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Biomedical subjects

H Shubin

Publications and source records attributed to H Shubin.

At least 37 records · Page 2Linked to original sources
PubMed1975

Pulmonary edema related to changes in colloid osmotic and pulmonary artery wedge pressure in patients after acute myocardial infarction.

Pulmonary artery wedge and plasma colloid osmotic pressures and their relationship to pulmonary edema were investigated in 26 patients with acute myocardial infarction of whom 14 developed pulmonary edema. In the absence of pulmonary edema, both the pulmonary artery wedge pressure and plasma colloid osmotic pressure were in normal range; after onset pulmonary edema, a moderate increase in pulmonary wedge pressure and reduction in plasma colloid osmotic pressure were observed. When the gradient between the plasma colloid osmotic pressure and the pulmonary artery wedge pressure was calculated, highly significant differences were demonstrated (P less than 0.002). In the absence of pulmonary edema, this gradient averaged 9.7 (plus or minus 1.7 SEM) torr; following appearance of pulmonary edema, it was reduced to 1.2 (plus or minus 1.3) torr. During therapy with digoxin and furosemide, reversal of pulmonary edema was closely related to a concomitant change in the colloid osmotic-hydrostatic pressure gradient. These observations indicate that both increases in pulmonary capillary pressure and decreases in colloid osmotic pressure may follow the onset of pulmonary edema. Such decline in colloid osmotic pressure and especially the reduction in colloid osmotic-hydrostatic capillary pressure gradient may favor transudation of fluid into the lungs.

Adult↗
PubMed1975

Pulmonary edema during volume infusion.

The relationship between left ventricular filling pressure and plasma colloid osmotic pressure to pulmonary edema was examined in a group of 37 patients, the majority of whom were hypovolemic. Sixteen patients developed pulmonary edema during fluid infusion. In the 21 patients who did not develop pulmonary edema, the left ventricular filling pressure was slightly elevated but the colloid osmotic pressure was not reduced. The majority of these patients were treated with colloid solutions (group I). In five of the 16 patients who developed pulmonary edema, the left ventricular filling pressure was elevated and there was no reduction in the plasma colloid osmotic pressure. These patients received only colloids (group II). In the other 11 patients who developed pulmonary edema, the left ventricular filling pressure was normal but the plasma colloid osmotic pressure was reduced to 16 +/- 2 torr (group III). The colloid osmotic pressure in this group was significantly less than in the other two groups (P less than 0.01). Most of these patients received large volumes of crystalloid solutions. After administration of furosemide, clearing of pulmonary edema in this group was associated with normalization of the plasma colloid osmotic pressure. Infusion of large volumes of crystalloids in hypovolemic patients can be hazardous, for reduction of the plasma colloid osmotic pressure may predispose to the development of pulmonary edema even when the left ventricular filling pressure remains normal.

Adult↗
PubMed1974

Centralized hospital care for the critically ill.

The remarkably effective techniques now available for preserving vital functions in critically ill or injured patients were essentially unknown only 20 years ago. Resuscitation and protracted support of organ function by the use of ventilators, pacemakers, renal dialysis machines, and other potent devices were incentives for the development of critical care facilities. Special care units evolved to facilitate application of these lifesaving techniques. The first of these were postoperative and general intensive care units, followed more recently by units for respiratory, cardiac, and coronary care and for renal dialysis and shock. In most instances such specialty units have funcitoned separately and largely independently of one another. We now recognize opportunities for pooling resources and amalgamating critical care units into facilities physically and administratively closer to a larger critical care service. This underlies the concept of a center for the critically ill which makes it possible to expand the use of available beds, qualified staff, instrumentation, and supplies. Equally important, such an arrangement supports the team approach to patient care, nowhere more urgently needed than in the management of the critically ill patient, who usually has multisystemic disease or injury. Basic to this arrangement is our most recent recognition that there are no fundamental differences between medical and surgical patients, or between cardiac and pulmonary patients. At the same time, we recognize that critical care is a 24-hour-per-day, 7-day-per-week hospital service by well-trained physicians, nurses, and technical personnel who are prepared to take incisive action at the bedside to sustain vital functions.

Coronary Care Units↗
PubMed1973

Treatment of shock caused by bacterial infections.

Bacteremia caused by Gram-negative enteric organisms accounts for the majority of instances of shock complicating bacterial infection. Control of the infection and maintenance of normal blood volume constitute the primary considerations in immediate treatment. The use of three or four doses of corticosteroid agent over a period of 24 hours is regarded as advantageous for routine treatment. Conservative and selective use of isoproterenol and phentolamine are justified for management of patients who do not respond to the administration of bactericidal drugs and volume repletion. Levarterenol and metaraminol are rarely indicated. Intravascular coagulation complicated by bleeding diathesis may serve as an indication for anticoagulation. With more effective management of the hemodynamic defects, patients are now more likely to survive the shock state only to develop a fatal form of pulmonary failure which is yet poorly understood. Close attention to respiratory management is therefore advised.

Anti-Bacterial Agents↗