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Biomedical subjects

M L Birnbaum

Publications and source records attributed to M L Birnbaum.

At least 19 recordsLinked to original sources
PubMed1984

High tech/low touch?

Explore the source record for details and available documents.

Intensive Care Units↗
PubMed1982

Evaluating outcome from intensive care: a preliminary multihospital comparison.

To contrast mortality for groups of ICU patients treated in different hospitals, we surveyed 795 consecutive ICU admissions in 5 ICUs using a general severity of illness classification system. After obtaining information from the medical record on age, sex, indication for ICU admission, and severity of illness, we used a logistic multiple regression equation to project death rates for each ICU based on data from a sixth reference hospital. There were substantial differences in severity of acute illness among the hospitals which accounted for most of the variation in death rates. In all ICUs, however, projected death rates were quite similar to observed deaths. These findings suggest that the use of a general severity of illness index and multivariate statistical techniques could, after further refinement and validation, improve interhospital comparisons of the outcome of acutely ill patients.

Critical Care↗
PubMed1980

Use of Clinitest urine test for indirect estimation of blood glucose levels in the critically ill.

The use of the Clinitest urine glucose test as an indirect way to monitor and control blood glucose levels in critically ill patients was studied. Part 1 of the study was a review of 16 patients records to determine the correlation between 348 paired Clinitest readings and blood glucose levels. Part 2 was a study of six patients from whom a total of 83 arterial blood samples were obtained, each followed 15 minutes later by a urine sample that was tested quantitatively by autoanalyzer and qualitatively by Clinitest. In Part 1, only 43% of the paired readings were within clinically acceptable levels. In Part 2, there was an 11% error rate between quantitative urine glucose values and the corresponding Clinitest results, and the relationship between arterial and urine glucose concentrations was unpredictably variable. The study indicates that both Clinitest error and a variable relationship between arterial and urine glucose concentrations make the use of Clinitest as the sole monitor and basis for controlling blood glucose levels in critically ill patients as unsatisfactory and potentially dangerous procedure.

Adult↗
PubMed1978

Mobile critical care unit safeguards lives during transfers.

Providing access to high-quality critical care services for patients in small or remote hospitals is an important problem faced by many hospitals in this country. In an effort to meet the needs of critically ill patients who might be saved if they could be safely transported from their community hospitals to a large medical center with more specialized care capabilities, the University of Wisconsin Hospitals, Madison, designed a Mobile Critical Care Unit. The details of the unit's construction and of the program's operation are presented herein.

Ambulances↗
PubMed1978

Pre- and postoperative pulmonary function abnormalities in coronary artery revascularization surgery.

Pulmonary function studies were conducted one to two days prior to, two weeks after, and an average of 116 days after coronary artery revascularization surgery. Preoperation it was found that 11 of 19 patients had mild to moderate obstruction, 8 of 17 had diffusing capacity less than 80 percent of predicted, and 9 of 17 had mild hypoxemia. Many of these abnormalities seemed related to smoking. After surgery, significant reductions in volumes, diffusion and PaO2 were found at two weeks. By the last study, there was improvement in volumes and diffusion, but they remained significantly reduced in comparison to preoperative levels. Arterial oxygen tension (PaO2) had returned to preoperative levels. Correction of diffusion for volume showed there to be no change in any of the study periods suggesting chest wall alteration is a major component of the abnormality. It is concluded that close monitoring of pulmonary function is indicated before and after operation in this patient population even if the patient is asymptomatic.

Carbon Monoxide↗
PubMed1977

Contribution of arterial blood lactate measurement to the care of critically ill patients.

Arterial blood samples from 202 critically ill patients were studied. Lactate concentration, PO2, PCO2, pH, oxygen saturation, total CO2, and toe temperature were measured. Base excess, buffer base, actual bicarbonate, and standard bicarbonate were calculated. Analysis of the initial data obtained from each patient revealed that lactate concentration alone could not be used to predict survival. Elevations in lactate concentrations were observed in all types of acid-base disturbances. Survival was lowest (30%) for patients in metabolic acidosis with respiratory compensation, mean lactate concentration 10.5 mEq/l (mmol/l), and highest (65%) for patients in uncompensated respiratory alkalosis, mean lactate concentration, 2.57 mEq/l (mmol/l). Knowing the type of acid-base disturbance is necessary to evaluate the significance of elevated blood lactate values.

Acid-Base Imbalance↗
PubMed1977

Hazards of mechanical ventilation--therapeutic implications.

The side effects and adverse reactions associated with the use of positive pressure volume cycle ventilators are described with a focus on information the pharmacist needs to know to monitor patient drug therapy. Mechanical ventilation is discussed with regard to pulmonary and blood gases, infections, cardiovascular effects, renal-fluid status, metabolic considerations, central nervous system effects, gastrointestinal effects, musculo-skeletal reactions, discontinuance of mechanical ventilation and the use of inhalation drugs.

Blood Gas Analysis↗
PubMed1975

Static pulmonary compliance in ponies.

Static pulmonary and total compliance during expiration was measured in fifteen healthy anesthetized ponies. Mean body weight of the ponies was 140.6 kg and ranged from 83.6 to 211.4 kg. For the fifteen ponies, mean values and SD were: total compliance (Ct), 168.7 plus or minus 47.2 ml/CMH2O, and mean pulmonary compliance (Cl), 368.4 plus or minus 90.3 ml/cmH2O. Both Ct and Cl were significantly dependent on body weight, calculated surface area, height at the withers, and circumference about the chest. Repeatability of compliance measurement from day to day was confirmed by measuring compliance on consecutive days in four ponies.

Animals↗
PubMed1975

Prolonged perfusion with a membrane oxygenator in awake ponies.

Prolonged extracorporeal membrane oxygenation (PEMO) was performed in 6 adult ponies with the membrane oxygenator in vein-to-artery bypass circuit. A flow rate equal to 46 per cent of control cardiac output was diverted through the PEMO circuit of 10 to 24 hours. Three of the 6 ponies were perfused for at least 20 hours and developed no complications. Immediately following initiation of PEMO, left ventricular output decreased; however, in the interval between 6 and 24 hours, left ventricular output was increased above control levels. Aortic pressure and left ventricular work were markedly elevated during PEMO. Pulmonary ventilation and oxygen uptake also decreased initially but were elevated during later stages of bypass. Pulmonary compliance did not change, except in those studies in which problems were encountered with perfusion techniques. Hepatic glycolysis and hyperglycemia occurred and were more severe in ponies with catheter-produced thrombi. Marked diuresis, which could be attributed only partially to the hyperglycemia, was present throughout PEMO. Based on the minimal morphologic changes observed in the ponies, extracorporeal circulation diverting one half of the cardiac output through a membrane oxygenator can be safely performed for up to 24 hours.

Animals↗