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Biomedical subjects

V K Puri

Publications and source records attributed to V K Puri.

At least 55 records · Page 3Linked to original sources
PubMed1983

Resuscitation in hypovolemia and shock: a prospective study of hydroxyethyl starch and albumin.

In a prospective study comprising 50 patients, we evaluated the hemodynamic, pulmonary, renal and coagulation changes after resuscitation with 2 colloidal fluids, 6% hydroxyethyl starch (HES) and 5% albumin (ALB). Twenty-five patients studied in each group were well matched for age, clinical presentation, presence of shock and type of surgical procedures. A standard fluid challenge with 500 ml of either solution significantly (p less than 0.01) increased pulmonary artery wedge pressure (WP), mean arterial pressure (MAP) and left ventricular stroke work index (LVSWI) and decreased systemic vascular resistance index (SVRI). Increases in LVSWI of 43% to 68% over baseline in HES patients compared favorably to 15-22% increases in ALB patients. The cardiopulmonary variables at 12 and 24 h were comparable in both groups. Improvement in cardiac function was also reflected by better tissue perfusion as judged by reduction in arterial lactate from 2.9 to 1.5 mM/L (ALB) and 2.6 to 1.4 mM/L (HES). Increased O2 delivery and reduced O2 extraction without significant deterioration of PaO2 or alveolar-arterial O2 gradient were observed with stabilization of circulation. Clinical bleeding due to colloid resuscitation was not documented and renal function was not affected significantly by either fluid. It seems that HES may offer a cost-effective alternative to ALB for patients requiring colloid resuscitation.

Aged↗
PubMed1983

Right coronary artery occlusion after acute proximal dissection (hematoma).

A known hypertensive presented to the hospital with sudden onset of chest pain and shock. ECG, cardiac enzymes, aortogram and echocardiogram were normal. Hemodynamic monitoring and radionucleotide angiogram demonstrated a severely dyskinetic right ventricle. Autopsy revealed proximal aortic dissection with extramural compression of right coronary artery, resulting in right ventricular dysfunction.

Acute Disease↗
PubMed1983

Myocardial contusion following nonfatal blunt chest trauma.

Currently available diagnostic techniques for myocardial contusion following blunt chest trauma were evaluated. We investigated 30 patients prospectively over a period of 1 year for the presence of myocardial contusion. Among the 30 patients, eight were found to have myocardial contusion on the basis of abnormal electrocardiograms, elevated creatine phosphokinase MB fraction (CPK-MB), and positive myocardial scan. Myocardial scan was positive in seven of eight patients (87.5%). CPK-MB fraction was elevated in four of eight patients (50%). Definitive electrocardiographic changes were seen in only two of eight patients (25%). It appears that myocardial scan using technetium pyrophosphate and CPK-MB fraction determinations are the most reliable aids in diagnosis of myocardial contusion following blunt chest trauma.

Adult↗
PubMed1982

Catheter colonization and bacteremia with pulmonary and arterial catheters.

We prospectively studied the incidence of catheter-related sepsis in 51 critically ill patients who underwent 52 arterial and 37 pulmonary artery catheterizations over a period of 3 months. Daily cultures of blood and catheter insertion site were done and the catheters were cultured semiquantitatively at the time of removal. Catheter colonization defined as growth of 15 or more colonies was observed with 9 (10%) catheters and bacteremia with 4 (4.5%) catheters. The skin cultures were positive in 56% of the colonized catheters compared with 11% of sterile catheters (p less than 0.01). The mean duration of catheterization of 3.8 days in colonized catheters was not different than 3.3 days in noncolonized catheters. Presence of concurrent infection and use of antibiotic did not change the rate of catheter colonization. Often, microorganisms other than those colonizing the catheter were recovered from blood. Femoral arterial catheterization appeared to be more often associated with colonization than radial catheters. It appears that the arterial and pulmonary artery catheter colonization occurs in about 10% of catheters and predisposes to catheter-related sepsis. Semiquantitative cultures of the catheter may aid in better documentation of catheter-induced sepsis.

Arteries↗
PubMed1981

The stat laboratory: facilitating blood gas and biochemical measurements for the critically ill and injured.

The stat laboratory has evolved to fulfill the need for rapidly available laboratory data in support of clinical decision-making af the bedside of the critically ill or injured patient. The operation of a stat laboratory, which was first organized more than 12 years ago, is described. Methods of organization, instrumentation, technics and sequencing of analyses, and costs for a standard panel of stat laboratory measurements on arterial or mixed venous blood are described. In addition to blood gases, measurements include hematocrit, hemoglobin, oxygen saturation, methemoglobin, carboxyhemoglobin, blood lactate, plasma electrolytes, plasma osmolality, plasma colloid osmotic pressure, and estimated plasma protein content. The panel of tests is completed and reported within 11 min after a 5-ml sample of arterial or mixed venous blood is delivered to the laboratory.

Blood Chemical Analysis↗
PubMed1981

Shock due to profound hypothermia and alcohol ingestion: report of two cases.

Cardiovascular failure (shock) associated with acute alcohol ingestion and severe hypothermia (core temperature 23 and 21 degrees C) was studied in 2 patients. In each case, perfusion failure was associated with lactacidemia, severe bradycardia, and agonal respirations. Infusion of fluids and mechanical ventilation reversed shock and prevented a fatal outcome. One case, complicated by renal failure and volume overload with pulmonary edema, was managed with peritoneal dialysis. These findings suggest that perfusion failure associated with severe accidental hypothermia after acute alcohol ingestion is due to a combination of hypovolemia, bradycardia, and respiratory depression.

Adult↗
PubMed1981

Hydroxyethyl starch for resuscitation of patients with hypovolemia and shock.

The authors evaluated the effectiveness of 6% hydroxyethyl starch (hetastarch) solution for treatment of hypovolemia in 46 critically ill patients. Thirty-two of the patients were studied retrospectively and in 14 patients, cardiopulmonary variables were prospectively measured. A total of 29 patients were in shock secondary to hypovolemia (13), sepsis (13), or myocardial infarction (3). Average hetastarch infusion volume was 829 and 842 ml, respectively, in prospectively and retrospectively studied patients, with maximum of 2000-2500 ml infused over 48 h. Approximately 30% of 24 h fluid needs were supplied with colloids. Infusion of 500 ml of hetastarch in 14 prospective study patients was associated with increases in pulmonary artery wedge pressure (WP) from 9 +/- 1.5 to 12 +/- 2.1 mm Hg, cardiac index (CI) from 2.9 +/- 0.2 to 3.5 +/- 0.3 (p less than 0.05) along with an increase in mean arterial pressure (MAP) from 87-99 mm Hg and reduction in arteriovenous O2 difference [C(a-v)O2] from 4.9 to 4.2 ml/dl. Intrapulmonary shunt (Qsp/Qt) was similar (20 vs. 21% as were alveolar-arterial O2 gradient [P(A-a)O2] (164 vs. 158 torr), whereas O2 consumption (VO2) increased from 224 to 247 ml/min. Immediate survival was 90% in shock patients and 100% in nonshock patients, whereas hospital survival was 65.5% and 88%, respectively. The authors conclude that hetastarch is an effective fluid for resuscitation of hypovolemic patients. This synthetic colloid does not appear to adversely affect pulmonary function.

Adolescent↗
PubMed1980

Complications of vascular catheterization in the critically ill. A prospective study.

Invasive hemodynamic procedures are increasingly used for monitoring critically ill and injured patients. The results of a prospective study on complications of 210 vascular catheterizations in 116 critically ill patients are reported. A total of 80 central venous (CV), 71 pulmonary artery (PA), and 59 arterial (A) catheterizations were performed during an interval of 6 months. Catheters were inserted by percutaneous techniques for all but seven of the procedures. CV catheters were associated with complications in 3.7%. However, complications were encountered in 10% of the PA catheterizations and 13.5% of systemic A catheterization. It appears that in a group of patients with observed hospital mortality of 36%, invasive monitoring is associated with a significant complication rate.

Adolescent↗
PubMed1980

Experimental aortic occlusion: A model for the study of regional shock with specific reference to blood lactate.

A model of regional shock is described to study the dynamics of lactacidemia which accompanies perfusion failure. The suprarenal abdominal aorta was occluded with a balloon catheter to reduce the mean perfusion pressure to 25 mmHg in 5 dogs each for 60 and 120 minutes, while 5 dogs served as controls. Increases in arterial lactate from 2.4 r - 1.1 to 4.9 r - 1.2 mM/L were observed by 60 minutes. Lactate concentrations sampled from arterial and venous sites proximal and distal to the obstruction, showed good correlation (r=0.96) during and for 240 minutes following deflation of aortic balloon. Lactate clearance in experimental animals was accomplished by 90 minutes of re-establishment of flow to the lower extremities. Hemodynamic changes included tachycardia, upper body hypertension, with any increase in left ventricular filling pressures. Marked hemoconcentration observed in experimental animals was suggestive of plasma losses in splanchnic circulation, confirmed by autopsy findings of bowel edema and infraction, In this model of regional shock, absence of true lactate "washout" was also confirmed.

Animals↗