: a preliminary multihospital comparison.

To contrast mortality for groups of ICU patients treated in different hospitals, we surveyed 795 consecutive ICU admissions in 5 ICUs using a general severity of illness classification system. After obtaining information from the medical record on age, sex, indication for ICU admission, and severity of illness, we used a logistic multiple regression equation to project death rates for each ICU based on data from a sixth reference hospital. There were substantial differences in severity of acute illness among the hospitals which accounted for most of the variation in death rates. In all ICUs, however, projected death rates were quite similar to observed deaths. These findings suggest that the use of a general severity of illness index and multivariate statistical techniques could, after further refinement and validation, improve interhospital comparisons of the outcome of acutely ill patients.

Critical Care↗
PubMed1981

Surgical intensive care: current perceptions and problems.

To ascertain the problems and needs of surgical ICUs, questionnaires (prepared by the author) were submitted to 50 medical directors and ICU head nurses at major hospital centers throughout the country. Is there a demand for intensive care not being met? If so, why? What is the frequency of overcrowding or need for triage? Thirty-one of the 50 questionnaires were returned, most fully completed. Demographic information about the hospital and surgical ICU itself was obtained. In most hospitals, patients requiring elective surgery and who need postoperative intensive care were not canceled even though no ICU bed was available. The major factor which limited surgical ICU caseload was the lack of ICU nurses needed to manage the volume of patients requiring intensive care in already existing beds and with equipment already purchased and in use. The current nurse:patient staffing ratios are approximately 1:2 in most ICUs. Nurse staffing averaged 82% of the authorized complement (range 15-50%). The ICU nursing turnover rate was extremely variable, ranging from 50-75% per year in seven units to as low as less than 15% in six units. This survey suggests that both large and small hospitals have difficulty carrying out their surgical ICU mission because of the demand for more ICU facilities is outstripping the supply of ICU staff. The medical and nursing critical care societies must address these problems and attempt to solve them.

Health Services Needs and Demand↗
PubMed1980

Comparative effects of calcium chloride and calcium gluceptate.

Calcium chloride and calcium gluceptate were compared in their ability to increase plasma ionized calcium concentrations ([Ca2+]). To correct a low ionized calcium concentration, each of 10 critically ml of a 10% solution, containing elemental calcium 27 mg ml-1) and calcium gluceptate (20 ml, containing elemental calcium 18 mg ml-1) over a 5-min period in randomized order approximately 6 h apart. [Ca2+] and haemodynamic variables (mean arterial pressure (MAP), mean right atrial pressure (RAP) and heart rate (HR)) were monitored for a 30-min period following completion of calcium infusion. Infusion of either calcium preparation was associated with similar increases in [Ca2+] (5 min after infusion of calcium chloride: 33 +/- 3.1%; calcium gluceptate: 32 +/- 4.3% (mean +/- SEM)) and the effects on MAP were similar for each solution (11.1 +/- 1.8% and 9.7 +/- 2.4%, respectively).

Adult↗
PubMed1980

Comparative evaluation of new fine-screen filters: effects on blood flow rate and microaggregate removal.

Fine-screen filters were studied in a simulated clinical situation wherein ten units of outdated concentrated erythrocytes were rapidly transfused per filter to determine flow rates and effectivenesses of debris removal. Preliminary studies to evaluate flow rates with outdated whole blood indicated that the Bentley PFF-100, Fenwal 4C9003, and Biotest MF-10 fine-screen filters allowed flow rates sufficient to justify further detailed testing. For comparative purposes, the filter the authors have used clinically, the Pall Ultipor 40-micrometers filter, was studied again. As many as ten units of outdated, concentrated erythrocytes (hematocrits 75--85 per cent) were infused through each of the fine-screen filters at 300 torr pressure. All filters (except one of five Pall filters) accepted all ten units. The Bentley PFF-100 filter allowed the highest flow rates, such that the tenth unit of erythrocytes required 5 +/- 3 min (1 SD) to pass the filter. The Biotest MF-10, Bentley PFF-100 and Fenwal 4C9003 filters retained more debris/g erythrocytes, decreased screen filtration pressure, and eliminated more particulate matter (as determined by Coulter counter testing) than did the Pall Ultipor filter. When three or more units of blood are transfused, any of the four filters tested is cost-effective when compared with the current 170-micrometer standard transfusion filter.

Blood Flow Velocity↗
PubMed1980

Recovery room care of the surgical patient.

The recovery room provides short-term intensive care to a wide variety of patients, better assuring their smooth, uncomplicated, rapid postoperative course. Many disorders (of all organ systems) occur acutely but, with proper recognition and treatment, they may be resolved very rapidly. The key to optimal postoperative management is anticipation, recognition, and immediate action along with close observation and monitoring of both the therapy and the process derived from therapy. The recovery room will justify its existence by limiting the number of postoperative complications and enhancing the postanesthetic, postsurgical recovery.

Anesthesia↗
PubMed1976

Survival, hospitalization charges and follow-up results in critically ill patients.

In 226 consecutive critically ill primarily postoperative patients, we determined survival and quality of life, hospitalization charges, and consumption of blood and blood products. The patients were physiologically unstable and required intensive physician and nursing care. By one month, 123 patients had died (54 per cent), 70 were still hospitalized, and 31 were home; only one of 103 survivors had fully recovered. By 12 months, 164 patients (73 per cent) had died, 10 were still hospitalized, and 51 were home. Twenty-seven of 62 survivors had fully recovered. Hospitalization charges averaged $14,304 per patient. The total charge for blood and blood fractions was $617,710--21 per cent of the total hospitalization charge; $515,711 (83 per cent) of the blood charge went to 164 nonsurvivors, whereas $101,939 (17 per cent) went to the 62 survivors. These data document the use of increasingly limited resources in the management of critically ill patients. The medical profession must make difficult decisions to allocate these resources effectively.

Age Factors↗
PubMed1976

Renal failure and postoperative respiratory failure: recurarization?

The occurrence of acute postoperative respiratory failure in three patients with renal failure is presented. The most likely cause was the return of muscle paralysis after the apparent antagonism of tubocurarine by neostigmine (recurarization). In addition to reducing the dose of tubocurarine, the authors recommend that pyridostigmine be used as an antagonist instead of neostigmine because the former has a longer duration of action.

Adult↗