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Biomedical subjects

J D Edwards

Publications and source records attributed to J D Edwards.

At least 73 records · Page 4Linked to original sources
PubMed1990

Practical application of oxygen transport principles.

Management of shock is generally guided by hemodynamic data, but the true aim of therapy should be optimizing oxygen delivery (DO2) and consumption (VO2). Available data do not support the hypothesis that there is a single critical threshold of DO2 below which tissue hypoxia occurs; thus, DO2 and VO2 should be addressed for each patient. Interventions that raise BP, such as infused catecholamines, may actually decrease DO2, as can mechanical ventilation with PEEP. Therefore, the clinician should avoid responding solely to hemodynamic data and should direct interventions toward delivering the optimum amount of oxygen to the patient's tissues.

Hemodynamics↗
PubMed1989

The haemodynamic effects of sublingual nitroglycerin spray in severe left ventricular failure.

The use of sublingual nitroglycerin spray has been studied in twenty patients referred to our Intensive Care Unit for further treatment of severe left ventricular failure. Within five minutes of spray administration significant falls in pulmonary artery occlusion pressure, mean arterial pressure, heart rate, right atrial pressure and systemic vascular resistance occurred. Similarly significant increases in cardiac index, stroke volume index and left ventricular stroke work index were found. These results show a considerable improvement in the haemodynamic parameters of invasively monitored patients and we believe that its administration undoubtedly "buys time" for the critically ill patient. However, we would caution against its routine use at present in view of the potential problem of hypotension, until further information is available.

Administration, Sublingual↗
PubMed1989

Hemodynamic and oxygen transport response to modified fluid gelatin in critically ill patients.

The hemodynamic and oxygen transport effects of the rapid infusion of 500 ml of modified fluid gelatin, an artificial colloid widely used in Europe, were studied in a group of critically ill patients suffering from cardiovascular instability. Oxygen consumption tended to increase. There were no significant changes in heart rate, shunt fraction, or systemic vascular resistance index. There were significant increases in mean arterial pressure, pulmonary artery wedge pressure, stroke index, cardiac index, and oxygen delivery. There were significant decreases in Hgb concentration and arterial oxygen content. The overall circulatory effects of modified fluid gelatin are beneficial.

Adult↗
PubMed1989

Use of survivors' cardiorespiratory values as therapeutic goals in septic shock.

The responses to therapy of 29 patients in septic shock are described. Patients received controlled plasma volume expansion followed by infusions of norepinephrine, dobutamine, and dopamine to achieve appropriate therapeutic goals. Increases in oxygen delivery (Do2) from 605 +/- 40 (SEM) to 843 +/- 27 ml/min-m2 (p less than .001) were associated with increases in oxygen consumption (Vo2) from 130 +/- 6.8 to 169 +/- 6.2 ml/min.m2 (p less than .001). The overall hospital survival rate was 52%. We suggest that the rational use of adrenergic agents and the achievement of appropriate physiologic end-points for therapy not only result in the reversal of hypotension, but also maintain or increase Do2 and Vo2, and may improve survival.

Adult↗
PubMed1989

Mass casualties.

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Disasters↗
PubMed1988

Oxygen consumption following trauma: a reappraisal in severely injured patients requiring mechanical ventilation.

Oxygen consumption (VO2) immediately following major injury in man has been said to be reduced. The evidence for this is poor. We have therefore measured VO2 soon after major injury in 16 patients. VO2 was reduced in only two patients, within the normal range in four and increased in ten. VO2 was maintained by increased oxygen extraction in six patients leading to low levels of mixed venous oxygen saturation. There is no evidence for an 'ebb phase' response in man.

Adolescent↗
PubMed1988

Reversal of intractable septic shock with norepinephrine therapy.

Ten patients with severe septic shock were studied. After plasma volume expansion to an optimal pulmonary artery wedge pressure, above which there were no further increases in cardiac index, all patients remained hypotensive and oliguric. The arterial hypotension was unresponsive to increasing doses of dopamine and dobutamine alone and to a fixed combination of both. In all patients studied, infusion of norepinephrine alone reversed the hypotension and increased significantly the mean arterial pressure, systemic vascular resistance and left ventricular stroke work index (p less than .005). There were only minor increases in heart rate. Oxygen transport indices measured in six patients demonstrated variable alterations in oxygen delivery and consumption.

Adult↗
PubMed1988

Apache II scores.

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Decision Making, Computer-Assisted↗
PubMed1988

Trauma audit--the use of TRISS.

The TRISS methodology for evaluating trauma care has been applied in two UK hospitals over a 12 month period. Unexpected deaths occurred in both hospitals and were related to delays in transport between hospitals. The delays were instigated by the receiving hospitals and never the despatching hospital. Unexpected survival occurred in one of the hospitals. The common factors were: 1. Patients were taken there directly and did not require further transfer. 2. They were resuscitated by a consultant. 3. They were electively ventilated. 4. CT Scan excluded a neurosurgical emergency. 5. When surgery was required it was carried out early. 6. They were treated for several weeks in an ICU with 24 hour direct consultant involvement. They all developed septic shock and acute respiratory distress but ultimately made a full recovery. This evidence supports the view that direct transfer of patients to Trauma Centres in the UK is likely to reduce unnecessary deaths. The development of such a system and the location of such centres must be based on objective measures of case mix and performance. We recommend the establishment and development of a Major Trauma Outcome Study (MTOS) (UK).

Diagnosis-Related Groups↗
PubMed1987

Atrial fibrillation precipitated by acute hypovolaemia.

Six patients with varying degrees of acute cardiorespiratory failure were seen. All patients deteriorated noticeably when rapid atrial fibrillation developed. In all patients intravenous digitalis failed to slow the ventricular response, and in three patients misguided attempts at electrical cardioversion failed. Haemodynamic monitoring showed a normal or low pulmonary artery occlusion pressure in all patients. Controlled expansion of plasma volume was associated with an immediate slowing of the heart rate in all patients, and the heart rate in all patients returned to sinus rhythm within 30 minutes of transfusion. It is suggested that hypovolaemia in critically ill patients may contribute to the development of atrial fibrillation.

Atrial Fibrillation↗
PubMed1987

Danger of using core/peripheral temperature gradient as a guide to therapy in shock.

During the treatment of 26 shocked patients, measurements were made of the central blood to peripheral skin temperature gradient. No significant correlation was found between this gradient and cardiac index (CI), or systemic vascular resistance (SVR) or its index (SVRI). There was no significant correlation between the change in gradient and the changes in CI, SVR or SVRI in any single patient. We conclude that it is incorrect to base any judgment of a patient's hemodynamic status on a core/peripheral temperature gradient during shock, and it is irrational to initiate therapy based on this measurement.

Cardiac Output↗
PubMed1987

Cardiogenic shock in right ventricular infarction managed with a combined thermodilution and pacing pulmonary artery flotation catheter.

When cardiogenic shock complicates right ventricular infarction it is widely appreciated that rational therapy can only be achieved by use of plasma volume expansion and inotropic agents guided by invasive monitoring (Cohn et al., 1974). In these cases, there is a high incidence of symptomatic heart block and serious atrial and ventricular dysrhythmias (Cohn, 1979). Thus, venous access may be required for monitoring, pacing, infusion of fluid, and vasoactive or antiarrhythmic drugs. A case of right ventricular infarction complicated by cardiogenic shock, heart block, multiple arrhythmias and severe hypoxaemic respiratory failure is described. Technical problems in venous access were encountered and overcome by the use of a single multi-purpose catheter for haemodynamic monitoring, infusion of drugs and fluids and passage of a pacing wire. We believe that this is the first description of the use of such a catheter in the United Kingdom, although the use of a multi-purpose pulmonary artery flotation catheter with fixed pacing electrodes has been described before (Zaidan & Freniere, 1983).

Aged↗
PubMed1987

Optimizing surgical management of symptomatic solitary hepatic cysts.

Four men and six women with symptomatic solitary hepatic cysts were encountered over an 11-year period. Average age was 49 years (range, 10 months to 67 years). Most common clinical features included right upper quadrant (RUQ) pain, a palpable RUQ mass and early postprandial satiety. Liver function studies were uniformly normal. Ultrasound and computerized tomography CT were virtually diagnostic alone or in combination. Eight patients had unilocular, simple cysts and two patients had multilocular complex cysts also designated as biliary cystadenomas. Cysts recurred in four patients treated surgically by needle aspiration, incision, and internal drainage or external catheter drainage. All four patients required reoperation, which included hepatic lobectomy in three patients and extensive unroofing in one patient. No cysts have recurred in six patients treated by extensive unroofing or excision of the cyst and none has required reoperation. One patient who underwent hepatic lobectomy for cyst recurrence after an inadequate primary procedure was found to have an unsuspected carcinoma in the cyst wall. The conclusion is that extensive unroofing of unilocular solitary hepatic cysts minimizes the likelihood of cyst recurrence and obviates the need for hepatic resection. Total cyst excision is indicated for all multiloculated cysts to avoid overlooking a biliary cystadenoma or for unilocular cysts if the biopsy specimen of the cyst wall demonstrates an unsuspected neoplasm.

Adult↗