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Biomedical subjects

G Gurman

Publications and source records attributed to G Gurman.

At least 37 records · Page 2Linked to original sources
PubMed1993

Importance of pre-existing co-morbidities for prognosis of septicemia in critically ill patients.

OBJECTIVE: To determine admission characteristics associated with the outcome of septicemia in critically ill patients and more specifically assess the prognostic value of pre-existing co-morbidities. DESIGN: 5 year-retrospective cohort study. SETTING: Surgical Intensive Care Unit (ICU-20 beds) in a 1600 bed-tertiary care center. PATIENTS: Among 5457 patients admitted to the ICU between 1984 and 1988, 176 (3.2%) met prospectively-defined criteria for blood culture-proven septicemia (8.77 per 1000 patient-days). Overall septicemic patients had a 5-fold increased risk of death compared to non-septicemic patients (relative risk 5.03, 95% confidence intervals 4.17-6.07, p < 0.0001), and this estimate persisted after stratification according to age, sex, primary diagnosis and conditions of admission to the ICU (emergency/elective). RESULTS: Prognostic factors recorded on admission to ICU that were associated with mortality from septicemia among 173 patients were older age, higher admission Apache II score, gastrointestinal surgery, ultimately and rapidly fatal diseases and the number of co-morbidities in addition to the principal diagnosis (active smoking, alcohol abuse, non-cured malignancy, diabetes mellitus, splenectomy, recent antibiotic therapy, major surgery, or major cardiac event). In the multivariate analysis with logistic regression procedures, Apache II and co-morbidities were identified as the two independent predictors of mortality. CONCLUSIONS: Pre-existing co-morbidities assessed at the admission to the ICU significantly improved the prediction of mortality from septicemia compared to Apache II score alone.

Adult↗
PubMed1992

Protocol for studying depth of anesthesia using the spectral edge frequency.

The preliminary results of a multicenter study designed to determine the utility of the processed EEG in combination with heart rate and blood pressure for estimating anesthetic depth are reported. The study is planned to include 1,000 ASA I, II, and III patients undergoing surgery with at least a 60-minute duration of anesthesia. The preliminary results indicate that the use of EEG and clinical signs may provide better control of anesthetic depth. The study design provides ideal conditions for determining whether spectral edge frequency is a useful criterion for management of routine general anesthesia in a typical clinical environment.

Anesthesia, General↗
PubMed1990

The rate of gastrointestinal bleeding in a general ICU population: a retrospective study.

We retrospectively reviewed 298 charts in order to evaluate the efficiency of a protocol used to prevent gastrointestinal bleeding among ICU patients. The protocol included the use of an antacid (186 patients), iv administration of cimetidine (66 patients), or both drugs when the combination was needed because of a persistently low gastric pH after antacid (28 cases). In 18 cases the implementation of this protocol was stopped when enteral feeding through a nasogastric tube was started. All four groups were homogenous for average age and the presence of risk factors at admission as well as at the time of bleeding. Nevertheless the percentage of gastric bleeding during ICU stay (coffee-ground vomitus haematemesis and/or melaena) widely varied: 5% for the antacid group; 15% in the cimetidine group; 25% in the "both" group and 56% in the "enteral" group. Possible explanations for these differences are discussed. The results support the use of treatment protocols in order to prevent gastrointestinal bleeding in patients with risk factors who are admitted to ICU.

Antacids↗
PubMed1989

Augmented bacterial adherence to tracheal epithelial cells is associated with gram-negative pneumonia in an intensive care unit population.

Gram-negative pneumonia is a frequent complication of intubated patients in an intensive care unit (ICU), and the adherence of the bacterial pathogen to the respiratory epithelial surface is thought to be the critical initial step in the infection process. However, the correlation between bacterial adherence to tracheal epithelial cells (TEC) and the acquisition of pneumonia and whether intubation or its duration affects bacterial adherence to TEC is unknown. To examine these factors we initially established that the normal adhesion index range for Pseudomonas aeruginosa strain 492c adherence to TEC was zero to 18.83 cfu/TEC on the basis of the adhesion indices of 12 healthy volunteers and 20 surgical patients undergoing elective bronchoscopy. Forty-two analyses of the adhesion index for P. aeruginosa binding to TEC of 24 ICU patients were performed in this study. Analysis of the data indicated that the adhesion index was not correlated with intubation or the duration of intubation. However, an elevated bacterial adhesion index was significantly (p less than 0.001) correlated with pneumonitis. Pneumonitis was observed in 11 of the 12 patients who had an elevated or augmented bacterial adhesion index, whereas pneumonitis was observed in only one of 12 patients who had a normal adhesion index. The bacterial adhesion index was found to parallel the clinical situation in five patients where three patients developed high adhesion indices and acquired pneumonitis and two patients who initially had pneumonitis and elevated adhesion indices subsequently resolved their pneumonitis, and their adhesion indices fell to within the normal range.

Adult↗
PubMed1988

A new intensive care worksheet.

This article presents a new manual daily worksheet for recording data on a patient's status in an Intensive Care Unit. It permits a rapid view of the whole picture of the patient's condition at a certain hour since the system of recording is based on the time an event happened. Only one single page is used for each day. Space is provided for essential data, ventilatory parameters, laboratory results, fluid balance, drug therapy and special treatments. Attended staff, invited consultants as well as nurses add written notes which complete the picture provided by numbers. It does not replace the computerized interpretation, statistical analysis or storage of data, but it comes as an easy-to-use daily tool at the bedside.

Forms and Records Control↗
PubMed1987

Adherence of Pseudomonas aeruginosa to cilia of human tracheal epithelial cells.

Pseudomonas aeruginosa was found to adhere selectively to cilia of human ciliated tracheal epithelial cells (TECs). P. aeruginosa bound in equal numbers to TECs of smokers and nonsmokers, with the mean adhesion index for binding of P. aeruginosa 492c to TECs of healthy individuals (+/- standard deviation) being 6.83 +/- 6.00 bacteria per TEC.

Adult↗
PubMed1980

The use of alpha-system set for arterial catheterization.

The use of a new set for arterial catheterization (Alpha-system) is presented. In fifty patients arterial cannulation was performed (femoral artery was used in 47 cases). The mean duration of cannulation was 6.7 days. Some minor complications, such as haematoma (5 cases), kinking of catheter (2 cases) and technical difficulties are described. Five out of 50 catheter tips were colonized by gram-negative germs. The use of the Alpha-system set avoids to a large extent haematoma, as the tapping hole is completely occluded by the catheter, and the plastic sound (instead of a metallic one) neither perforates the opposite wall nor dislodges an atheromatous plaque. We recommend a careful clinical and arteriographic control of the region supplied by the cannulated artery as well as a strict aseptic technique of puncture and dressing.

Adult↗