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P Marik

Publications and source records attributed to P Marik.

29 records · Page 2Linked to original sources
PubMed1998

The obese patient in the ICU.

Data from recent surveys indicate that a staggering 34.9% of US adults are overweight. Obese adults are at in increased risk for many chronic medical conditions, and this increases the likelihood of admission to an ICU. The critically ill obese patient presents the ICU team with many unique problems. Obesity may result in significant alterations of pulmonary and cardiac function, as well as the handling of many drugs. An appreciation of these and other changes is essential in the management of the obese ICU patient. The purpose of this article is to review some of the basic concepts related to the treatment of obese patients in the ICU.

Adult↗
PubMed1996

Alcohol-related admissions to an inner city hospital intensive care unit.

We investigated the impact of alcohol-related medical emergencies on health care utilization in an inner city hospital medical intensive care unit (ICU). Data from 200 consecutive admissions to the medical ICU were collected prospectively. The major reason for each patient's admission to the ICU was recorded and the causal relationship between alcohol abuse and the admission diagnosis was determined. Clinical and demographic data as well as the insurance status and cost of goods and services delivered were determined for all patients. Twenty-one per cent of all the ICU admissions were directly alcohol-related, with a mean hospital charge of $52,527. The alcohol-withdrawal syndrome was the commonest alcohol-related admission, with a mean ICU stay of 5 days and a mean hospital charge of $21,336. Of the patients with non-alcohol related admission diagnoses, 61% had health insurance, compared to 42% for the patients with alcohol-related admission diagnoses (P < 0.05). Patients with alcohol-related admissions tended to be younger and male. In conclusion, we demonstrated that alcohol-related admissions are common in inner city hospital ICUs and consume considerable hospital resources. The treatment of these patients is costly, with hospitalization being essentially non-curative. In this era of health care reform, more effective primary and secondary preventative measures are required to control this pervasive health care problem.

Adult↗
PubMed1993

Hydrocortisone and tumor necrosis factor in severe community-acquired pneumonia. A randomized controlled study.

BACKGROUND: Community-acquired pneumonia is a major cause of death in third world countries. Antimicrobial therapy may have little impact on the natural history of patients with severe pneumonia. We hypothesized that the intrapulmonary production of tumor necrosis factor-alpha (TNF-alpha) may be responsible for the progressive lung injury and shock commonly seen in patients with severe pneumonia after commencing antibiotic therapy. AIM: To investigate the effects of a single bolus of hydrocortisone on the clinical course and serum TNF-alpha levels of patients with severe community-acquired pneumonia. DESIGN: Randomized placebo-controlled study. SETTING: Multidisciplinary ICU of a tertiary care teaching hospital. PATIENTS AND METHODS: Patients with three or more British Thoracic Society criteria of severe pneumonia were studied. Patients were randomized to receive either a single dose of hydrocortisone (10 mg/kg) or placebo 30 min prior to commencing antibiotic therapy. Patients were treated with cefotaxime and other antibiotics as clinically indicated. Blood for TNF-alpha was taken at the time of hospital admission and repeated 2, 6, and 12 h after starting antibiotic therapy. RESULTS: Thirty patients were studied: 16 received placebo and 14 received hydrocortisone. The patients who received placebo tended to be sicker than the patients who received hydrocortisone. The baseline TNF-alpha value was 989 +/- 374 pg/ml in the placebo group and 827 +/- 394 pg/ml in the hydrocortisone group. In both groups of patients, the TNF-alpha levels did not change significantly with time. There was no correlation between the TNF-alpha levels and the APACHE II score, lung injury score, or outcome. The only variable that predicted outcome was the APACHE II score. CONCLUSION: Bactericidal antibiotics do not increase serum TNF-alpha levels in patients with severe pneumonia. Hydrocortisone given prior to antibiotic treatment had no effect on the serum TNF-alpha levels or the clinical course of patients with severe community-acquired pneumonia.

Adult↗
PubMedDate not supplied

Management of increased intracranial pressure: a review for clinicians.

Emergency physicians are frequently confronted with head-injured patients, many of whom have intracranial hypertension. Since direct correlations have been reported between increased intracranial pressure (ICP) and adverse outcome, it is important to rapidly identify and treat these patients. Furthermore, since the actual brain damage that occurs at the time of injury cannot be modified, the maximization of neurological recovery depends upon minimizing secondary insults to the brain, most notably preventing hypotension and hypoxemia. Volume resuscitation to maintain an adequate mean arterial pressure, airway control, and sedation and analgesia to prevent surges in ICP remain the cornerstone of early management. These principles and the emergency department management of the head-injured patient are reviewed in this paper.

Brain Injuries↗