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Biomedical subjects

K Hillman

Publications and source records attributed to K Hillman.

At least 19 recordsLinked to original sources
PubMed1999

Intra-abdominal hypertension is an independent cause of postoperative renal impairment.

HYPOTHESIS: Intra-abdominal hypertension exerts an effect on renal function independent of other confounding variables. DESIGN: A prospective study of all patients admitted to an intensive care unit following abdominal surgery was undertaken between September 1, 1994, and July 31, 1997, in a single university hospital. MAIN OUTCOME MEASURES: Intra-abdominal pressure (IAP) was measured every 8 hours (normal IAP, 0-17 mm Hg); 18 mm Hg or higher was considered increased. Forward stepwise logistic regression determined whether intra-abdominal hypertension is an independent cause of renal impairment. RESULTS: A total of 263 patients (174 after emergency surgery), whose mean +/- SD age was 61.0 +/- 18.7 years and Acute Physiology and Chronic Health Evaluation II score was 14.6 +/- 7.7, were studied. Intra-abdominal pressure was increased in 107 (40.7%) of the 263 patients. Renal impairment occurred in 35 (32.7%) of the 107 patients with intra-abdominal hypertension and in 22 (14.1%) of the 156 with a normal IAP (odds ratio, 1.62-5.42). Using the Wald maximizing model, renal impairment was independently associated with 4 antecedent factors: hypotension (P= .09), sepsis (P = .006), age older than 60 years (P = .03), and increased IAP (P = .004). CONCLUSIONS: To our knowledge, for the first time in a large clinical study, IAP has been shown to be an independent cause of renal impairment, and it ranks in importance after hypotension, sepsis, and age older than 60 years. Surgeons need to be aware of the importance of intra-abdominal hypertension in patients postoperatively.

Abdomen↗
PubMed1998

Acute hospital medical staffing during the night shift.

There has been little or no attempt to define the need for 24-hour medical cover, nor its appropriateness in acute hospitals, despite the great cost implications and the question of the quality of that care. This study examined the medical activity during the 'night shift' in an acute hospital. There were an average of 2.59 calls per night, most from the emergency department (247/475) and general wards (108/475). Many calls were related to active resuscitation (88/475) and immediate treatment (83/475). Over 40% (81/286) of patients had to be transferred to a higher level of care, such as an intensive care unit within the hospital. By collecting data on the demands of health care during what amounts to over a third of the hospital's time, it was established that a high level of medical care was required. Appropriate levels of staffing, using junior doctors trained in acute medicine, was able to be provided to match need as determined by these data, and extra staff at higher costs were avoided.

Acute Disease↗
PubMed1998

Temporary abdominal closure: a prospective evaluation of its effects on renal and respiratory physiology.

This study prospectively analyzed outcomes in 49 consecutive patients undergoing temporary abdominal closure (TAC) between 1993 and 1996 at a single university hospital. There were 37 males and 12 females, mean age was 57 years (range, 25-79 years), mean Acute Physiology and Chronic Health Evaluation score was 27 (+7.8 SD), and mean Simplified Acute Physiology II score was 53.0 (+/-15.4). The reason for TAC was decompression in 22 patients, inability to close the abdomen in 10 patients, to facilitate reexploration for sepsis in 8 patients, and multifactorial in 9 patients. After TAC, there was a significant reduction in intra-abdominal pressure from 24.2+/-9.3 to 14.1+/-5.5 mm Hg and improvement in lung dynamic compliance from 24.1+/-7.9 to 27.6+/-9.4 mL/cm H2O (p < 0.05). Although 10 patients experienced brisk diuresis, there was no significant improvement in renal function; in fact, serum creatinine increased. The median length of stay was 35 days (range, 1-232 days). The mean number of abdominal operations after mesh insertion was 2.6+/-2.4. There were 21 deaths, for a standardized mortality rate of 0.80. Although it achieved significant reductions in abdominal pressures and improved lung dynamic compliance, TAC did not result in improved renal function or patient oxygenation.

APACHE↗
PubMed1997

Quality of life outcomes after intensive care. Comparison with a community group.

OBJECTIVE: Compare the health related quality of life of intensive care patients with a community sample. DESIGN: Self-completed questionnaire posted to a consecutive sample of 238 patients 16 months after discharge from an intensive care unit (ICU) and to a random community sample (n = 242). SETTING: The Liverpool Hospital is the main referral and teaching hospital in a community of 620,000 people. It has a ten-bed general ICU. PATIENTS AND PARTICIPANTS: All patients admitted to the ICU over 8 months with a length of stay > or = 24 h and a sample drawn from the community telephone directory. MEASUREMENTS AND MAIN RESULTS: The self completed questionnaire contained physical and psychosocial health and quality of life (QOL) scales. Analysis of variance indicated that ICU patients were more physically ill and anxiously depressed than the community sample. Sixty-three per cent of patients had not attained full health, were functionally impaired and had a poorer QOL than those patients who had returned to full health and the community. Psychosocial health (apart from anxious depression) was related to the level of perceived physical health rather than to whether or not they had been admitted to the ICU. Those subjects not in full health had poorer interpersonal relationships, less positive attitudes about life, more anxious depression and more suicidal depression. CONCLUSIONS: ICU patients following discharge have worse perceived health and more anxiety than others in the community. Sixty-three per cent of patients had a poorer QOL and functional health than those who returned to full health and those in the community.

Analysis of Variance↗
PubMed1996

Intraabdominal pressure and gastric intramucosal pH: is there an association?

This study evaluated the potential association between increased intraabdominal pressure (IAP) and abnormally low gastric intramucosal pH (pHi) (</= 7.32) in postoperative patients and assessed its effect on patient outcome. Altogether 73 patients undergoing major abdominal surgery over a 9-month period were studied prospectively. All underwent gastric tonometry and intravesical IAP measurements three time daily. An IAP of >/= 20 mmHg and a pHi of </= 7.32 were considered abnormal. The development of the following complications were also documented: hypotension [mean aortic pressure (MAP) < 80 mmHg], abdominal sepsis, renal impairment, and death. The median APACHE II score was 16 (range 5-34). Twenty-two patients had upper gastrointestinal (GI) surgery, 27 lower GI surgery, and 24 aortic surgery; 44 of these patients underwent emergency surgery. Abnormal pHi (</= 7.32) occurred in 36 patients while on the intensive care unit. Compared to patients with normal pHi, abnormal pHi patients were 11.3 times (3.2-43.5) [odds ratio +/- 95% CI] more likely to have an increased IAP. Abnormal pHi was significantly associated with hypotension (chi2 = 6.8;p = 0.009), sepsis (chi2 = 3.7;p = 0.06), renal impairment (chi2 = 28.3;p = 0. 0000001), relaparotomy (chi2 = 4.1;p = 0.04), and death (chi2 = 9. 7;p = 0.002). This study demonstrated a significant clinical association between increased IAP and abnormal pHi. An abnormally low pHi was associated with poor outcome.

Abdomen↗
PubMed1995

Prospective study of intra-abdominal hypertension and renal function after laparotomy.

The value of postoperative monitoring of intra-abdominal pressure (IAP) in surgical patients has not been established. This study prospectively evaluated the occurrence of increased IAP and its association with renal impairment and outcome in surgical patients admitted to an intensive care unit. One hundred consecutive patients after laparotomy were studied, 88 of whom had complete IAP measurements. IAP was measured using an intravesical catheter and was considered increased when equal to 20 mmHg or above. Renal impairment was defined as a postoperative serum creatinine concentration of greater than 130 mumol/l, or an increase in serum creatinine of greater than 100 mumol/l within 72 h of surgery. The median (range) APACHE (Acute Physiology And Chronic Health Evaluation) II score of the patients was 13.5 (4-43). The incidence of raised IAP was 29 of 88 (33 per cent). Renal impairment was present in 29 of 88 (33 per cent), of whom 20 of 29 (69 per cent) had raised IAP (P < 0.01). The odds ratios (95 per cent confidence interval) for the development of renal impairment and death in patients with increased IAP were 12.4 (3.8-41.7) and 11.2 (2.8-47.9) respectively. There is a clinically significant association between increased IAP and renal impairment in patients admitted to an intensive care unit after laparotomy.

Abdomen↗
PubMed1995

Preparation of the critically ill for transfer in metropolitan Sydney.

The transfer of the critically ill patient is often complex and difficult, and may contribute to increased morbidity. It is therefore valuable to have an understanding of the practical problems relating to patient transfer, and common management strategies, in order to minimise adverse outcomes. Key issues in the process of transporting the critically ill patient in metropolitan Sydney include: (i) particular problems and pitfalls during the transfer process; (ii) risk factors in transferring patients and the appropriateness of escorts and transfer procedures; (iii) procedures for arranging a patient transfer; (iv) the role of the NSW Medical Retrieval Co-ordination Centre (MRCC); (v) preparation of the patient for transfer, (vi) education of staff on the concept of safe matching of patient needs to appropriate escorts; and (vii) the need for a co-ordinated patient transfer system to Sydney metropolitan hospitals. An understanding of these issues, and an appropriate response to them from hospital staff will ensure safe and efficient transportation of critically ill patients in metropolitan Sydney.

Ambulances↗
PubMed1995

The effect of mixtures of Lactobacillus spp. on the survival of enterotoxigenic Escherichia coli in in vitro continuous culture of porcine intestinal bacteria.

Mixtures of strains of Lactobacillus spp., two of strains inhibitory to growth of the porcine enteropathogen Escherichia coli O149: K88ac: K91 in a co-culture screen, and one of strains with no effect on this pathogen, were examined to determine their effects on the retention of this pathogen in an in-vitro continuous culture system designed to maintain a representation of the porcine ileal microflora. Strains effective in co-culture also increased the rate of decline of the pathogen in the continuous culture. The inhibitory effect exceeded the displacement effect observed with non-inhibitory strains.

Animals↗