Intravenous containers and solution packaging.
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
J R Wesley
Publications and source records attributed to J R Wesley.
Method of pulmonary and membrane lung gas exchange measurement during extracorporeal membrane oxygenation.
A method for measuring simultaneous MemL and NatL gas exchange during neonatal ECMO has been described. Closed-circuit spirometry techniques were used for both measurements. This technique demonstrated minimal pulmonary gas exchange at low airway pressures prior to pulmonary recovery and measured the gas exchange of metabolism in these critically ill neonates.
Carbon Dioxide↗
Pediatric TPN: efficacy and toxicity of a new fat emulsion.
Fat emulsions are particularly valuable in pediatric total parenteral nutrition (TPN) because they provide an isotonic solution rich in calories. Little is known about the ideal composition of fatty acid emulsions, however, and very few formulations are commercially available. A new fat emulsion using a safflower oil base has recently been approved. We have used this new emulsion to provide a significant percentage of the nonprotein caloric requirements (24 to 42%) in 4 patients requiring TPN. These patients ranged in age from 1 to 15 years and received no enteral nutrition during the 3-week course of the study. Nutritional improvement without major toxic effects was documented in each patient.
Adolescent↗
Comparison of a new 10% and 20% safflower oil fat emulsion in pediatric parenteral nutrition.
A new 20% safflower oil fat emulsion was compared with its 10% counterpart in a small series of pediatric patients. Five infants and children, studied for a 2-week period, received either the 10% or 20% emulsion for 1 week and the other emulsion the 2nd week. No serious toxicity or side effects were noted in any of the patients following the infusion of either emulsion. In addition, significant weight gain was noted in the children, and clinical improvement was apparent in all cases. This preliminary study suggests that the 20% Liposyn is as safe and effective as its 10% counterpart.
Bilirubin↗
Studies on the efficacy of a new 20% fat emulsion in pediatric parenteral nutrition.
A new 20% safflower oil emulsion was studied in a small series of pediatric patients. Eight infants and children were evaluated over a 2-week period. The 20% fat emulsion supplied a major portion of daily caloric requirements. No serious side effects or toxicity were noted. No major changes in blood chemistries were observed; however, a statistically significant increase in serum albumin was noted. In addition, 63% of the patients gained weight during the study. This investigation supports the contention that 20% Liposyn is a safe and effective component of a parenteral nutrition program for children.
Body Weight↗
Biotin deficiency in a patient with short bowel syndrome during home parenteral nutrition.
A 54-year-old woman with short bowel syndrome was supported with home parenteral nutrition. Six months after receiving 2200 kcal/day of balanced home parenteral nutrition without biotin, she developed biotin deficiency with complete hair loss, eczematous dermatitis, waxy pallor, lethargy, and hypersthesias . Blood and urine samples were collected prior to treatment. Serum zinc was 64 micrograms/dl (nl 50-150 micrograms/dl), and the triene/tetraene ratio was 0.068 (nl 0.4), thereby ruling out zinc and essential fatty acid deficiencies. Serum biotin was 332 pg/ml (nl 520 +/- 220 pg/ml), and urine biotin was 5.22 ng/mg of creatinine (nl 4.3-95 with a mean of 30.2 ng/mg creatinine). The same parenteral nutrition regimen was contained and oral biotin was administered (10 mg/day). After 3 wk, serum and urine biotin levels were 650 pg/ml and 35.6 ng/mg creatinine, respectively. New hair growth was evident and all of her other symptoms resolved. Intravenous biotin was then provided (5 mg/day) for a month after which serum and urine biotin levels were 1316 pg/ml and 178 ng/mg creatine, respectively. The patient has been subsequently maintained on an intravenous multivitamin product containing 60 micrograms biotin per daily dose and remains free of signs and symptoms of biotin deficiency.
Biotin↗
Home parenteral nutrition: a hospital-based program with commercial logistic support.
Since home parenteral nutrition was introduced in the 1970's, a number of medical centers have formed successful home parenteral nutrition programs which have reduced expenses to the patient and third party payers by 50 to 73% over in hospital costs. However, the cost of maintaining these programs for training and follow-up has largely been absorbed by the hospital as a nonreimbursable teaching expense. To offset the costs of our growing program in these times of budget "caps," we have established an agreement between our hospital and commercial home care company which provides for patient instruction and follow-up by the hospital parenteral and enteral nutrition team and logistic support by the home care company. We used the average cost of our first five patients to establish a fee schedule which the commercial company agreed to pay the hospital parenteral and enteral nutrition team for its services. This agreement reduces the number of nurses and pharmacists that the commercial company would otherwise have to hire for teaching and follow-up of home care patients, and supports the concept of regional care in medical centers where parenteral and enteral nutrition teams maintain quality control, continuity of care, and efficient teaching programs for patients requiring home parenteral nutrition.
Delivery of Health Care↗
The metabolism of an exogenous lipid source during septic shock in the puppy.
Septic shock induces physiologic and hemodynamic responses that may alter the host's ability to metabolize an exogenous source of lipids. The present study examined the metabolic changes occurring during septic shock in the young animal receiving an intravenous fat emulsion. Five 8-wk-old male Beagle puppies were studied. Each animal served as his own control twice, during which time 14C-palmitic acid alone or with a 10% fat emulsion (Liposyn) was administered. Septic shock (cardiac output less than 50% of control) was induced with an intravenous bolus of live Escherichia coli. During shock the puppies received intravenous 14C-palmitic acid and Liposyn. The mean respiratory quotient for the shock dogs (0.96 +/- 0.01) was significantly (p less than 0.05) higher than that of the controls (0.83 +/- 0.06). The amount of expired 14CO2 was 25.0 +/- 15.9% for the shock animals, 53.9 +/- 28.1% for the Liposyn controls, and 75.7 +/- 30.5% for the controls receiving only 14C-palmitic acid (these differences are all significant, p less than 0.05). After the onset of shock, serum triglyceride levels peaked within 2 min at 851 +/- 540 mg/100 ml and remained elevated at 333 +/- 213 mg/100 ml. Triglyceride levels in the Liposyn control animals returned to baseline values (54 +/- 13 mg/100 ml) at the end of the 4-hr experimental period. Free fatty acids in the shock dogs reached a maximal level of 1.44 +/- 0.09 mEq/liter at 1 hr and remained at this elevated value for a significantly longer period of time than in the Liposyn control puppies. Glycerol value followed a similar pattern and cholesterol remain unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Association of parenteral nutrition catheter sepsis with urinary tract infections.
The infection rate (IR) of central venous catheters (CVCs) used for parenteral nutrition (PN) was prospectively evaluated over a 12-month period, with emphasis on the relationship between CVC sepsis and preexisting sites of infection. Sepsis was presumed if the CVC tip or blood culture was positive, or if defervescence followed CVC removal. Four hundred seventy-three CVCs were placed for PN for a total of 5,422 patient days, with a mean length of stay of 11.5 days. Twenty two CVCs led to sepsis for an IR of 4.65% or 4.06 infections per 1000 patient days. Twenty of the 22 septic CVCs were in patients with other sites of infection. The IR was 12.0% (20/166) when other sites of infection were present and 0.65% (2/307) in the absence of a second site. The mean length of stay was 13.2 days for CVCs with other sites of infection and 10.3 days for CVCs with no other site of infection. Fifty nine percent of septic CVCs had secondary sites of infection that included urinary tract infections (UTI). Of all septic CVCs, 22.7% had no site of infection other than UTI. The presence of UTI appears to present a high risk of CVC sepsis. Appropriate identification and treatment of UTI prior to CVC insertion is recommended.
Catheters, Indwelling↗
Total parenteral nutrition catheter sepsis: impact of the team approach.
For a period of 32 months from the inception of the Parenteral and Enteral Nutrition (PEN) Team at the University of Michigan, the infection rate (IR) related to central venous catheters (CVCs) for total parenteral nutrition (TPN) was prospectively evaluated. Six hundred twenty-two catheters were placed in 377 patients for a total of 9,200 patient days. The length of CVC stay ranged from 2 to 108 days with a mean of 14.5. CVC longevity was longer on units where certification of nurses by the PEN team was mandatory (mean 20.4 days, IR 3.5%) vs comparable units which utilized informal instruction (mean 14.4 days, IR 3.5%). Twenty-two catheters led to patient sepsis for a rate of 3.5%, or 2.39 CVC-related infections per 1000 patient days. The preteam infection rate was 24.0%, as determined by a 6-month prospective study. Infection rates for CVCs used for TPN only and those used for parenteral nutrition (PN) plus blood products, antibiotics, and CVP measurements were identical, 3.5%. The team approach can effectively increase PN catheter longevity and reduce infection rates. Conservative cost accounting of best and worst case scenarios determined a range of $3,700 to $8,900 per episode of catheter sepsis.
Catheters, Indwelling↗
A water-sealed indirect calorimeter for measurement of oxygen consumption (VO2), carbon dioxide production (VCO2), and energy expenditure in infants.
We have developed a water-sealed infant calorimeter (IC) system which uses the techniques of closed-circuit spirometry to measure oxygen consumption (VO2) in premature and full-term infants. Carbon dioxide production (VCO2) is simultaneously calculated from the effluent mixed expired CO2 and the circulating flowrate. Respiratory Quotient (RQ) and Energy Expenditure (EE) are then calculated from the primary data. Measurement of VO2, VCO2, and calculation of RQ were +/- 5.0% of predicted values determined by burning ethyl alcohol or volume extraction and CO2 infusion in our bench model. Measurement in 11 premature infants produced mean values for VO2 and VCO2 of 8.5 +/- 2.5 ml/min/kg and 8.5 +/- 2.4 ml/min/kg, respectively. This system is noninvasive, does not interfere with infant tube feedings or iv infusions, and permits safe, long-term monitoring of the infant's metabolic activity. It allows a more exact matching or oral or intravenous feedings to the actual energy expenditure of the infants, and offers potential advantages for the nutritional management of sick infants.
Calorimetry↗
A.S.P.E.N.: respecting the past, managing the present, preparing for the future--growth factors in the media soup.
Explore the source record for details and available documents.
Enteral Nutrition↗
Managing the future for nutrition support.
Explore the source record for details and available documents.
Cost-Benefit Analysis↗
Metabolic rates of newborn infants with severe respiratory failure treated with extracorporeal membrane oxygenation.
Explore the source record for details and available documents.
Energy Metabolism↗
The endorectal pull-through for the management of familial polyposis.
The standard surgical approach to multiple polyposis has been a total proctocolectomy and an end ileostomy because of the premalignant nature of the disease. This operation has been successful, but has resulted in a significant amount of psychological trauma due to the presence of an abdominal stoma. For that reason, we have utilized the sphincter-saving operation, namely, the endorectal pull-through for the definitive management of patients with familial polyposis since 1979. During the years 1979 to 1984, seven patients (4 female and 3 male), ranging in age from 10 to 30 years, have undergone an endorectal pull-through at our institution. Four of these patients had previously undergone a subtotal colectomy and ileoproctostomy and were seen because of persistent polyps in the remaining rectum. The operation consisted of a total colectomy, a mucosal proctectomy, an ileoanostomy and a loop ileostomy (1 patient did not undergo a loop ileostomy). The loop ileostomy was closed about two months after the pull-through procedure. There was no mortality and only one complication was seen postoperatively. This complication consisted of a bowel obstruction one week after ileostomy closure which was successfully treated with an enterolysis. Patient satisfaction has been excellent. All patients have either returned to full-time work or full-time school activity. All were completely continent immediately after ileostomy closure, both during the day and at night. The median stool frequency one year after the operation is five stools per 24 hours. Our results with this operation have encouraged us to recommend the endorectal pull-through to all patients with multiple polyposis.
Adolescent↗
Septic shock in colony bred puppies versus random source puppies.
Many shock studies utilize unconditioned random source animals. To determine whether unconditioned random source dogs and colony bred dogs differ in response to septic shock, the following experiment was undertaken. Colony bred puppies and unconditioned random source puppies were pretreated with methylprednisolone and were subject to live E. coli induced septic shock. Resuscitation was carried out with Ringer's lactate and 5% albumin. Cardiac output dropped to less than 50% of control values in all animals. The colony bred puppies maintained a significantly higher cardiac output and pulse pressure and required a longer time for their cardiac output to decrease to 50% of control levels than did the unconditioned animals. In addition, the serum acid phosphatase rose significantly (indicating cellular damage) in the unconditioned group and did not change in the colony bred dogs. Marked hyperglycemia occurred in the unconditioned puppies whereas only a mild decrease in serum glucose was seen in the colony bred animals. These data indicate that extreme caution should be exercised in interpreting the physiological response of the unconditioned animal to experimental septic shock.
Acid Phosphatase↗